No One Dies Alone

by Evan Ross

The pager rang at 7:02 in the afternoon. It was the first time it had done so in my presence and for a moment I couldn’t believe it was ringing. Surely it was someone’s phone here by the pool, one of my friends by the grill. Surely this wasn’t my pager.

I reached down, popped it out of its holder and lifted it up, squinting to see the numbers on the screen through the glare of the Texas sun. Five digits glowed back at me. I picked up my phone, hand not entirely as steady as I would have liked, and I punched in the phone number for the hospital’s Medical ICU.

Evan Ross, second-year medical student at UT Southwestern

This was happening.

A nurse’s voice came on the other end of the line. I told her who I was and why I was calling. She put me on hold. All I could hear was poolside revelry, splashes and laughter. Then another nurse’s voice on the line: “We have a patient,” she said, “we’ve withdrawn care, but his mother won’t come to see him. He has a friend in town, but he won’t come either.”

“You called the right guy,” I said, hoping that was the truth.

Twenty-three minutes later I walked into the MICU, the smell of disinfectant and plastic sounding a sharp contrast to the grilling and chlorine and freshly cut grass I had left behind. In the room I saw a man sitting up in bed, eyes wide open. I had not expected him to be awake and it took me a split second to wrap my mind around it. He was going to die, but he wasn’t dead yet; he was going to die, but for now he was wide-awake.

I spoke briefly with his nurse, the woman who had called me. She gave me the most brief of back-stories: a mass in his neck was constricting his airway. He had declined surgery and wanted no more interventions. What little comfort we could bring him was all we had to offer. I nodded, as if to show that I understood, as if I could possibly understand.

The man was sitting up in bed, his body rocking back and forth as if he was in a trance, his eyes fixed on the middle distance, an oxygen mask tight to his face. He did not seem to see me come in, so I took his hand and introduced myself. I told him I was there if he needed anything. A few seconds later he stopped rocking, his head swiveled towards me, his eyes found mine, and for a moment I knew that he saw me. Then his gaze slipped past me, his focus somewhere beyond. I felt him squeeze my hand as he resumed his back and forth, back and forth, back and forth. That was the last time he showed any sign of being aware of what was happening in the room.

All through the night as he fought to breathe I could see the skin tighten against his neck and chest. He may have decided against surgery and declined further interventions, but this was not a man who was going out without a struggle. At one point he grimaced at the wall and reached for his oxygen mask. His hands were not strong but he succeeded in pulling the mask off of his face. He shook his head as if to clear out the cobwebs, never once ceasing his slow oscillation. Moments later he took my hand and pulled himself forward, making as if to get out of the bed and walk away. Then he stopped and lay back, putting his hands behind his head as if he didn’t have a care in the world. I couldn’t help but smile.

His condition predictably deteriorated as the night wore on, but it didn’t strike me as a particularly violent process. His vital signs didn’t seem to be falling so much as gliding slowly downwards like a bird tracing a lazy circle above the earth. He was dying, yes, but it was clear that he had decided it would be on his terms.

My partner in the program had agreed to arrive at midnight to take over the vigil and maintain it until 6 a.m., so I darted home for a few hours of sleep. When I came back I found the man on his back, fatigue having robbed him of his rhythm. His eyes now watched the ceiling, and his mouth was open wider than it was when I had left. His breathing was louder now, more difficult and less steady. He’d seem to forget to breathe for seconds at a time then pant to make up the difference.

As the sun began to rise outside, I noticed that his breathing had become much quieter. I somehow knew that it was time. I squeezed his hand as I listened to his last breath. I waited for him to gasp, to remember to breathe once more as he had a thousand times before, but he never did. I watched his pulse flutter in his neck, the beats of his heart arrive further and further apart until another beat didn’t come. The monitor beeped. It was over.

I don’t know what he was seeing when he stared at the wall, and I’m not certain he was completely aware of my presence. I can’t explain what his rocking motion was about or why his family couldn’t come to attend his final moments. I don’t know the etiology of the mass in his neck, and I can’t say why he refused further care. I don’t know much about that night, but I do know that this was why I decided to come to medical school in the first place. I know that this vigil’s end is where me being a doctor begins.

Editor's Note: The article, written by Evan Ross, a second-year medical student at UT Southwestern, recently won first prize in a creative writing competition held by the Texas Chapter of the American College of Physicians (ACP). The theme for the 2011 competition was “Work-Life Balance: Where Does Being a Doctor End and Me Begin.” Mr. Ross wrote the article about his experience in the No One Dies Alone (NODA) program.