Hektoen International

A Journal of Medical Humanities

An act of cowardice

Michael Shen
Indianapolis, Indiana, United States


Charon carries souls across the river Styx. Alexander Dmitrievich Litovchenko. 1861. Russian Museum, St. Petersburg.

In autumn, the leaves turn yellow and die. The cirrhotics in the unit do the same. Their path already charted, their lives like leaves in the wind, we carried them as long as we could. We poked and drained and filled, knowing that nothing would change the inevitable. Like leaves, the cirrhotics were subject to gravity; they fell to earth.

I had only worked on the service for a couple of weeks, and I had watched many people die. It was the inevitability that made it easier. Death seemed so ever-present that suddenly, you got out of the habit of hoping. You did not grieve, you did not mourn. Life slipped through the cracks in the hospital linoleum and you hardly noticed. But even in someone so out of the habit, even with so little to encourage it, hope bubbles up. You get distracted, you lose track, and you find yourself drowning in it.

John had been in the ICU since before I started on the service. He was a cirrhotic. Like many cirrhotics, his abdomen would swell up over the course of a week, his liver leaking fluid into his abdominal cavity. We drained it on Sundays, pulling out milk cartons of fluid with a needle. He did not enjoy the experience: strong with delirium, he fought us, spitting and cursing and threatening. We would hold him down and dodge his swings, working all the while. In the end, we would take out the needle and he would collapse, as if we had drained some essence from him with the straw colored fluid.

And yet, despite those Sundays, John and I became friends. My early morning visits happened to coincide with his clearer moments, and we were able to talk. Still cloudy with delirium, he would tell me odd stories with jagged turns, of a tranquil Indiana farm life intermingling with terrible memories of war. I would mine out details; a wife, a job in a car factory, Korea, the loss of a finger from one of the former. Our relationship deepened, and one morning he told me of his son. He told me they had a fight years ago, and that he had never repaired their relationship. His voice broke, and I realized he knew. I remember the feeling of falling, the creep of dread and fear and hope. I remember how I knew it was a mistake to tell him, and how I told him anyway, that I had never repaired my relationship with my father. In the afternoons, John did not remember my name but remembered our friendship. He said that he would like to fish with me when he left the hospital. I said that I would like that as well. In the time since I have not been able to tell if I was lying to him, not to mention if I was right or wrong to.

The work in the unit went on. I poked, I prodded, I drained, and I filled. It was dreary work. The bodies flowed in, and they flowed out. The only hope on the unit was the ICU fellow. Like us, he fought valiantly and hopelessly against death, but his real power was in knowing when to give up a fight, and convincing others to do the same. He would enter a dying man’s room and secure from a family those golden tickets: Do Not Resuscitate orders. In a ward of dying men, he was busy. His visits saved the patient from needless suffering; the family from the sound of cracking ribcages and electric paddles; and the staff from the experience of an ugly, drawn out death.

I was in the meeting when John’s Do Not Resuscitate order was obtained. I listened, impassively, as the fellow discussed John’s situation with his wife. I heard the fellow’s magic, his reason and his compassion, and I suddenly understood. John was dying. In his time on the unit, he had become more confused, more lethargic, more yellow. He had begun that long, inevitable fall. His prognosis was grim. He was dying, yes. Of course he was dying. But how could he be?

In the next two weeks, my visits with John became shorter. He became less verbal, less there. His memory of me vanished. I told myself that there was less — no, nothing, for me to say. Of course it was true. Of course it was a lie. I could not look at him. When we drained his abdomen on my last day, he hardly protested. It was peaceful. I remember how his mouth was slightly open when we finished, how his eyes were dark yellow, and how they peered out empty through the half-closed lids. I remember how the fluid from his stomach was bloody, and how it foamed.

I left the service while John was still alive. I was relieved that I had not watched him die. I do not know what became of him after I left. I know he is dead now. Of course he is. Of course he is not. Is it so wrong to believe that maybe, some leaves might last the winter?



MICHAEL SHEN is a Medical Student at Indiana University School of Medicine.


Spring 2019   |  Sections  |  End of Life

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