Early December 1996

I’m post-call again.  Bliss.


The alarm on the code-pager went off at twenty minutes after six, exactly as I set it, rousing me from a good ninety minutes’ slumber.  Rapture.

Aye.  Bliss and rapture rule the day.

In a half-hearted attempt at grooming and hygiene I ran dripping-wet hands through my hair, then went down to the cafeteria for some strong coffee.  Snuck a smoke outside on the patio, and presto, ready to greet the day with enthusiasm and vigor.

Fucking joy supreme.


So I can’t be Mister Sunshine all the time.  What of it?


Anyhow, by seven a.m. I’ve seen that the medical student who’s working with me has written notes on both of the folks I’ve been to see so far.  His notes are astute and to the point, and he already has orders waiting for my counter-signature on the chart.  Things are looking up. 

“This is doable,” I think to myself.  “Okay.  Off we go.”

Mrs. Clemson is next on my list.  I heave myself up out of a chair at the Eleven C nursing station and head off toward the opposite wing, trying to put a bit of bounce in my stride.  I hum a gay little tune to myself and actually break into song as I’m rounding the corner near her room.

“Don’t be quitting the day-job, honey,” one of the nurses offers.

I look back in faux-horror.  “Aww, now where’s the love in that?  I’m just a happy golucky young intern, trying to help out some poor sick folks, and what thanks do I get?  Am I offered boxes of candy or a warm smile?  No.  Instead I am assaulted wantonly and without provocation by my good colleagues in the healing arts.  O what a sad and dreary world it is . . . “  I clasp my hands together and offer sad puppy-dog eyes before starting to giggle madly. 

“Long night, eh?” the nurse asks.

“No no, it was wonderful,” I lie.  “I feel most excellent this morning.  Wheee!” 

Punchy.  Yep, that’s the word for it.  I am definitely punchy.  Wow.


So I stride into the patient’s room with a hearty and booming, “Good morning, Mrs. Clemson!”

Usually, Mrs. C. would look up at me in confusion and respond with a quiet, “G’mornin’.”  Today she says nothing.  Interesting. 

I look at her a bit more closely.  Her head is canted at an odd angle, and she looks just slightly pale.  I think to myself, “O, no.”

I reach for the sacred stethoscope and venture forward to listen to her heart and lungs.  As I reach up under her gown, my hand brushes across her abdomen.  She’s warm.  “Okay,” I think to myself, “warm is a good.”  Stethoscope lands on her chest.  I listen very carefully indeed.  Nothing.  “Hmmmm,” I think.  Lungs next.  Since she clearly isn’t in any sort of frame of mind to cooperate, not unlike Mrs. Q. up the hall, I don’t even consider trying to sit her up in bed for a proper exam.  My stethoscope goes to one armpit, and then the next.  Nothing. 

I step back from the bed and regard her again. 

“How about that,” I say out loud.  “I do believe she’s no longer with us.”

Stupid though it seems, I really can’t believe it.  I mean, she’s still warm.  I go back and listen to heart and lungs again.  I tap on the stethoscope, just to make sure it’s working.  For my efforts I get ringing ears.


I go for the carotid pulse.  Nothing.  Mrs. C. is dead.


I step away from the bed again, looking at her.  “Damn,” I think to myself.  “She really is dead.”  I start to stride out of the room and find much to my surprise that there’s this stupid insipid grin spreading on my face.  Try though I might to banish it, the thought keeps coming back to me:  “Well, that’s one way to get ‘em off the list . . . “

It’s twenty-three minutes after seven a.m.  I find her nurse and ask, “When’s the last time someone went in to see Mrs. C.?”

“About seven,” she says, “why?”

“Well, I think she’s ready for transfer out.” I tell her.

“What?  Where?”

“She’ll be going to the ECU.”

“ECU?  What do you mean?  There’s no `ECU’ here,” she says.

“Eternal Care Unit.   Mrs. C. is no longer with us,” I tell her.

The nurse’s eyes get wide.  “You mean -- ?”

“Yes.  She is defunct.”

“Omigod, I’m glad it was you that found her and not me.  Are you sure?”

I just look at her.  I can’t quite get the stupid grin off my face. 


It would have been different if it was a Bad Thing, but it wasn’t, you know?

No, you probably don’t.

