My Long First Date with Death
By: Erin Stair, MD, MPH
Still crusty-eyed, I sluggishly walk into the New York City hospital’s musty surgical on-call room. It’s 6 AM and still dark out. To lighten the mood, I start joking with the other medical students, identically dressed in loose-fitting, light-blue scrubs. All of us would rather be somewhere else, but we are obedient, competitive and waiting for our chief resident to arrive and give us orders.
I dread being on-call, which is every fourth night for twenty-four hours straight. I hate it, because the hospital offers us nowhere to sleep, and when I don’t sleep, I’m miserable and can’t think right. To prevent insomnia-induced insanity, I pull a mattress off one of the transport beds parked in the hallway and lug it into the freezing cold dialysis waiting room so I can rest, usually between the relatively calm hours of 2 AM and 5 AM. At 5 AM, I wake up, put the mattress back where I found it and use a computer to see if my patients’ blood labs were updated. If no blood was drawn, I’m forced to nag the tired nurses until it is. I would draw blood myself, but students aren’t allowed to draw blood. I unwillingly harass the nurses, because otherwise the residents scream at me for blood not being drawn and labs not being updated. The nurses usually ignore me or snap at me for constantly inquiring about blood. The whole ordeal is a humiliating, aggravating lesson in humanity, somehow filed under medical education.
Our surgical chief, Samir, an obese, tired-looking Indian guy shuffles through the door. He stinks of cigarettes and is wolfishly eating a doughnut. The red jelly oozing out of his powdery pastry makes me think of the massive bleeding back ulcer I saw yesterday. That vision and the smell of cigarette smoke makes me nauseous. Samir smokes whenever he catches a break. He’ll lean against the back wall of the hospital, out of view from most of the patients, and smoke his hospital stress away. Most of the surgical residents smoke, maybe to stay awake or maybe to control their nerves. Probably both.
He plops down at the head of the table, and his heaviness makes the room shake. The rest of us, about fourteen students, nervously sit around him with pen and paper in hand. This is the point where we’ll be assigned our patients to monitor for the next twenty-four hours.
The phone rings. Samir answers it. His face molds into a serious expression. He hangs up, looks at me and says, “Erin. You’re only going to have one patient today. He’s a VIP, so you need to do a really good job. Biggus is his name. He’s in the ICU. Go up there now.”
I hear the other students anxiously muttering to each other as I scurry out of the room and take the stairs two floors up to the ICU. A surgical attending physician, Dr. Mir, a thin, smart, Indian guy with thick glasses, greets me near the nurses’ station.
“You’re here for Biggus?” he asks impatiently.
“Yes,” I answer.
“Okay, great,” he says then slides a little closer to me till the edge of his baggy scrubs are touching mine. “You’re going to be here for a long time. Tell me, have you ever watched someone die before?”
His question catches me off-guard. I think for a moment. I’ve seen people near-death or dead. I’ve been to a lot of wakes. I assisted on many autopsies when I did a pathology rotation, but I never saw someone actually die.
“No,” I finally answer with slight trepidation in my voice. Death frightens me. I feel too young, energetic and even narcissistic for Death, especially a lot of Death all at once. It’s sad and permanent and makes everything seem meaningless. Perhaps everything is meaningless, but I need to ignore that so I don’t get depressed and off myself. I always get antsy studying terminal illnesses and want to slam my books shut. I want to sprint out of nursing homes, which feel like waiting rooms for Death. I always skip over the obituaries section in the newspaper. Even though I grew up next to a cemetery and from my backyard watched lots of dead strangers in polished, flower-covered coffins get lowered in the ground, Death remains a phobia for me.
“Okay. That’s okay. It’s a process and can take a while. His family will probably be around his bed most of the time. He’s unconscious now and four days post-op for a colectomy. He was diagnosed with colon cancer about a month ago. Turns out the cancer has spread. The cancer landed him in the ICU as well as a possible infection post-op. It was a lot further along than we originally expected. Now, I don’t expect him to get out of this, but his wife insists that we try anything and everything to keep him alive. Here’s where you come in. I need you to monitor his ins and outs. He’s already not making much urine. If you notice anything different about his breathing or if his blood pressure drops too low, you need to let us know right away. Okay?”
