10:35 am.

Abstract

“Who else is left?” the attending wearily asks toward the end of our morning rounds.“Adena,” I respond, knowing no further summary is needed given her 2 months and counting with us.AdenaThirty-three years with multiple co-morbidities. On dialysis thanks to complex Type 1 diabetes. Left leg amputated thanks to a deep tissue infection. Now under our care for a nasty wound on her hand, a persistent infection that requires our strongest intravenous antibiotics. We can only guess at her cardiac state, too fragile for an angiogram after a recent myocardial infarction.Her medical notes are detailed. But the notes miss the identity of the beaming, dimpled patient before me.AdenaMother to 6- and 3-year-olds.AdenaDaughter. Sister. Wife.AdenaDreamer. Optimist. Fighter.We find her sitting upright, eager for good news.“I'm to be discharged today, then?”Her most recent swabs have come back negative. I unroll her bandage. The attending examines the area. By now we know the telltale signs of his satisfaction.She starts from the bed in excitement. She is gushing about calling her husband to share the news, make arrangements, to end this standstill she is in and return to her real life. As I turn away to continue with my day, she calls out to me.The expression on her face is unmistakable: pure joy. I find myself filled with a familiar mixture of melancholy and relief, experienced when well-liked long-stay patients are cleared to head home. I must have been showing it—her expression darkens, mirroring my pensive one.“Don't worry, nothing is wrong,” I assure her. She nods at me and replies that she knows.“There's something about being here, becoming one with the hospital furniture... well for 2 months anyway,” Adena says. “I am eager to get back,” she continues. “But I didn't expect to feel so much fear...”I inch myself toward her, making sure I keep my posture inviting and attentive, and let my silence encourage her to continue.“What worries me,” she starts, steely gaze transfixed on the wall ahead, “Is it is my duty to look after Rizqan and the kids…but what use is a weak wife and mother to them?” She meets my eyes, tears freely coursing down her face. I feel drawn into comfort, in spite of myself. Of course, they taught all the relevant communication techniques in medical school: displaying empathy, listening effectively, the kind of language to use. They trained us exactly for moments like this. Instead, in this moment I find my mind racing, scrambling for words that are appropriate. Precepts from medical school crash into residency reality. Do I provide encouragement that all will work out or advice to plan for eventual early decline? How much do I give away? What should I say versus what she needs to hear? Should I let the blows fall at once or by degrees?Slowly, I muster the courage to validate her worries and try to normalize them. She seems skeptical, but I sense a shift in her—she trusts me. Perhaps it is the white lab coat, the comforting sense of institutional knowledge I represent. Even as her mind senses that the words do not fully fit, her heart believes. She clasps my palms and rewards me with a warm look.I pat her hand and smile. The physiotherapist arrives, chattering in a way that drives overly caffeinated residents to distraction. I hurry away to prepare discharge documents, sign them, and move on.I clearly remember the time—9:46 am, a half hour had passed—when I hear the shouts. We rush forward, not knowing what this could be. Not expecting what this could be.AsystoleAdena. Lips blue. Body limp.AsystoleAdena. On the receiving end of chest compressions. The code team notified, on their way in. I jump in to volunteer CPR at the next switch.Asystole“Her husband. He's on the way over. Someone needs to call her husband.”The staff nurse abides by protocol. His phone rings audibly—he's already just outside.“How long has it been?” Forty minutes. No return of spontaneous circulation. We stop to assess the presence of a rhythm and pulse.Her husband glimpses through the curtain, standing tall. He's beaming, excited to take her home: Adena is finally leaving the hospital.Just not as we envisioned it.How does one deliver this news to him? How does one keep going through the fading of the smile, the confusion in the eyes, the desperation in his anguish? How does one watch a happy day turn into the darkest of all? The truncating of a life they had planned, and delayed, and delayed?I stand there. Feet glued. Stomach churning.10:35 am.