It is an unusual experience to take care of a patient who is mechanically ventilated. In the Emergency Department, we encounter patients in respiratory distress often. Sometimes, patients are in so much distress that a breathing tube is placed down their throat. The tube is connected to a ventilator that helps them breathe. These ventilated patients may stay in the Emergency Department for a short while, but at some point they are transported to the Intensive Care Unit (ICU) to hopefully receive airway support until they are ready to breathe on their own.

I spent about one month in the Respiratory ICU this past October. While I have participated in the care of mechanically ventilated patients in the Emergency Department, prior to October, I do not feel like I had truly seen the mechanically ventilated patient. In the ICU, some patients need a ventilator for days to weeks. Sometimes the rest of their lives. Externally, most patient’s look the same when connected to a breathing apparatus: sedated, minimally responsive, a glassy, distant look in their eyes when pried open for a physical examination. The harsh hum from a machine pushing oxygen in and out of weak lungs seems forced and unnatural, robotic almost. You don’t truly realize how sick a patient is until their kidneys and heart start failing in addition to all the original problems leading them to their ventilated state. The gravity of certain disease states fully registers with time. Time with the ventilator.

It is a strange cycle to wake up every morning at the crack of dawn and see your patients who may or may not be doing better or worse with each passing day, all the while looking the same. Sedated and minimally responsive. It grows monotonous. You become invested in the tearful family members at the bedside. Sometimes you are even tearful yourself, though you never knew this person prior to their time in the ICU.

Many people do get better, sometimes surviving infections and pulmonary trauma from the forced ventilation. Many get worse, and ultimately, after hours of conversations with family and primary decision makers, invasive care is withdrawn. We stand with our patients and watch the minimal, remaining signs life slowly cease to exist until we call the time of death.

There are moments in the ICU that are joyful, and seemingly filled with miracles. As a resident physician working thirteen hours a day, six days a week, time often moves slowly. And sometimes it feels as though we are prolonging the inevitable – death. With loud, clunky machinery and intrusive interventions.

The nonfiction section of this issue of Please See Me has an unintended, overarching theme of death. It is honestly quite fascinating how each of the pieces has been crafted to describe the many layers and pathways to the end of a human life.

Borderless Dreams describes the harsh, emotional realities of medical training and questions if our doctors are given enough resources and space to cope with the death of our patients and severe illness.

Echoes walks readers through the abrupt, unexpected death of a child, while Too Many Broken Hearts discusses a mother’s experience with the slow death of her child with cancer. At the Gas Station takes readers through a story about depression, an unwillingness to continue living, and a mother’s analysis of her daughter’s suicidal ideations.

In a Near Future, 1968 Again is a beautiful and raw piece that swiftly walks readers through the process of abortion, allowing us to think critically about seemingly controversial topics in 2022 society.  Lullaby for the Dead is another powerful piece that raises questions about healthcare, and the lives we value in the United States.

On a slightly lighter note, Funeral Songs, takes us through a discourse that encourages celebration and life, even in times of sorrow. Henk’s Choice is a peaceful work that has stuck with me during my month working in the ICU. Hanne Jensen, a hospice worker, and the author of this piece, discusses dying with dignity and what that really means.

As I reflect on my time in the ICU, I think about the conversations I have had surrounding death. I wonder if our society would be different if we normalized the forbidden end of life conversations early on and often. Would we still see so many spend their last days with the hum of a mechanical ventilator forcing oxygen into troubled lungs? Or would we explore other options, so that our souls had more peace when our end was near?

Brenda Arthur is the guest nonfiction editor of Please See Me.