Her grip on my hand is tight. Almost as tight as the elastic on the oxygen mask stretched across her face, digging furrows into her thin, sallow skin.
“I. Want. To. Stop.” Each word takes a separate, painful breath, and her shoulders heave up and down, out of sync with her words. “No. Tubes. No. More.”
I kneel by the side of the bed, putting my left hand over the frail one tucked in my right. The last 24 hours have been a sleepless nightmare for both of us, with each new hour harboring some new disaster.
It seems that both of us realize that this new change is the final blow.
“Are you sure, Mrs. Moore?”
“Yes. Fam’ly.”
I pat her back, feeling her bones slipping beneath my fingers as her lungs clamor for air that remains elusive. “We’ve already called them. They’ll be here soon.”
“Don’t. Leave.” The command is so soft I almost miss it.
“Of course not. We’ll stay with you until your family comes.”
For a frail, 40-kilo lady, she is strong. I switch hands as I set up a vigil by her bedside, waiting for her family to arrive. We dim the lights, and a nurse kindly donates her phone with a jazz music playlist.
“Do you like jazz music?” I ask Mrs. Moore, whose eyelids are starting to twitch.
“Yes,” she says, without moving her lips. “M’sic. Good.”
I set the phone closer to her ears, where she can hear the melody over the roar of high-flow oxygen and the screech of monitors sensing distress.
On second though, I unplug the monitors.
For a while, it is peaceful. Mrs. Moore’s grip on my hand loosens slightly, and we listen to the music. She keeps her head turned in my direction, though I’m not sure why. Her stare is unsettling, and I offer to turn her bed so she can see out the window.
“No.” Two coughs, and a shaky wheeze. “Tell. Me.”
So I do. It’s a quiet night in southside London, just alive enough to contrast with the death-tinged unease creeping into the room. The clear, inky sky is a shade bluer than black, with droplets of starlight dancing in constellations I’ve never been able to remember. A red pickup truck darts like a splash of color under a streetlamp. The lights in an apartment downtown blink off, drowning a slice of the skyline in darkness.
I trail off as her unblinking gaze fixates on a corner of the room. But Mrs. Moore isn’t asleep. Not yet.
“Nice.” A squeeze on the hand. Weaker than before. “Thanks.”
We listen to the music. The seconds tick by. Then minutes. Then hours. I wonder, not for the first time, where the anticipated family is.
To pass the time, I make idle chitchat. As she grows weaker, Mrs. Moore turns confused, and the conversation turns pleasantly nonsensical. Something about turtles and swimsuits. I nod periodically, remembering my smile is invisible under my masks.
But then the conversation turns somber.
“Dizzy,” she tells me, turning her head away from me for the first time that night.
“Try closing your eyes,” I say. I have no idea if that will help, but it sounds like a good idea. Subtly, I check her pulse. It’s weakening. Just like she is.
Mrs. Moore doesn’t close her eyes, but, within a few minutes, she reaches a verdict. “Gone.”
“Well, that’s — ”
“Scared.”
My spine stiffens. This is different. “Scared?” I repeat, stretching my memory to all of the communication training I’ve been through. “What are you scared of?”
“Dying.”
The word is puffed out. A wisp of lucidity in the confusion.
I squeeze her hand harder, though which of us needs the reassurance, I’m not sure. “Your family will be here soon.”
But the reassurance falls flat. I’m glad no one is here to witness this exchange — particularly all of the master communicators my department can boast of. Certainly they would have the answer to what must be a very simple question, but, in the moment, the answer eludes me.
Luckily, Mrs. Moore has a suggestion for me.
“Story.”
“A … a story?”
“Story.”
Well, the word is clear, if nothing else. The writer in me yawns itself awake, and I settle back in my chair, keeping my hand resting comfortably in hers. “Well … there’s a place that I know … a place where tulips bloom … tulips and other … flowers?”
Wait, why is this so hard? I’m a writer. Making up stories is my forte.
But Mrs. Moore hums her approval, indicating I’m doing something right. I try to ignore the grip of death in the center of the room, and, instead, focus on my words. “Every morning, the tulips open their petals to catch the morning sun. And every night they tuck themselves back together, fast asleep until…”
My breath catches in my throat, and tears sting my eyes. I don’t know what I’m saying. I don’t know what I’m doing.
Gosh, I don’t even know what I’m doing here.
As I hesitate, Mrs. Moore’s eyes flutter shut, and I feel even worse than before. Every thread in my soul is screaming at me to do something. To fix. To heal. To save. To act.
And yet here I am, sitting in a darkened hospital room, watching as forces I cannot see — I cannot fight — tear away the woman in front of me. A woman with a family … with memories … with a life…
My fingers creep down to Mrs. Moore’s wrist once again. I can’t find a pulse.
Her family arrives moments later and, minutes later, I pronounce her death, complete the necessary paperwork, and leave the ward.
As residency has taught me, I take a long walk around the hospital, steeling my nerves to face the chilly night air and the long drive home. The parking garage and the streets are deserted. The world is asleep.
As I pull into the driveway, I pause, looking at the closed-up tulips under the streetlamp outside my house.
Only then do I allow the tears to finally flow unchecked.
Author’s note: All patients referenced are fictional composites and de-identified to prevent recognition.
Image credit: Tulips by rajapal licensed under CC BY 2.0.
Fellow Physician Contributing Writer
Schulich School of Medicine & Dentistry at Western University
Beatrice Preti is a PGY-4 fellow in medical oncology at the Schulich School of Medicine & Dentistry at Western University in London, Ontario.