“She’s a 66-year-old with a history of whatever, who came in for whatever,” the medical admitting resident told our ICU team as we approached her room in the emergency department. What he meant was, come here now to help me stabilize her.
After the central line was running pressors and her ventilator settings were adjusted, we learned the fuller picture. Her history was uterine cancer, recurrent and metastatic. She came in because she couldn’t breathe. The diagnosis was recent. Because of this, she and her husband had only begun to broach her goals of care. The palliative care notes from the time of diagnosis were worded delicately. The patient and her husband had been devastated by the news that what had been gone for years was back. They had needed time to think.
Three weeks later, she was admitted to our ICU.
The ICU is a vast forest of constantly changing conditions that require action on the order of minutes. As a fairly new intern, my job was to record the trees. Trees came in the form of prerounding. Between 4:30 and 6:30 every morning, I would enter each patient’s room, write down every line and tube in her body, and write down every substance entering or leaving it. I would listen for how well air navigated its way into and out of lungs, observe what color urine was, and feel how swollen lower limbs were. It was always dark, and I was always brief.
Her legs were very, very swollen.
Later in the day, I sat at the computer writing notes while facing her room. I watched her chest rise and fall in line with the vent, surprised how that detail was noticeable even from 20 feet away. Her husband was hunched in a folding chair. He held his head in one hand and her hand with his other. I had never seen anyone sit so still for so long.
Those were my glimpses of the forest. My senior resident taught me the word “paavam.” In Hindi, it means “pitiful,” she told me. “Whenever I look at him, that’s the word that comes to mind.”
The mornings were dim and tangled. I ran out of space on my template to write the number of drips she was on.
One morning, I started when I squinted to read the dose of vasopressin. Her husband was in the room, chair squeezed in the tight space between bed and sink.
“Hi,” I mumbled awkwardly. I wasn’t ready to see him. It was too early.
“How are you?” I added. That seemed like a good thing to ask.
“Her glucose is 108 today,” he said. “That’s not bad, is it?”
“No, it’s not,” I agreed.
He didn’t say anything. I kept writing, even after my template was filled. There was a safety in not looking up.
I’m not sure how intentional it was, on either of our parts. Later in the day, the lights would come on and the rest of the staff would trickle in. And I would watch him through the glass door, angry at myself for being able to find refuge among the trees.