He leans in closer to me and slowly, somewhat threateningly says, “He’s a personal friend of the president of the hospital. A VIP. So, don’t let us down.”
My nerves are guns firing bullets through my bloodstream, but I force myself to nod with an aura of feigned confidence. My instinct is to bolt- out the door, down the street, to the subway station and never come back. I hate Death. Christ, pick another student for this gig. I have a Death phobia and yet they are forcing me to sit with it for the next 24 hours. It’s like exposure therapy on steroids. At least I won’t have to nag a bunch of nurses in the AM to draw blood- a silver lining.
Mir turns and motions me to follow him toward ICU Room 2. He pulls back the faded blue curtain, and I try not to gasp. A fifty-something, yellowish, dry-skinned man with a gaping mouth is lying unconscious on the hospital bed. One of his crusty eyes is closed and the other is half-way open. A green tube stretches from the ventilator behind his bed and into his throat. Every few seconds his upper body jerks up and forward, as if he has the hiccups, and I don’t know if that’s the ventilator’s doing, his heart’s, or something else. There are six IV bags hanging around his bed, which is the largest number I’ve ever seen used on a patient. The man looks trapped in a maze of tubes. My eyes carefully trace the line from each bag to his body, so I know what is going in where. A urine bag, which contains only a trace of brown-stained pee, hangs at the side of the bed. A monitor on the opposite side of his bed displays his vital signs. So far, his breathing rate is regular, no doubt due to the ventilator, his heart rate is steady, and his blood pressure is fairly normal at 115/70. Still, the room looks and smells like Death. He isn’t going to make it.
Sitting in a brown chair next to Biggus’ head is an attractive, strawberry-blonde, older white woman. Dark circles outline her distraught green eyes. I peg her for his wife. Next to her is a well-dressed woman who appears slightly younger with the same strawberry-blonde hair. Probably a sister.
“Mrs. Biggus?” Dr. Mir asks quietly as he walks behind her chair and gently puts a hand on her shoulder. “This is Erin. She’s going to stay here all day and monitor your husband for us. If anything looks strange or if there’s any changes, she’ll immediately grab one of us. She’s one of our best, so don’t worry.”
One of our best? He must not have witnessed my lack of surgical knot tying and suture skills in the OR yet.
Mrs. Biggus looks at me and politely attempts a smile. “Thank you, Erin. This is my sister, Bonnie. We’ll be staying here throughout the day,” she says with an Australian accent. I thought she’d have a New York accent. The Australian one is refreshing and sounds less like Death than the New York one.
I look at her sympathetically and say, “No problem. I’ll be sitting over there in the corner. If you have any questions or need anything, just ask.”
Dr. Mir speaks to Mrs. Biggus and her sister for a few more minutes. As he’s leaving, he says, “Don’t lose hope just yet. I have seen people come out of this state, and right now his vital signs are stable. Let’s just see how he progresses through the day.” It’s false hope. Everyone in the room knows it but needs it.
I get comfortable in the chair and browse through my Board review book. Every now and then, I’ll glance up at the monitor or at Mrs. Biggus, who’s staring lovingly at her husband’s jaundiced, cracked face and rubbing his motionless limp hand. It makes me want to curl up in the chair and disappear. I’m assigned to be in the room, but I’m an intruder. This is her and her husband’s moment. Most likely their last. I shouldn’t be here.
A half hour passes. It’s nearly 11:30 AM. Mr. Biggus looks exactly the same. Either Mrs. Biggus or her sister’s stomach rumbles. I pretend not to hear it and keep my head down in my book.
At noon, Mrs. Biggus breaks the silence. “Erin, my sister and I were going to grab something to eat from across the street. Would you like anything? We’ll be back within the hour. Also, I’m expecting my son to come. I’m not sure what time, but just wanted to let you know.”
“Oh, thank you for offering, but I’m fine,” I say. Her husband is almost dead. I’m not asking her for a sandwich.
