They tell me you always remember your first. If that’s the case, what images of you will remain imprinted on my brain, snapshots of one, with sandy hair, brown eyes, mocha skin? Will it be your long, spindly fingers? The way when I first saw you, you were sitting bolt upright, eyes wide, hair standing on end as if haunted by some specter of mortality? Or will it be your last days, coma-silenced, sweat from the Caribbean sun going unwiped on your cheeks, condensation from days wearing an oxygen mask chapping your full lips? You were my first patient, my first death.
If you could speak, what would you have told me?
I know you were so much more than the woman, sitting cross-legged, too weak to get up and use the washroom, crying because you had to “number two” and there was no one there to clean you.
I want you to tell me about your son. He looked so beautiful in his suit at your funeral! What he was like? Did you love his father? What it was like for you not to have your daughter at home?
I was told you loved to bake and had boundless energy. What if I had met you on the street five years prior? Or I had joined your church? We would have bonded over macaroni pie and callaloo, making orange juice and cutting up salad together.
You would have welcomed me into your home for dinner rather than me feeding you nibbles of crackers and praying you didn’t choke on the drops of water. I would have seen the woman you were rather than the shell of a woman fed up with her own helplessness and ready to go home.
The first time I saw you
The first time I saw you in Ward 12, while at Susanna’s bedside, it took me days to realize you were the same person I had met months before. The one who I frustrated with my inability to understand your last name. The one, sitting cross-legged on her bed in room nine.
I remember desperately willing you to take bites of your tray of rice and beans just like I did with the crackers in your final weeks. I was afraid of the way your scapulae protruded. And, how my fingers could easily encompass your upper arm.
Did you recognize me, the token white girl wandering about the hospital? Or were you past the point of knowing just another of the faces of the medical team that would not let you die in peace?
You were my first, you know. The first patient I sang to, almost inaudible: ‘Twas grace that taught my heart to fear… The first patient I’d seen seize and the first time I thought someone was going to die. You were the first person I read to, the first one I touched. The first patient I had ever lost.
I touched your arm because you were crying
I didn’t know how to calm you. I knew the ward was fed up with you, your incessant moaning. They didn’t see your utter misery, your helplessness. They didn’t understand that for you, this virus was taking everything. You simply couldn’t live like that. But you weren’t yet sure you wanted to die.
I touched your arm because maybe then you could sleep. Maybe then there would be silence, you would have peace.
I was scared, you know. Not of the virus. I understand the virus. I was frightened because I didn’t know what to do. No one trains you for when it’s just you and the patient. This is especially true when the patient is in pain and you have no medical skills to speak of. No one tells you how to ease a stranger’s suffering just by being a fellow human being.
I touched your arm, and you shut your eyes. Maybe you slept. I just stood there, my oversize bag sliding off one arm, the other hand just moving up and down. Softly. I had nothing to say. You wouldn’t have heard anything anyway. Just the repetition, up and down.
Sometimes you would cough, startling me out of my reverie, my prayer. Sometimes your eyes would flicker open. Mostly, you just stayed silent until I left. I always willed you to sleep more as I stepped soundlessly away. Just rest now, just be at peace, just don’t give up.
I thought you were going to die on me
On Monday, you seized. I thought you were going to die on me, right there. I prayed and prayed not now, not now, not while she seems in such pain! Your arms jerked first, then your entire upper body, tightening, stiffening, rigor-like. Your face contorted, eyes rolled back. It looked like agony.
Whatever the seizure did to your face made it look like the most painful thing you had ever experienced. I called for the nurse, terrified. My heart raced. Not now, oh God, not now.
By the time the nurse came, you had finished. Rigor released, sunken back into the bed, breathing but not responding. I went through exactly what I had seen and the nurse told me not to worry, you’d done it before. Before? Before?
Still, because we called your name again and again and you never flinched, she went for the doctor on call. He came with his intern and I repeated again everything I had seen, what triggered it. I kept my hand on yours and kept repeating your name softly. Still nothing.
After the seizure, they hooked you up to monitors
It took a seizure that left you unresponsive for them to hook you up to monitors to keep track of your heart and pressure. (The wards only had two or three monitors for the 30 or so patients on the two sides. I would learn that to be put on monitors meant that you were critical, your days were numbered.)
I stayed with you for more than an hour that night, terrified that at some point you would stop breathing. I wanted to be sure you were ok but also not wanting to leave you alone.
I sat on the edge of your bed, again gently running my hand up and down your arm. I prayed. I sang almost soundlessly. I watched. I willed you to wake. Every few minutes I would say your name, ask if you were all right, if you could hear me.
Finally, by the time I was getting ready to leave, I called out to you again and you turned your head slightly, opened your eyes. You became more like you were the previous days, not talking, not eating, not taking your tablets, but awake, somewhat responsive. I breathed a sigh of relief. I could go home now.
The last time you open your eyes
That February Monday would be the last time you would open your eyes to me. By the time I came to check on you and a friend from church who had suffered an anaphylactic reaction. You were the only two left on this particular ward at the time.
