Christmas In The I.C.U.
This blog was originally published in the New York Times.
The plastic chairs creak as we sit. I wipe a few crumbs off the table and watch them fall to the floor as I prepare to tell my patient’s adult son what I suspect he knows already but doesn’t want to hear: After weeks in the intensive care unit, his mother’s organs are failing and she’ll never wake up or breathe on her own again.
He’s not surprised. From her bedside each day, he has watched her fade. But Christmas is coming and he’s busy with family visiting, a dinner to plan. So he has a request.
“Can we keep her going until after the holidays?” He continues, his tone cautious. “I mean, as long as she’s not in pain, can’t we just wait? Maybe she’ll even get better?”
It’s holiday season in the hospital and it seems as though everyone is looking for a miracle.
When I was an intern, I spent Christmas in a busy New York City cardiac intensive care unit, where the nurses transformed our procedure room into a huge potluck. A handful of patients who had made it out of the I.C.U., including one man who’d received a heart transplant a few months back, left their beds to join the celebration. Outside the room there was sickness and the punishing pace of procedures and lab work to follow, but for a moment, it felt like a party.
A few years later, as a senior resident, I was assigned to work on the oncology inpatient unit, where our mission on Dec. 24 was to figure out how to get as many patients discharged as possible. We scrambled to call in prescriptions and arrange transport and secure home services — perhaps we could not get rid of the cancer, but we could burst into their rooms and announce that we had performed the impossible and we would deliver them to their loved ones for the holidays.
I’m not sure what it is about Christmas. I have eaten my Thanksgiving turkey and mashed potatoes in many different cafeterias over the years, lonely and homesick as I am sure my patients are too, but I haven’t felt the frenzy to send them home. Even on New Year’s Eve, ordering blood draws while watching the ball drop on television, we go on with our work as planned.
It’s not as if Christmas was central to my childhood. I can’t remember a time when I actually believed that a man in a sleigh landed on my rooftop and squeezed down my chimney while I was sleeping so that he could bring me presents. To the contrary, I’m told that I liked to proclaim myself a scientist and refused to accept things I could not see, test and prove. But there must have been something special, because I can still conjure the excitement of unopened gifts under the tree and the delicious warmth of family togetherness that felt, for a moment, as if it could last forever.
Now, decades later, sitting across from my patient’s son in that room, I think about his questions and what it is that he’s actually asking. It’s possible that he’s simply trying to avoid the inconvenience of a death, with a house full of relatives and a dinner to plan. But I’ve seen him sitting in the corner of his mother’s room each day, and so I can’t help thinking it’s something else too. Perhaps he’s grasping at the hope for holiday magic — the sense that if we want something enough, even if that something is as fantastical as avoiding death, we might just get it.
Yet all I can give him is the truth. So I tell him that his mother is not in pain. I explain that we can try to keep her comfortable until his family is ready, but we can’t promise that she’ll make it through the holidays, because we can’t change the fact that she is dying.
He nods and stands, surprising me with a handshake as we leave the room. We both know there will be no miraculous recovery. Though we’re sometimes able to arrange last-minute Christmas discharges and turn procedure rooms into potlucks, there is so much sadness that we can’t fix.
But maybe on that day, there will be this — a doctor who pauses at a bedside to talk with a patient a few minutes longer than she has to, a shift that’s quieter than expected, a relative who makes it into town in time. Maybe there will be a son who leaves dinner before he has finished dessert, because he knows that the next day his family will gather and the doctors will shut off the machines and it will be over but tonight, he will say his own quiet goodbye.
And when I leave work on Christmas, and it is dark outside and my eyes blur with sleep, the lights outside the hospital look a little bit like stars.