They walk out of the room. I stand up, stretch, and tiptoe to the opposite side of the bed to check the urine bag. The amount of pee is the same. He isn’t making urine. One of the ICU nurses, a very sweet and competent Filipina girl, rushes in and swiftly switches out one of the IV bags. I respect the ICU nurses, because they know how to do their job very well. She smiles at me and says, “You poor thing. You’re in here all day?”
“That’s awful. But, here,” she says and hands me a bottle of eye drops. “His eyes will start to get really dry. Just put a few drops in them from time to time.”
I take the eye drops and awkwardly smile. Before sitting back down, I feel Mr. Biggus’ hands. They are burning. The surgeon mentioned Biggus has an infection, so maybe he’s running a fever. I slowly lift up the white hospital sheet to peak at his lower legs. They aren’t too swollen, so that makes me feel okay about his current heart function. I scan his body up to his lower abdomen, where a colostomy bag rests. It’s feces free. No pee. No poo. Things are shutting down.
It’s 1 PM by the time Mrs. Biggus and her sister return. The sister smiles and hands me a paper bag. Inside are a sandwich and a Coke.
“Oh, really. You shouldn’t have,” I say.
“No, no. This is a tough job for you too. Please enjoy it,” she answers.
I’m starving, so I accept the bag while the two women sit down in the same spots as this morning. Mrs. Biggus raises herself off the seat, leans over the bed, smiles at her husband and says, “John… John, we’re back. Sorry we left you for a bit,” she whispers, kisses him on his forehead and stares at his lifeless face before sinking back down into her chair.
I try to make as little noise as possible opening the brown paper bag, but it’s useless. Paper bags are obnoxious and don’t go well with Death. I reach inside, grab the sandwich, unwrap it and take a nibble.
“I can’t believe just last week he was outside mowing the lawn and watering the garden. He always loved doing yard work this time of year,” Mrs. Biggus says to no one in particular.
“He sure did. I remember when you visited me in Australia and called home. He didn’t even take the call ‘cause he was outside fiddling around with something in the yard,” her sister responds. They both laugh.
I chew my sandwich slowly and swallow even slower, to the point where it feels like it’s stuck in my throat. Then I wrap the rest of it up and put it in the bag. I can’t eat a sandwich. I, my sandwich, the loud paper bag shouldn’t be here. We are intruders. This is their moment. I feel like a fly on the wall begging to be swatted.
A beeping noise distracts me from my thoughts. It’s the monitor. His blood pressure drops to 95 over 65. I stare at the numbers for a few seconds. Then his pressure rises to 120/80. Then back down to 90 over 60. The monitor beeps periodically. Finally his pressure hits 110/72 and seems to steady there.
“What does that beeping mean, Erin? Is everything okay?” Mrs. Biggus asks me.
I’m really not sure. I’m not familiar with the ways of Death.
“It’s just the monitor,” I announce with a little too much confidence. “But his pressure seems stable now.”
I secretly wish I am the expert I sound like. Mrs. Biggus nods and hangs her head. I lean back in my chair and begin reading again. Mr. Biggus continues dying.
At around 4 pm, Dr. Mir pokes his head inside the room.
“How is everything?” he asks while looking at me.
“Good,” I answer. I feel like a jerk for saying that, a response I often say when things aren’t good at all. “I mean, he’s stable for now.”
Dr. Mir nods and walks over to Mrs. Biggus and her sister. He makes small talk before Mrs. Biggus asks him how he thinks her husband is doing. Dr. Mir eyes Mr. Biggus analytically. Then he says, “He’s stable, for now. Let’s take it one step at a time and get him through the night.” The false hope everyone needs. The three of them chat for a few minutes longer. Dr. Mir says goodbye and leaves the room.
Mrs. Biggus and her sister are chatty for the next two hours. They exchange funny stories about Mr. Biggus. I place my book face-down in my lap and begin listening. Sometimes I laugh out loud with them. It feels good to laugh.
