It was a busy Friday afternoon in the pediatric intensive care unit. The prior evening, he began having profuse lower gastrointestinal bleeding necessitating urgent transfer to the intensive care unit. He was 22 years old with a history of sickle cell disease and had received a peripheral blood transplant the prior year. His clinical status was precarious at best, but he had bled in the past and had always made it back to us on the general floor.
However, this time felt different. He was breathing on his own, but with bacteria growing in his blood and labile blood pressures, his body was beginning its final hibernation. His mental status was declining, and we had yet to hear him speak since this acute decline.
“I have a meeting to go to.”
Those were the last words I ever heard him say. We had asked how he was feeling, and that was his response. In my few years of fellowship, I had not yet heard a patient state that to me. He struggled to string those words together as he tried to sit up in bed. I looked up from his bedside to my attending to ask if she heard what he said, and she was just as perplexed. We each grabbed one of his hands and asked him to repeat himself, but he closed his eyes and remained silent. His mom, at the foot of his bed, appeared equally as confused by his utterance. What meeting could he possibly be talking about, and why over the course of the last tenuous 24 hours, were those the only words he felt compelled to share with us?
He had graduated college the summer before, pre-med no less, and he and his family decided it would be a good time for him to undergo bone marrow transplantation for the hopeful cure of his sickle cell disease. In the year that followed, he would go on to experience nearly every complication possible. In fact, he would go on to spend that entire year in the hospital: a prisoner to a new innovation meant to prolong his life, but instead shortened it.
A week after he spoke his last words to us, his mother and father made the compassionate decision to withdraw care and remain present with him in the last few moments of his life.
As a pediatric hematology and oncology fellow, death sometimes feels like a way of life. As I walk through the halls of the hospital, I can’t help but picture death as a mischievous young child darting in and out of patients’ rooms, staying longer in some rooms yet refusing to enter others. Death skips down the halls to her own beat while humming a jingle to herself and having known all of us since birth and keen on our reunion. Friends and family often ask, “How do you deal with death?” In my field, death becomes a constant companion.
In the hospital, every room and every corridor keep a score. Patients may die, but their memories linger. Our patient’s last words continue to haunt me. How could I cease hearing his last words upon entering the room he died in? How could that room belong to anyone else after him? I wasn’t the only one affected by his death; it had left many physicians in tears — from junior members to senior faculty. Many a medical student reminds me of him as I wonder if that’s what he would be doing right now. In my attempts to understand much of anything about his uttered “meeting,” I came to realize I didn’t truly know much about him beyond his disease and its many complications. He had defied his parents by secretly becoming an organ donor shortly before death; the true irony being that his organs would never become suitable for donation. Presumably, he had believed in some overarching purpose to life: perhaps, a higher power.
I don’t know what meeting he was hoping to attend. However, I can’t help but wonder, in the midst of all of our good intentions, were we keeping him from it?
Image credit: Sickle cells by National Center for Advancing Translational Sciences licensed under CC BY 2.0.
Fellow Physician Contributing Writer
University of Minnesota Medical School
Asmaa is finishing up her second year of Pediatric Hematology and Oncology fellowship at the University of Minnesota. She never thought she would find herself in the great state of Minnesota but the arctic winters have only made her braver. She has a strong interest in bone marrow transplant, pharmacogenomics, and global health. She is currently studying to obtain an MPH and enjoys biking and writing in her free time.