I knock on the partly open door and peek around the curtain. A grainy yellow light above the hospital bed falls on a frail, trembling woman as she struggles to comb her wet grey hair.
“Margaret?” I say quietly.
She does not hear me over the hiss of the supplemental oxygen. I watch her for a moment longer.
It was a Thursday morning, my first day on the medical oncology service. I hurriedly gathered my white coat and badge, the block letters “3rd Year Medical Student” unmistakable in fresh ink. Taking a deep breath, I forced myself to look up at the cancer center.
This is going to be difficult, I thought.
A full head of white hair.
Each in its place.
Not just neatly.
Meticulously.
Perfectly.
A full head of white hair. That’s what I see in my minds’ eye, when I close my actual eyes and conjure up my grandfather.
My husband George got to know Ruthie while he was sitting with his mom during her final days in an assisted-living facility. Ruthie, a hospice worker, was a middle-aged woman who had reentered the workforce after raising her kids. As a nursing-assistant trainee, she was learning on the job, with George’s mom, unconscious and steadily declining, as one of her first patients.
Soon after meeting Ruthie, George was struck by her lack of self-confidence.
From the computer screen a few inches away, Oliver’s honey-brown eyes gazed into mine in the unadulterated way that only children’s eyes can, matching the directness of his question:
“Is he going to die?”
I don’t know what it’s like on the other side of the mask.
Not the cloth mask, which I now wear every day, as habitually as my socks. I mean the plastic bipap mask, which provides the highest level of ventilation COVID patients can receive, short of intubation.
That mask.
“After eighty-five years of life, I still don’t know what death is,” said Lonnie, as I sat beside her bed in the nursing home. “I just know it scares the heck out of me.”
Despite decades as a hospice social worker, I don’t know what death is either; but I’ve spent much time with patients exploring the question together.
“What scares you?” I asked.
Days before she died
my mother stood in line,
took a picture for a passport—
For months, as I’ve visited Evan as his hospice social worker, he’s been praying to die. In his early nineties, he has been dealing with colorectal cancer for more than four years, and he’s flat tired out. As he sees it, the long days of illness have turned his life into a tedious, meaningless dirge with nothing to look forward to other than its end. He’s done, finished. He often talks about killing himself.
On this visit, though, his depression seems to have lifted. He’s engaged and upbeat–and this sudden about-face arouses my suspicions: Has he decided to do it? Is he planning a way out?
A pacemaker and defibrillator
Sheets pressed hard with suffering
Seven fingers and one arm, gangrenous dead
Unknown liters of blood
Failed kidneys
Gearing up for my night shift in the COVID-19 intensive-care unit, I don my personal protective equipment (PPE)–a white plastic air-purifying respirator (PAPR) hood. The hood connects via a tube to a large battery pack that I strap onto my waist over my scrubs. I turn on the battery and shiver when the rush of cool air blows past my ears. I walk into a bright white antechamber where a safety officer inspects me.
“You’re good to go,” she says. “Stay safe.”
As a pulmonary and critical-care medicine fellow, I care for patients with a broad variety of respiratory ailments. But little did I know, as I examined my patient Mr. Smith in the outpatient pulmonary clinic this past winter, that I’d see him again only months later as my first patient with COVID-19.
Mr. Smith was tough as nails. A stoic retired steelworker and former smoker, he suffered from significant emphysema, but was inclined–by nature and by necessity–to fight through his symptoms with limited medical help.
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