June
David Peters, MD - Resident Physician, Department of Family and Community Medicine
I was looking intently at a sandwich tray when I broke down in tears. The platter was centered on a timeworn table with a faded-pink laminate top, within a windowless locker room repurposed as a provider breakroom. The tray had arrived earlier that day, much to the delight of the ICU staff. I, in contrast, had spent much of the day trying to avoid it. My aversion to this tray was not because of anything I had against Primo Hoagies, but because it had been sent in by Bill’s family. I had spoken on the phone with Bill’s wife and son every afternoon since he had entered the Methodist ICU in respiratory distress the week prior, each call meeting their sense of optimism that he might wean off of the ventilator with discouraging news and regrettably reminding them of the COVID-19 visitor restrictions that prevented them from coming in to see him. Staring at the sandwiches, all neatly arranged in tiers of concentric circles, I envisioned Bill’s family; his wife, his siblings, his children, and his grandchildren – sitting around the living room together and sharing hopeful words through their masks. I imagined their mental picture of him: weathering the storm by himself but surrounded by attentive doctors and nurses. Though they knew he was unconscious, I wondered if they could still feel him reaching out for them. The sandwich tray was their refusal to be denied entrance into the ICU. It was both an expression of gratitude for his team and an assertion of love to revitalize Bill in his battle. Perhaps it would give him the warmth that was missing in their absence. I started sobbing, suddenly shivering with icy apprehension that I would soon tell them that he suffered a massive stroke overnight and would have no chance at recovery. I felt the sound of his son’s voice quivering over the phone burrow deep inside of me, nesting in the new space where more somber patient memories would soon dwell.
Intern year crawled along, and I watched more people labor through their last breaths alone. These were sobering moments that I struggled to exhale. I could not wholly express them to my partner, family, or friends, separated 300 miles apart from them. My smile withered without their laughter. My feet numbed to the once soothing feeling of my socks pressing on the creaky wooden floor of my apartment. The jovial relationships I had envisioned sharing with co-residents and hospital staff were replaced with transactional conversations held behind masks, face shields, and phone screens. Escaping for a few minutes to the top floor of the hospital where I could silo myself inside of a call room was freeing. Alone, I could feel my lungs scrape my chest as they filled with air and hear the hum of the nearby generator whispering to me while I lay face down in the call room bed, embracing a pillow. I was nothing but a keyboard and a mouse. I was just white noise walking through the hallway.
“Let me see you without your mask,” she pleaded. I lowered my mask. “Oh! you are going to make such beautiful babies,” she said. I blushed. Her comment surprised me. It was funny and colorful, gleaming through the silt of a series of identical, dispiriting days. To June, a 67-year-old woman with newly diagnosed pancreatic adenocarcinoma, I was transparent. She knew that I did not understand the complexities of her condition well, and that the vague updates I gave her each day collectively implied her bleak prognosis. Confronting her mortality over the course of her admission was as unpredictable as it was painful for her, an oscillation between emotional extremes, an avalanche to endure without a soul to receive her rescue signal. Her abdomen seared from within. Her red, sunken eyes echoed a depth of suffering beyond what I could conceive. But, through the scrap heap of my annotated handoffs and used gowns, she found something to hold on to, something from which I too had become estranged: me. She actually appreciated my clinical inexperience and my innocence. I did not have much to say as an intern, but I was someone who could listen, a friend unbound by the COVID visitor restrictions. My visits with her gradually became less medical. At times it seemed as if we were just sipping coffee together, taking time to show each other pictures from our lives beyond the four walls of her patient room on 7 West. With each passing day, I watched a stack of envelopes on June’s bedside table grow. The return labels held the names of her children, grandchildren, friends, and members of her church community. I asked her why she had not yet opened them one morning, to which she calmly replied, “I’m not ready yet.” I was immediately struck by this, for this statement was not a denial of her illness, but rather an acceptance of her mortality. She knew that she would never get to physically see most of her family ever again as a result of the pandemic. Those letters, thus, contained their presence, and would serve to stand in for the goodbyes that she would never get. They were the light to guide her through her last day of life. The letters were her sandwich tray. June died on the first day after she was discharged to inpatient hospice. I do not know how she spent her last day, but I like to imagine that she opened those letters, and one by one felt the warm touch of all the people whom she loved. I often reflect on that time I spent with her, and I wish that she could read the letter that I would write to her now.
Dear June,
You told me once to not see you as the person who was sick and dying in the hospital. You wanted me to see you the way you lived your days before those final three weeks. You showed me a picture of you with your family, dressed up and standing in a parking lot, with an ear-to-ear smile, your arms around your grandchildren. You showed me a picture of the sun setting from the view of your living room. You showed me a picture of you drinking a ginger ale. Most of this year, I have felt like I’m not supposed to be here in Philadelphia. I have longed for my family, my friends, and my partner every day. I have felt so alone, hidden behind the mask and the face shield that I wear. I have felt overworked but irrelevant, responsible but unfulfilled, and engaged but hollow. The pictures I shared with you of my life in Boston were how I thought I wanted you to see me, but I changed my mind. Please see me as the young doctor who ran out of answers and just sat beside you. Please see me as the friend whose hand held yours when morphine could not alleviate your pain. Please see me as the broken person that was revived when you said, “I love you.” You showed me that there is always light in the darkest of places. You showed me that there is always a path to happiness in the present, even when you run out of tomorrows. I love you too.