He was 55 years old, I'll call him Sam. He'd once said that he was afraid of dying because "there will be a lot of empty pages in my book." I'd taken care of him nearly all of my shifts for the past six weeks, throughout his stay in the ICU. For the first few weeks, he was intubated and sedated. His son and daughter told me that he was slightly hard of hearing, but would prefer to have the television on in the background. The Learning Channel or Discovery, if possible. So all night long, I kept the channel on one of those, switching only to avoid infomercials. In the quiet of the beeping pumps and whooshing ventilator, I would fill the silence by talking to him about what was on TV as I drew his blood, changed his dressings, gave him his bath. Together we learned about the black plague and Emperor Caligula. Some nights were rougher than others...but we got through cold sepsis and some other hypotensive crises and looked like maybe we'd made it through the weeds. Weeks passed and eventually he was extubated (breathing tube was removed). He was slow to wake up, but each day became a bit more interactive. He could indicate if he had pain or not, nod and smile, he even had the good grace to smirk at my bad jokes. My nurse friend, J, and I got him onto the cardiac chair and wheeled him around the unit as the sun rose, to say hello to everyone and check out the views. He smiled more, and preferred to sit in front of the window when possible. He couldn't speak very well yet, but I got pretty good at carrying on a conversation with him my interpreting his nods, smiles, shoulder shrugs, and eyebrow lifts. I remember the morning we watched the rain come down, and lamented that somehow, we'd missed the end of summer.
One night I came on shift to find that he'd been reintubated two days before, and was worsening overall. Liver failure, possible GI bleed, counts dropping, unknown infection. The next night, he had a little blue sticker next to his name card on the door: Do Not Rescusitate. I continued to administer his medications, check his blood sugars, draw his labs, record urine output, turn him side to side, keep his mouth and eyes clean. I watched as his blood pressure dropped lower and lower. I called his daughter, who came in at 4am to spend the night. I said goodbye at the end of my shift, knowing it was the last time I'd see him. But in my mind, the last time I really saw him was the morning we'd watched the rain come down, and lamented that we'd missed the end of summer.
Those pages in your book, Sam? They're not empty.
So I am sad now. The same small sadness that I don't feel quite entitled to, since I know his children and his family are truly grieving, and compared to them, I barely knew him. It doesn't get any easier, because now when I feel sad, it just adds on to the sadness that I had for Billy, and for W., and the guy with my dog's name, and and and...