A little after 7 PM, I excuse myself to the bathroom. I walk through the ICU to the dialysis waiting room, directly on the other side of the hallway, where one of the only clean bathrooms in the hospital exists. I sigh, knowing I won’t be catching a nap here tonight, when I notice two bouquets of flowers carelessly tossed on the plastic chairs. Many times before, I’ve seen tossed-away flowers in the chairs. I wasn’t sure where they were coming from, until one day I saw a hysterical Hispanic woman fly out of the ICU with a bunch of flowers in her hand. She was uncontrollably sobbing. Then she chucked the flowers on a chair in the waiting room and walked out. That’s when I learned the flowers were the innocent victims of human deaths. They were flowers that weren’t delivered in time. I felt sorry for the bouquets and started taking them home with me after work.
After my bathroom break, I go back to Biggus’ room. I stare at him for a good minute or two and decide he looks a little yellower than before. He’s still completely unresponsive. His hands might look more swollen, but it’s hard to tell. I peek at his ankles under the white sheet. Their circumference might have been slightly larger than earlier, but not by much. I glance at Mrs. Biggus and her sister. Their bodies and faces ooze anxiety. I feel sorry for them. Death seems to take a long time. For the spectators, it’s maddening. I remember a Hospice nurse once told me, “There’s something to be said for sudden death.” I thought she was ruthless. Now she sounds sagacious.
Mrs. and Mr. Biggus’ son arrives close to 8 pm. I’m shocked, inappropriately so, because he’s stunning. He has dark, thick brown hair, olive skin, and beautiful, bright green eyes. His complexion is flawless and his body is well-formed under a light green t-shirt and jeans. He’s young and beautiful and looks so out of place in a room dripping with Death. He glances my way, and I feel my body and mind simultaneously perk up. Attraction doesn’t stop for Death.
“Dylan!” Mrs. Biggus yelps as she jumps from her chair to hug her son. They embrace for a long time. Once they let go, he bends over and hugs his aunt, who’s still sitting in the chair. Then he turns to look at me. I smile and pray it isn’t too flirtatious. This is not the time nor the place.
“Dylan. This is Erin. She’s a medical student helping with daddy. Erin, Dylan just took the train down from Boston where he’s studying acting,” Mrs. Biggus calmly introduces me.
“Hi,” Dylan mumbles with a lethargic wave.
“Hi,” I reply. I notice I’m twirling my hair and instantly stop.
Dylan’s gorgeous head turns toward his dying father. His face puffs out and his eyes well with hopeless somberness. He grabs the hospital bed’s metal railing to steady himself while he stares at his dad’s thin, ominous face. I look down and away. I’m certain his dad was active and lively the last time he saw him. This scene has to be shocking and nearly unbearable for him. Everyone looks horrific on his or her deathbed. His father is no exception.
“Can he hear me?” Dylan stammers quietly.
“I’m not sure, honey. But say hello to him. I’m sure he knows you’re here,” Mrs. Biggus’ voice cracks.
“He probably can. Hearing is the last sense to go. I would definitely keep talking to him,” I encourage, hoping my interruption won’t be perceived as rude.
“Dylan, we were going to grab a snack to eat. We’ll leave you here, so you can have time alone with him,” Mrs. Biggus says through sniffles. Her sister gets up from the chair, stands behind Dylan and presses both her hands down on his shoulders. Then she kisses him on the cheek, before following Mrs. Biggus out of the room. I squirm uncomfortably in my chair, before deciding I could leave my duty station for a few minutes so Dylan can be alone with his dying dad.
“So you’re a student?” Dylan asks me. I glance at him, slightly alarmed. I’m certain he’d be talking to his father by now.
“I am,” I answer with a sympathetic smile. “I’m doing my surgery rotation right now.”
Dylan nodded then says, “That’s cool. I’m an actor up in Boston.”
“That’s great. I always wanted to try acting.”
“Why didn’t you?” he asks.
“Um… I don’t know really. I guess I still could.”
“Yeah, it’s fun. I enjoy it. I used to come to New York a lot for auditions. Not so much this semester, but next semester I should be down here more often. So do you live near the hospital?” he asks me.
