A Final Concert in the PICU

I learned of Alex’s death from an attending physician in UCLA’s division of pediatric hematology-oncology, where I was a second-year resident. We were in the middle of rounds, and upon hearing the news, our team grew somber.

“Alex passed peacefully, surrounded by her family and friends,” the attending told us. “Her family wants to thank the medical team for their care and support.”

Alex had been transferred to our pediatric intensive-care unit (PICU) for acute respiratory failure; she needed sedation, a breathing tube and blood-pressure support.

She was only twenty years old, an undergraduate at an East Coast university. We attributed her symptoms to metastatic cancer that had spread to her lungs. Although our team had known that she was seriously ill, the news of her death brought a sense of shock and sadness.

My mind raced back to her time in the PICU. The first few days were a blur: I’d spent her first twenty-four hours in and out of her room, monitoring her blood pressure and ventilator readings and intermittently joining her parents to watch a few minutes of college football on the room’s TV. Alex lay quietly, sedated, as her mother played Alex’s acoustic “chill” Spotify playlist to her.

That evening, as I made my rounds, her parents stopped me.

“We know you have other patients to check on,” her mom said, “but you’re welcome to stay and watch the end of the UCLA-Utah game with us, if you’d like.”

Two days later, Alex’s respiratory status improved, and her breathing tube was removed. At this point, the medical team had to ask: Will she want to be intubated when—not if—she experiences another such event? Will she want chest compressions?

From Alex’s oncologist, we learned that Alex wanted time to think about it, and she gave us permission to consult the hospital’s pediatric pain and palliative-care team.

As Alex’s health status improved, her personality shone through warmly. She had a pleasant demeanor and was full of life. One day I came in to find her sitting up and reading Dostoevsky’s Crime and Punishment as her father sat nearby.

I told her that one of my favorite novels was The Brothers Karamazov and asked Alex about her freshman year. She shared vivid memories of going to classes, basketball games and campus events.

“Alex loved college—she would love to go back if she could,” said her father.

Recalling Alex’s Spotify playlist, I asked, “Do you play music?”

“I was actually trying to learn to play guitar until, you know, I came here,” she answered.

I smiled under my yellow Halyard mask.

“I play guitar too,” I said. “Would it be all right if we played some music together?”

After lunch, I called UCLA’s Child Life department, picked up two guitars and swung by Alex’s room. Her mother and brother had arrived, and after greeting them, I handed her a Martin guitar.

“Would you like to play something together?” I asked.

“I’m still feeling a bit weak,” she replied. “Would you start by playing something?”

“Play us songs that you enjoy,” Alex’s mother said.

“I enjoy a variety of genres,” I said. “Hawaiian, gospel/church, acoustic pop, jazz…Here’s one of my favorites: Jack Johnson’s ‘Better Together.'”

Love is the answer,
at least for most of the questions in my heart
Like why are we here and where do we go,
and how come it’s so hard?
It’s not always easy
And sometimes life can be deceiving
I’ll tell one thing, it’s always better when we’re together
It’s always better when we’re together
Mmm, we’re somewhere in between together
Yeah, it’s always better when we’re together

As I sang the chorus, tears welled up in Alex’s eyes, and her mother and brother wrapped their arms tightly around her. After a few more songs, I left to finish my clinical duties.

That evening, having signed out to the night team, I checked back in with Alex. This time her father was there, along with several other relatives.

“We heard you played a concert in this room!” her father said. “If you have time, could you play us something before you go?”

I picked up the guitar and played some classic Hawaiian songs from my childhood—”Ku’u Home O Kahalu’u” and “Island Style.” Alex’s father asked me to sing Israel Kamakawiwo’ole’s version of “Somewhere Over the Rainbow.”

“Someday I’ll wish upon a star and wake up where the clouds are far behind me,” I sang. “Where troubles melt like lemon drops away above the chimney tops, That’s where you’ll find me….”

I felt my eyes start to water. Looking up, I saw tears on the faces in the room.

“Thank you,” I said, moved by the deep sadness of the situation and Alex’s family’s love for one another.

“Do you know any songs by The Lumineers?” asked Alex. She’d recently attended a concert of theirs.

“I’ll try to learn some,” I said.

Returning to work two days later, I was happy to see Alex looking (and feeling) much better. At day’s end, I brought out my guitar and passed another to Alex, saying, “Can we play a couple of Lumineers songs I’ve just learned?”

Together, we sang:

I belong with you
You belong with me
You’re my sweetheart….

Over the next three days, we played almost two dozen songs. I was glad to see Alex’s symptoms improving. Soon she was transferred out of the PICU and onto the hematology-oncology floor for observation. The night before she was to be discharged, I visited her and gave her a note thanking her for the joy of playing music together.

“You have a couple of years of residency left, right?” asked Alex’s mother. “What do you want to do with your life?”

I shared some of my clinical interests, feeling heartbroken that Alex would not be able to pursue her own dreams.

When I mentioned that one of my goals was to write, Alex said, “I’m so excited for you! I wish I could see where you’ll end up with your life. And it would be so cool if you wrote some fiction.”

The next day, Alex went home and spent time with her family. Two weeks later, she passed away.

I still wonder what drew me to connect with Alex over music. Perhaps we both saw music as a medium in which we could express the deep, contradictory feelings inspired by the uncertainty of death and dying. Since her passing, I’ve had the opportunity to play music with several other patients. Whenever I bring my guitar to the hospital, I still think about Alex with a sense of loss.

Playing music with Alex in the PICU—sharing moments of respite and genuine emotional connection through song—was one of the most joyful and meaningful experiences of my residency. Looking back, I know that these moments have made all my years of training worthwhile.

~          ~          ~          ~          ~

Postscript:

After I shared this piece with Alex’s parents, they sent the following reflection:

“I still cry every time I hear The Lumineers and ‘Over the Rainbow.’ I cannot tell you how much it meant to have you there singing with Alex during such a difficult time. Being a great doctor is more than just practicing good medicine. To me, it is about healing and comforting those in pain—helping to lift the spirits of patients and their loved ones.

“Ultimately, we all wish for a healthy outcome. But we are mere mortals, and we do not understand God’s will. In cases where the prognosis is grim, it is the small rays of sunshine that provide respite from despair and restore hope—even if briefly—to the patient and family. We will always share these memories of her together.”