Sometimes the most I can offer is to be present with people


I’m sitting in the ICU team room, staring at the computer, trying to look like I’m writing a note. But my head is pounding.

As an internal-medicine resident doing my first month of residency, I’ve found the ICU of the bustling county hospital a jarring place to start my training. Although I’d anticipated the clinical challenge of caring for very ill ICU patients, I was unprepared for the emotional burden of having to deliver devastating, life-altering news to them and their family members.

Faint yells emerge from Room 7. They have an almost rhythmic quality: “Ahhh!”… (three seconds) … “Ahhh!” … (three seconds) … “Ahhh!”

It’s Ms. Burton. I’ve just gotten back from checking on her, but I plod back again.

“Ms. Burton, are you in pain?” I ask loudly. She stops yelling and glances at me.

“No,” she says, her voice high-pitched and childlike.

Per her chart, Ms. Burton has suffered some kind of injury that caused her brain to be deprived of oxygen; no further details are known. Her face and arms are heavily bruised, and we’re worried that she’s being abused at home.

Hoping to ease her suffering, I try several different ways to ask what’s bothering her. Each time she replies, “I’m fine.” Eventually, she turns away, a blank stare on her face, and starts yelling again.

Forlornly, I gaze at her, then quietly say, “I’m so sorry.” I sigh, feeling disappointed in myself, and walk back to the team room.

The phone rings, and I answer it.

“Hi, Doctor, this is George calling about Mr. Smith in Room 15. His brother is here.”

My eyes glaze over as I anticipate my upcoming conversation with this patient’s brother — the conversation I’ve already had with three of his other family members.

“Thanks, George, I’ll be right over.” As I head for the door, the phone rings again. I pick it up.

“ICU,” I say wearily.

Quickly, a nurse speaks: “Ms. Lifton’s husband is going to be here shortly and asked to speak with a doctor.”

“I’ll be there soon, thanks.” I walk to Mr. Smith’s room.

Mr. Smith’s brother stands by the bed, clearly in shock at the sight of his brother, who’s intubated and has a second tube draining blood from his head into a plastic bag.

“Hi, I’m one of the doctors taking care of your brother,” I murmur. “Let’s talk in the family room.” I lead him across the hall. We sit down.

“What has your family told you about what happened?” I ask as gently as I can.

“Nothing,” he says woodenly. “I got the call last night that Billy was in the hospital, so I came this morning as soon as I could.” I gaze at him, knowing that what I’m about to tell him will change the rest of his life.

“I wish that I had better news. But unfortunately, your brother is in a coma.” I pause. His eyes slowly well up with tears.

“I’m so sorry,” I say, handing him a tissue and putting my hand on his shoulder. His body quakes with heavy, silent sobs.

“What happened?” he finally croaks in a broken voice, looking up at me. Briefly, I explain how his brother’s high blood pressure caused him to have a stroke.

As he continues to weep silently, I say, “You’re welcome to spend some time in this room if you’d like. Please let the nurse know if there’s anything I can help you with.” He nods, reaching for another tissue.

I close the door and stand in the hallway, rubbing my eyes. I feel so helpless. I want nothing more than to tell my patient’s brother that his loved one will recover. But the window of opportunity during which I could have made a difference to Mr. Smith’s health closed long before I ever saw him.

What can I actually do for Mr. Smith’s family? I wonder. Have I at least done a passable job of compassionately telling this man that his brother will never walk, talk or be the same again? Fleetingly, I realize that probably the most meaningful thing I can do for them is to communicate the medical situation patiently and clearly, lend a listening ear and offer my sympathies.

I sigh and head down the hall to see Ms. Lifton, who was brought here after suffering a cardiac arrest. On the way, I pass Ms. Burton’s room (“Ahhh! … Ahhh! … Ahhh!”).

As I walk in, I see that Ms. Lifton has been extubated and is waking up. Flailing about, she makes incomprehensible noises through contorted lips and tries to tear out her IVs. A nurse grabs her hands and calls her name, trying to get her attention.

I go and stand at her bedside, reflecting sadly that this might be Ms. Lifton’s new normal. Then I turn and see her husband standing in the doorway. He stares wide-eyed at this woman who’s been his capable life partner up to this point, but whose physical abilities now resemble those of a young child.

Slowly, he approaches her and reaches down to cradle her face. She tries to bite his hand. He recoils, and a tear falls from his face onto the sterile white bed sheets. He starts sobbing.

“She’s acting like she’s disabled,” he says to me hopelessly, desperately, pleadingly — clearly wishing that this were some horrible nightmare from which he could awaken.

“I’m so sorry,” I reply, trying to hold back my tears.

This must be one of the worst days of this man’s life, I think. Eventually, unsure what else to say, I retreat to the team room.

Sitting down, I give up any pretense of appearing busy. I rest my forehead on my hands, trying not to sob out loud. My mind and body throb with heart-wrenching thoughts and feelings: It’s so emotionally trying to witness the worst moments in people’s lives constantly… to be the one who’s delivering the bad news that changes someone’s life forever … to be unable to help someone who’s clearly suffering.

Caring for irreversibly ill patients like Ms. Burton, Mr. Smith and Mrs. Lifton feels like walking in at the very end of a long, complicated movie. I want to make a difference in their lives and health, but their stories have already unfolded.

The sad truth, I’m reluctantly learning, is that sometimes the most I can offer is to be present with people, to listen to their sadness and pain — and to express my own by saying, “I’m so sorry.”

Holland M. Kaplan is an internal medicine resident. This piece was originally published in Pulse — voices from the heart of medicine

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