I’m stunned by all of his questions. I feel like he’s flirting with me. The minute I run my hand through my hair tells me I’m flirting back. All of it feels so wrong. His dad is dying. He shouldn’t be flirting with me nor I him. Flirting and Death don’t go together.
“I live in Hell’s Kitchen. In a really small, dirty apartment,” I answer with a smile. Then I feel uneasy. I can’t flirt with him anymore. This feels uncomfortable. I feel…greedy. “You know, I’m going to step out for a bit. I’ll be back in twenty minutes or so.”
Dylan nods, but his eyes are once again fixated on his father. It’s his time to say goodbye. I quietly leave the room and begin a twenty-minute stroll through the busy hospital. I end up in the cafeteria and buy a coffee. I drink it fast.
I come back at 8:25. Dylan, Mrs. Biggus and her sister are talking loudly to each other. I’m hoping none of the medical staff notice my longer than usual break. When I walk back in the room, all three of them smile at me. I smile back.
“We just learned that visiting hours are over at nine. We’re exhausted and going to leave soon, then come back first thing in the morning,” Mrs. Biggus announces.
“Oh, sure!” I say brightly. “You know, I’ll step out again so you can say goodnight.”
“Thank you, Erin. We appreciate that.”
I wander through the chilly hospital floors again. I feel sticky, bloated and tired and am not sure I’ll stay awake for the rest of my watch no matter how much coffee I drink.
I come back to the room at 9 PM. The family has left. I stare at Mr. Biggus longer than before. I shift closer to his bed and slowly lean over his face. His eyes look dry, so I grab the eye drops from my pocket and put three droplets in each eye. I inhale deeply. His breath smells fruity and sweet, acidic. I figure his kidneys, the main organs that rid the body of acid, are shutting down, so he’s compensating by blowing it out his mouth. I glance at his urine bag. It’s the same amount as this morning. I look at his monitor. His blood pressure is bouncing around from normal to low. I assume that’s okay, since none of the nurses, who can also see his vital signs on their station monitors, are doing anything about it. Then I sigh, plop back down into my chair and settle in for a long night with Death.
I wake up to a deep, caffeinated voice saying, “He’s on three pressors! I’ve never seen anyone on more than two live. Never.” It’s 11 PM, and I must have dozed off. I clumsily sit up in my chair and see the on-call family medicine doctor, Dr. Hansen. He’s standing with his hands on his hips and staring at Mr. Biggus. When he notices that I’m awake he waves me away and says, “Don’t worry about it. I won’t tell anyone you dozed off. I think it’s ridiculous they’re making you stay here for twenty-four hours straight.”
I smile sheepishly. “What were you saying about the pressors?”
“Well, in all of my clinical experience, I’ve never seen anyone on more than two medications to maintain their blood pressure beat Death. He’s on three. If you have to be on three drugs to maintain your pressure, you have a slim chance of making it. It’s a waste of resources.”
I frown and nod. He mutters something under his breath, turns and leaves the room.
Around 1 AM, I hear a gargling noise. I hop out of my chair and stand at the edge of Mr. Biggus’ bed. I turn my ear toward his chest, lower my head and listen. The noise is coming from his throat and seems to get louder when he inhales. The Death rattle. I remember reading that when someone gets close to the end, he or she loses the ability to swallow secretions. The secretions remain trapped in the throat and make a rattling noise, which some poet somewhere must have dubbed the Death rattle. I quietly listen for a few more minutes. The noise is ominous and unnerving. I move to the bottom half of his bed and check the swelling in his ankles. They’re obviously bigger than before. His heart is also closing shop. Each organ, shutting down one by one. I back away from the beeping, gargling bed and into my chair, fearful of what’s coming. I hug my knees to my chest. My eyes feel over-stretched, like they can’t shut. My heart is pounding and a new pile of sweat is making my scrubs stick to my skin. The Grim Reaper is near. I feel like I need a baseball bat to hit the giant, shadowy soul thief as soon as he enters the room.
