Letting Go

Another month in the MICU is about to pass in what seems like a blink of an eye. I enjoyed the fast pace and the thrill of saving the lives of patients in the most dire need. Just this past week, I took care of two patients who cardiac arrested and were in an anoxic brain comatose state. For both, we performed the hypothermia protocol, bringing the core body temperature down to prevent lasting damage to the brain. So far, they are doing better and will have limited residual effects in the months to come.

But sometimes we can’t save lives, and we must learn how to let go. One of my patients was a younger man with liver failure. He was on multiple vasoactive agents and antibiotics to combat infections. One night he deteriorated and needed a TIPS procedure. We all knew this intervention would be futile. I was standing at the foot of the bed while his wife sat next to him holding his hand. The hand she held was blue, cold, and seemingly lifeless because of the three pressors he was on. As she looked at her husband, connected to a ventilator with multiple lines coming out of his body, I wondered what she was thinking and how holding his frigid hand may have brought her to the decision she made to let him go. It’s one thing as a medical professional to advise “comfort care.” It would be an entirely different one to be in that chair holding a loved one’s hand, realizing that I would never again share big moments in life or simple pleasures with that person, … eating ice cream at a pier, taking a road trip, or looking at the stars and dreaming with them.

Earlier in the month, I cared for an older gentleman with multi-organ failure on artificial life support. We couldn’t find the source of his sepsis, and his pressor requirements were increasing by the day. I spoke with his wife every day when she came to visit. After twenty-something days, on Father’s Day the son came to his bedside, looked at his mother, and said, “It’s time.” Several of his hospital team members were in the room, hoping for and knowing what the “right” decision was. As the intern, I am in charge of handling the orders, knowing labs, and maneuvering the computer so I was standing in the back of the crowd. My patient’s wife spoke to the attending about withdrawing care, and she began to weep. She slowly made her way through the crowd in the room, and everyone on the team turned their heads toward me as she put her hand on my arm and asked, “Do you think this is the right decision?” I gave her my honest opinion, and she agreed to let go, despite having fought for weeks to hold onto hope. With a simple keyboard stroke, I ordered comfort care protocols for my patient.

I went home that night and remembered something my grandfather told me in India when I was a middle school student. We were at his farm when a merchant approached with some doves in a cage. They were beautiful creatures and I wanted to keep them, but I’ll never forget my grandfather telling me “If you love the doves, you would let them fly into the wind.”