I sat outside the room where we told them.

The news.

Where his mom said: I had a feeling this was coming.

Waiting.

She said they wouldn’t be able to find their way back.

Take all the time you need. I’ll wait outside. Show you the way.

An excuse to press my back against the wall. Slide to the floor.

It looked like I was the one unraveling.

But it wasn’t my news. I just watched the delivery. Sat in solidarity.

They unraveled.

Dirty scuff marks on the faux-wood floor. Dents in the wall made by heavy beds.

He’s our only one.

Happy Father’s Day.

Negative

“Why are you being so negative?” The cardiac surgery fellow was smiling when he asked me. His eyes matched his blue OR scrubs exactly. Equal parts alluring and unnerving. I couldn’t look away.  

Wait, what? Is he serious?

“Because…I don’t think he’s getting better?” I hated how my statement sounded like a question. The final syllable curving up an octave like the corners of a mouth when a man says—you’d look prettier if you smiled!

“The bleeding is slowing down. See?” He gestured insistently at the numbers on the dry-erase board.

0700: 600 mL.

Then—180, 100, 60, 10.

Obviously. I’m the one who recorded those. I know the numbers. That’s my handwriting. I’ve counted and cataloged every drop. I put them on the board for everyone to see. I don’t care what the numbers say. He’s turning blue.

“Yeah, but—”

“You need to think more positively,” he said.

“No. I don’t.”

A third cooler of blood arrived. More products were typed and crossed, ready to be given.

The patient was hemorrhaging.

I was being told to have a better attitude.

I hung the thirteenth unit.

Blue eyes watching.

Patients die all the time. Just not like this.

“It’s not that bad.”

Oh, but it is that bad. Why aren’t you listening?

Those unnerving eyes. They weren’t angry. They weren’t mean. They just didn’t believe me. He was the surgeon. It was my handwriting on the board.

Sweetheart. Stop overreacting. Much prettier when you smile.

He didn’t say it, but he didn’t have to.

So I carried on like a good little nurse for the next six hours. Until the ICU attending leaned in the doorway with the same concerned look I’d had since 7 AM.

“The surgery fellow said the bleeding is better and he’s just third spacing,” I said.

“You don’t third space 50 units of blood.”

“Yes, I know that.”

“Get him on the phone.”

All the surgeons came then. They talked in low voices out of earshot. When they took him back to the OR it was booked as a “chest re-exploration.”

Have fun on your exploration! Be sure to pack your good attitude.

Why aren’t you smiling, blue eyes? It wasn’t that bad, was it?

They found two liters of blood compressing his heart. Suture and Evarrest® patches were used to staunch the offending vessels.

Everest? Geez, you really did go exploring.

Too little too late. The trek should have started earlier.

The hypotension was prolonged.

A low-flow state.

The patient’s eyes are brown.

They are fixed.

They are dilated.

He has twenty hours left.

By this time tomorrow I will have already turned off the machines. 

The Drip

My patient was in the process of dying when the pharmacy called.

“Do you really want us to make this drip? It looks like you’re withdrawing soon.”

“Probably. But not yet,” the nurse practitioner said. The call had come in during the family meeting. She shot from her chair in the uncomfortable sadness, the jovial ringtone in direct conflict with the weight in the room.

“Oh. So you still want the drip?”

“Yes, please.”

“But according to the chart—”

“It’s—not—happening—yet.” With one hand on her forehead in exasperation, she paced the hallway like her steps could erase the callous suggestion on the other end of the line.

“Fine. The attending needs to sign off. I need to talk to him.” The NP thrust the phone at the attending in disgust. He took it with a look of: I can’t believe this shit.

“This is Dr. Shaw.”

“Do you need the drip?”

“Yes, please.”

“Are you withdrawing soon?”

“Probably. But not yet.”

“So you need the drip?”

“Yes.”

“Are you sure?”

He stormed out of earshot so I’m not sure what he said. In any event, his restraint was admirable.

Make the goddamn drip assholes or just say what you’re too chicken-shit to actually admit—he’s going to be dead soon and you don’t want to waste precious hospital resources on someone who will be in the fridge by 1800. Would you like me to mention this to his parents? They’re waiting on the priest for last rites. I could ask them if making the drip is worth it, or should we skip the rites and call it now?

Make the fucking drip.

He’s not dead.

Yet.

Kleenex

On our way to the meeting, the nurse practitioner grabs a box of Kleenex from the countertop. She sees me watching—sets it back down.

“Oh, that’s too obvious,” she says.

“No,” I say. “Bring them. Thank you for remembering.”

We’re always second guessing.

The room is empty except for a small beige table, four mismatched chairs. The walls are lined with stacks of bright yellow isolation gowns.

They’re an unnatural shade. Jaundiced yellow. Sickly.

His parents will hear the news from our soft-spoken attending. His eyes say, “This shouldn’t have happened.” He didn’t say it, but he didn’t have to.

I see the pulse in his mom’s neck from across the table. “I think I’ll always wonder what would’ve happened if they’d taken him sooner,” she says.

“I think we’re all going to wonder that,” the attending says.

The mother nods. “He’s our only one.”

His dad hasn’t spoken.

“Happy Father’s day,” she whispers. Not a trace of irony—like it has suddenly occurred to her what day it is.

The room fills with stiffness. No one moves. A low-flow state.

Until his father begins to cry.

Cleaning up

Once he was dead, three of us hauled him left, then right, then into the body bag.

The zipper was so long we each did a section. Reached as far as we could. Handed it off to the next.

After all the calls were made I started cleaning.

Wrappers, empty syringes, caps—trash.

Chest tubes, oxygen tubing, Ambu bag—trash.

Strip the IV pole. All eight channels still loaded with tubing, the ends y’d into one. They’re hanging limp on the dirty floor. They aren’t attached to him anymore.

Eight half-empty bags of meds tossed in the sink.

I pulled some scissors out of the sharps bin.

Thought: “This is a bad idea.”

But no one had come to empty the container and it was stuffed way past the line marked MAX FILL. I could just reach a pair I had prematurely thrown away. It seemed like a waste to open new ones.

After the retrieval—my fingers blessedly puncture-free—I returned to the sink.

Normal people hold the bags up and let them drain. I started stabbing.

I wasn’t careful on purpose.

Tiny holes pricked into plastic. I amended my strategy to include cutting. A great gush of compounded calcium chloride splashed out of the basin and soaked my shoe.

Then I found the drip: Giapreza® (angiotensin II).

Three thousand dollars of liquid gold.

Stabbed. Cut.

Washed it straight down the drain.

Do you still want it?

Should we still make the drip?

You know we hate to ask but that shit—

ain’t free.

Katherine Toler is a critical care nurse and narrative medicine writer based in St. Louis, Missouri. Her work is forthcoming in Survive & Thrive: A Journal for Medical Humanities and Narrative as Medicine. She writes about the moral ambiguity, emotional fallout, and dark humor that characterize life at the bedside. She is currently working on a collection of essays.