2 AM comes and goes. I feel delirious, beyond tired. The ICU night shift is quiet yet busy. I watch as nurses in pink scrubs hurry to and from rooms. One of my classmates brings me a coffee from downstairs. I take a few sips and stare at Mr. Biggus. He looks pretty much the same. Maybe dryer and more shriveled, but for the most part, the same. I once read an article by Hospice which talked about the process of dying. It stated Death can take a long time since the spirit is busy resolving earthly issues before exiting the body. Perhaps Biggus is taking his time, because he’s attending to important matters of the spirit. I don’t always believe in a soul or a spirit. Right now, I do. I believe in good spirits and bad spirits. I believe I’ll see the Grim Reaper hovering over Biggus’ helpless body.
At 4 AM, I grow jittery. My older sister, a doctor, always told me that people usually die in the early morning hours. I sit rigid in my chair with my eyes glued to the monitor. I’ve been continuously drinking coffee and feel caffeinated blood pumping fluidly through my limbs. I did some lunges and arm stretches. I’m ready, ready to wrestle Death if it comes to that. I glance at Mr. Biggus’ body and hope to see a more dramatic sign of impending doom. I’m half-expecting him to explode in fireworks of blood and flesh or maybe ghostly beings will appear and carry his soul away- something profound and definitive.
I study him longer, but nothing strikes me. Nothing looks or feels dramatic. His position hasn’t changed. There’s no spirits in the room. The monitor sounds the same, and his breathing rate has stayed steady for the last fifteen hours or so. I’m slightly disappointed. I thought Death would be more histrionic. I thought it would live up to its reputation in poems and horror movies. Instead I feel like I’m watching an old car traveling at a steady speed on a one-lane road that will eventually sputter and stop.
At 5:16 AM, the numbers on the monitor plummet. His blood pressure was at 90/50 for the past two hours, and then at 5:16, without warning, both numbers incrementally drop to 0.
“Wait. What? He has no pressure.” I mutter, as I urgently jump out of my chair. “Was that it? Was that Death?” Tired and confused, I hurry into the main ICU area and loudly say, “Code? Anyone? Code! Mr. Biggus. His pressure is at 0.” I couldn’t have sounded more unsure of myself if I tried. One of the night nurses blinks at me blankly. I keep repeating the words “code” and “no pressure” as if I’m a robot. She then runs into Mr. Biggus’ room with a stethoscope in her hand.
“Code! Call the code! Get the doctors stat!” she screams from the room with authority and gusto.
“Code blue in the ICU. Code blue in the ICU,” I hear over the loudspeaker.
Doctors come running from every corner and every door as if they’re a combat team closing in on the enemy. Soon, around thirty white-coated men and women are swarming Biggus’ bed. A resident swiftly rolls up his sleeves and begins doing compressions on Mr. Biggus’ chest. When he pushes down, Mr. Biggus’ body makes a noise that sounds like someone is walking through a mud bog. He’s congested with stagnant blood.
Another resident replaces the breathless first one and begins doing forceful compressions, but Mr. Biggus isn’t responding. I stand in the far corner of the room and watch, hoping someone will hurry up and call the code before one of Biggus’ ribs cracks. They look like two guys working out at the gym- on the Death machine. Then Dr. Mir walks in the room.
“Okay, gang. Let’s get two chest tubes going fast! Let’s go, surgical team! Two chest tubes stat!” he yells to a gaggle of residents in the doorway.
My jaw drops when I hear Mir’s orders. He’s going to try to drain the dead man by putting two holes into his chest cavity. And bring him back… for what? So he can die again in a few minutes? This is scary- much scarier than the Death. Death was merciful. Death was graceful. This is not.
This isn’t a science project, I think while slowly tiptoeing towards the door. The man is dead. He should be dead. Nature wants him dead. Even the residents seem reluctant to move. Dr. Mir barks orders at them again, which finally gets them moving. They better listen- he’s writing their evaluations. I decide I don’t want to watch anymore. This is just humans being stupid and self-important. It’s nauseating. I have seen enough. I’m leaving. I’m so tired and can’t think straight. I turn and walk out of the room. I’m going home to sleep- sleep off my long, disappointing date with Death.