Yesterday morning I walked into the transplant unit around 5:30 and glanced over at Mrs. K's room. She was still lying there, the ventilator moving her lungs, and the pressors holding her circulation.

I first met her last week when I was on call. She came to the emergency room because she was having bleeding with bowel movements. She was a small, elderly lady, with a quick smile and the most pleasant disposition. She'd been admitted to the hospital multiple times for the same issue, so she was used to sitting in the ER. I spoke to the Colorectal service and relayed to her that they will try to find the source of bleeding in the morning. Then I bid her goodnight as she waited to be admitted by the medicine team.

The next time I saw her, she was brought into the transplant/surgical unit after a subtotal colectomy. They weren't able to localize the source of bleeding, so they ended up removing most of her colon. She was still in good spirits and didn't complain of any pain.

She stayed in the unit for the next few days, so I ended up managing her care as the de facto unit resident. Her heart rate was always high, which might mean a lot of things, including poorly controlled pain and fluid loss. It was difficult to say, partly because she absolutely refused to complain about any pain at all. To some degree, we had to practice veterinary medicine, treating the more common, but less serious causes, while keeping in mind that she may have something much worse developing.

Different members of her family were always around, and it was obvious that she was loved dearly. They never demanded, never accused, never blamed, even when it became clear that her postoperative course was not improving.

She had severe respiratory distress one morning and ended up being intubated. Later that day, her blood pressure began to drop precipitously. She was started on pressors. She had blood cultures come back positive for infection. A CT scan showed nothing specific. She stayed in the unit that night, basically kept alive by modern technology.

A few minutes after talking to the overnight resident we glanced over at the telemetry monitor and saw Mrs. K's rhythm go into asytole - flatline. A code was called and continued for 20 minutes. As I was standing over her, giving chest compressions to keep her blood flowing, I looked up and saw her daughter watching from the hallway, tears running down her face. We stopped not long after.

The day went on. There's not much time for mourning the dead while the sick are calling. But now I'm home, and I happened to be looking at something I wrote years ago about a girl that I knew who passed away at a young age, and I can't help but think of Mrs. K.

Let me hold my breath and let this pass
And promise to savor each second
That follows the crash and anguished sobs
And the doctors who are beckoned.

Let me hold tightly to your promise
Of future glory, now near.
Yet risking a life as a pillar of salt
I look back from the pier.

Charon bids me climb aboard
And I cannot help but yield,
But my heart is left with those on shore,
Though I walk in Elysian fields.