The next day, the nurses had moved you from the back of the ward (where all three of you, my HIV patients, had been kept as would be the case for my patients in other wards) to the middle, where they could keep closer attention to you.
Eyes closed, corpse-like even, you inhaled and exhaled the oxygen pouring through your mask. Fluids came in one tube and out another. I repeated your name: “Lynn! Lynn! Wake up! Can you hear me?”
I willed you to wake up
Nothing. No turn of the head or an opening of eyes, not even a squeeze of my hand. I sat down on the bed beside you, massaging your arms, your shoulders, willing you to wake up.
I remember a tangle of doctors’ voices when I asked, talking about a medication reaction. They wanted to treat you with something else that should stop its irreversible damage to your pancreas. Maybe then you’d come back.
I wondered if that was in your best interest. You had stopped eating, stopped taking your tablets. You couldn’t live with a body that had betrayed you any longer. And you couldn’t bear not being able to get up and go to the bathroom on your own, much less run a household, be a mother, bake.
You tried and tried, but each time your body crashed, another five pounds were lost. You couldn’t make yourself eat. You couldn’t find the energy to walk your son to school. You wondered if it was worth it.
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Now, far away from your family, dropped off at the side of the ER too weak to walk in and present yourself, miserable at your lack of yourself, you have given up. You don’t want to do it anymore. You will miss your son, your daughter, but you simply can’t. Not again. And as much as I don’t know how to handle your leaving, I can’t blame you.
I came to see you every day
I came to see you every day. Sometimes more than once. I don’t know if you ever heard me or knew I was there. Or if you did, would you have known who I was.
I sat by your bed, sometimes talking to you, sometimes whispering prayers. I would clean your face with a damp paper towel to help keep the oxygen from leaving your lips crusting. And, to help keep your eyes from running.
Sometimes I would read to you from the Psalms or my favorite passage in John, or Mark Doty’s poems: which is the way with light: the more you break it, the nearer it comes to the whole (“Principalities of June”).
The woman in the next bed promised to pray for you
The older woman in the bed next to yours would cry when I read. She promised to pray for you. Could you feel it? And always touch—my hand on your arm, your hand. I’m trying to rub out the swelling from the slipped catheter and trying to make sure you weren’t in pain. Sometimes I simply hold your hand so that if in some way you could be aware, you would know you weren’t alone.
Your cousins came to see you, the ones you had stayed with. Mary came, and she brought your son. She cried for you, in the privacy of the clinic, wondering what would happen next.
We all knew. When it came, it wasn’t a surprise. I had watched your blood pressure drop over Friday and Saturday. Then I watched your heart rate increase again, your oxygen saturation drop slightly lower into the nineties. I was the last visitor you had, I think. I came Saturday at noon, read to you about light shattering, and becoming whole just as you were about to do the same.
The nurses told me softly when I came into the clinic Monday, “Lynn died at 6:15 Saturday night.” I knew it was coming and still, it took the wind from me, took me a few minutes before I could pull a smile to my lips and greet the morning’s patients.
Everything that happened after was just as it should be
I gave your cousins a hug and got the funeral details. I walked up to the ward. The woman beside you told me it was peaceful, you had just stopped breathing. As she held my hand and tears rolled down her wrinkled cheeks.
I stayed with Mary a while as she tried to collect herself to take care of your son.
I went to your funeral too. It was strange to see you as more than just skin and bones, with makeup lightening your cheeks and accentuating your eyes. Your hair was neatly coiffed rather than standing up.
I fought tears as your cousin told me of who you were before all of this. Your son looked beautiful in his suit, his hair neatly braided. He was somewhat confused as he held onto Mary. Are you watching over him now?
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There were magenta roses at your funeral
At your funeral, your cousin handed out magenta roses to those who had a special place in your life. Your closest friends, your daughter, Mary. She handed one to me, too. I didn’t know what to say. I hardly knew you.
Of the two weeks that I spent with you in the hospital, you were only awake for one, only talking for maybe four days. I felt helpless at your bedside as you nearly choked on cracker crumbs, crying because your fingers were too weak to open the package. I watched you stiffen and seize. I sat with you as monitors made sure you were still breathing.
What could I do for you? Every instinct wanted to save you from all of this. Maybe by letting you go, I did.
TDWI author, Margaret Cary, developed and teaches the Narrative Medicine/Personal Essay course at Georgetown University School of Medicine. Her students’ essays reflect their thoughts on being in medical school and becoming physicians.
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This post was first published on April 10, 2012. It was reviewed and republished on October 12, 2017 and again on 5/17/2020.
Nichole Boisvert wrote this story when she was a medical student at Georgetown University School of Medicine participating in Margaret Cary, MD's Narrative Medicine course.
She is a Board Certified Family Medicine Physician practicing in Martinez, California. She did her Practice residency at Contra Costa Medical Center in Northern California. She received a BS from Marist College where she majored in biomedical science, creative writing, and chemistry