The inertia builds as I get closer to the unit. When it comes to actually walking into her room, there are somehow so many things to do instead: find the chart, read the notes three times through, ask the nurse a dozen questions, fold my papers, check my pens, wash my hands twice – anything rather than walk right in.

She’s intubated, and wide awake, and dying, and she knows it. For two weeks. She was suddenly diagnosed with severe leukemia, and developed both fungal and viral pneumonias. That’s why the infectious disease team is seeing her. She also has acute renal failure, so renal is seeing her; she has cancer, so the hematologist is seeing her; she’s ventilated, so the critical care team is seeing her. She has no platelets and therefore no red blood cells, because she’s bleeding at every possible location. Daily infusions of red blood cells and platelets do no lasting good. She has no fever, and has been on antibiotics for weeks, but she can’t survive off the ventilator.

She hates the tube in her throat, but she and her family can’t quite manage to have a real discussion that will lead to some decision for her.

Every morning I walk in and she’s half asleep, and I have to say, “Good morning.” Then she opens her eyes and nods at me, and maybe nods a few more times as I ask the most basic yes/no questions I can think of: are you having any pain; have you had a fever. . . that’s it. And then she stares off at the corner of the wall while I listen with my stethoscope.

How can you have a conversation with a person on a ventilator? And it’s ten times worse when there’s something so momentous to discuss, her cancer, and its horrible prognosis. I don’t dare say anything specific about that, because you can’t put it in a yes/no question, and it feels like it would drive her crazy, if she should want to say something, and can’t.

This morning while I was listening to her rattling lungs her husband came in from the waiting area, and sat back down by her bed. I introduced myself as being with the infectious disease doctors, and said her fever was gone, and we assumed the antibiotics were working; but she has another bigger problem. He just nodded and looked over to her lying in bed. There was nothing else I could say, except that I’m praying for them. He nodded again, and kept looking at his wife.

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