GOOD-BYE | Jeffrey Millstein
Kate Porter just turned forty-three and has been working as a nurse on the med-surg unit for more than a decade. Rail thin and standing over six feet, she is innately high-energy and moves with the fluidity of a dancer. Most of her patients used to recover and go home to their families, but now it seems like they only get admitted to the hospital when at least two organ systems have irreversibly failed. Nearly a third are discharged to the morgue. She and her co-workers are not shy about sharing their frustration. She feels drained when she arrives, and nearly on empty when she leaves.
Complaining with the other nurses no longer helps her reset, and she often has more to unload to her husband when she gets home. This fills a growing portion of their time alone together. He is patient and understanding. And worried.
“You used to have a nice story to tell me about the hospital every once in a while.”
He has this way of saying things that gently hold up a mirror.
Today she has Mr. Curtin, an elderly former insurance executive, withered nearly skeletal by metastatic lung cancer. He lives alone since his wife died last year, and there is no safe option for him to be discharged home. On comfort care only at this point, he knows he’s getting close to the end and desperately wishes to see his daughter Alex one last time to say goodbye. They haven’t seen much of each other in recent years since she and her husband moved to Chicago for a work transfer.
Mr. Curtin is in 207b, one of the do-not-resusitate patient rooms. They are always farthest from the nurse’s station. Large and sparsely appointed, the smell of antiseptic mixed with meal-tray remains lingers in the air. The walls are bare except for a large white board with the date, time and nurse’s name handwritten on it. A television shows a landscape scene and plays New Age mood music. Most of the patients are too far gone to notice.
Kate is startled by whistling wind gusts that hurl a spray of freezing Philadelphia Nor’easter rain against the window. She turns back to her patient, adjusting his morphine infusion and swabbing his parched lips. “Alex is on her way Mr. Curtin. I just spoke with her. The weather is a bit rough, so it may take her a little longer than usual.”
“Do you think she’ll make it here in time?” he says in a barely audible whisper that consumes most of his strength. His daughter is still at least an hour away.
“She’s coming Mr. Curtin. She’ll be here soon,” Kate lies kindly.
Another blood pressure and pulse rate are due. She counts the slow rise and fall of his chest with each breath and is relieved to see him drift off into an opiate slumber. Finally, she’ll have some time to catch up with her other patients.
When Kate returns to Mr. Curtin’s room, his mumbles sound almost conversational. While she leans over the bed to adjust his oxygen tubing, he suddenly opens his eyes wide.
“Alex, you made it! I’m so relieved.” He smiles, grasps Kate’s forearm and pulls her toward him with surprising strength.
“Come now dear, let me see your face,” he continues.
Kate tenses, then resists for a second or two, until she realizes what is happening. She accepts his embrace and allows it to linger for a bit beyond her comfort.
“I love you so much Alex. I know I’m going to die soon. With mom gone, I just… needed to see your face and hold you close one last time.”
After she slowly pulls away from his grasp, Mr. Curtin’s breathing becomes more rapid and shallow, and the mumbling resumes. His face brightens and a peaceful smile forms.
There is a soft voice answering in the background.
“It’s OK. I love you too…Dad.”
The voice is her own.
Her patient begins to breathe more deeply and slowly for another minute or so, and then gives one last long exhale.
Kate stares at him, looking closely for any movement. She feels for a pulse and there is none. He is definitely gone. She works carefully and tenderly, trying her best to make him look comfortable for his daughter’s eventual arrival. She removes his nasal oxygen, intravenous line and urine catheter, wipes the congealed mucous from around his mouth and pulls the bed sheets up, covering him neatly to the chest.
Once satisfied, Kate sits down at the nurse’s station and rests quietly in liminal contemplation. Was this compassion or deception? Her hands tremble as she dials Alex’s number.
“How is he?” Alex asks with urgency, likely recognizing the hospital’s number on her phone.
“I’m so sorry Alex. He just passed.”
Kate knows to wait for the news to sink in. The sound of gentle sobs eventually breaks the silence. She consoles as she has learned to do so well in recent years and chooses not to tell Alex about her father’s final moments.
She will save that story for her husband.
Jeffrey Millstein is an internist, writer and educator and serves as a Regional Medical Director for Penn Primary Care. He is a pre-clinical instructor-mentor and serves as an office-based clinical preceptor for students at the Perelman School of Medicine at the University of Pennsylvania. His essays have been published in JAMA, The Journal of Patient Experience, Journal of General Internal Medicine, Intima: A Journal of Narrative Medicine, and Family Medicine. He is also a frequent op-ed contributor to The Philadelphia Inquirer.