Mrs. C. had really really bad senile dementia.  She had no clue about where she was or what was going on.  She came in with a roaring pneumonia, and truth to tell, I didn’t think she was going to survive the night.  She had Do Not Resuscitate status though, which meant that we were to do everything in our power to keep her comfortable, but beyond that, no heroic measures.  Fluids and antibiotics, yes.  Breathing tube and CPR, no.

Anyhow, the morning after I admitted her, she looked great.  She was eating and talking and generally giving everyone around her a hard time.  “God bless her,” I thought, “she’s going to pull through.”

Yesterday I was on the phone with one of her children.  “Your mom’s doing pretty well.  I think we’re going to switch her over to oral antibiotics tomorrow and try to discharge her the next day.”

“So she’s okay?” she asked.

“Well, I’m not saying that,” I hedged.  “Your mother is very sick.  I think she’s getting better, but she could still take a turn for the worse before we know it.  By no means is she out of danger.”

“Thanks, Doctor,” her daughter told me, “I appreciate your honesty.”


The point remains though -- it was not a Bad Thing.  Mrs. C. was sleeping comfortably at seven a.m. when the nurse saw her, and had died quietly in that sleep by the time I had made it into the room.  She hadn’t been scared or lonely; nor had she been neglected.  Family members had been in to visit her several times each day that she was under my care.  It’s not like she really knew who they were, but she had companionship-- someone to hold her hand.


So I can’t quite get the idiot look off my face.  I’ve had ninety minutes’ sleep in the last twenty six hours, and I still have about eight to go before I can go home.  I plop myself down at the big table at the nursing station and page the attending, fully expecting a fifteen minute wait before I hear back from her.  Much to my surprise, the phone under my hand rings about forty seconds later.

“Dr. K?”

“Yeah.  You paged?”

“Jah love.  It’s Marcus.  Mrs. C. is dead.”

“Really? -- No no, nevermind.  I’m only two floors down.  I’ll be right up.”


When she arrives, I tell her the story, such as it is.  She tells me to go back to my paperwork, saying she’s going in to see the patient.

“Fair enough,” I think to myself, and go back to trying to figure out which blanks I have to fill in on the death certificate.

Dr. K. comes out of the room two minutes later, grinning from ear-to-ear.

I look up at her startled.  “I have an excuse,” I tell her.  “I’ve been up all night.  What’s yours?”

“Well, when I went into the room the respiratory therapist was trying to fit her for nasal-canula oxygen.  I told her that I didn’t think the patient would be needing it.”

When I see that she’s utterly serious, I dissolve in giggles. 


Dr. K. and I talk briefly about what should be written on the death certificate, and then she phones the family and talks to them for a while before going off to other things.  After a while I finish up all the paperwork and then for some reason step back into the room to see Mrs. C. again.  She is decidedly more pale than she had been when I first saw her, and I realize that she must have died only minutes before I first arrived.  She’s cooler, too.

Crunch THUNK - I turn around at the noise to see someone from nutrition services bringing in Mrs. C’s breakfast tray.

“Uh - I don’t really think she’ll be needing that,” I say.

“Well we bring their trays whether they’re hungry or not,” she tells me, “you never know when they might decide to eat something.”

“No, really.  She’s a bit peckish this morning.  I sincerely doubt that she’ll even push the food around on her plate.” 

“Well Doctor,” she says snidely, “we have our policies . . . oh.”

 I smile at her politely.  “Yes?”

“You mean -- ?”

“Er, yeah.  She’s just not really going to be eating much in the near future.  I don’t think you need to leave the tray, okay?”

“Oh.  Oh dear, I’m so sorry.”

“It’s okay.  I honestly don’t think she minds very much.  Have a good morning.”


Eight hours later I’m telling the story to my folks in their kitchen over a half-eaten sandwich of my Mom’s glorious barbecue beef.  I start giggling all over again with the re-telling.  They look at me sorta funny, so I feel compelled to attempt an explanation.

“It was okay, you know?  She was comfortably asleep when she died.  She wasn’t scared or lonely.  The last thing she knew was a nice warm bed where there were kind and concerned people taking care of her.”

Mom looks at me strangely and asks if I’d like another sandwich.  I nod vigorously in the affirmative. 

A bit later, I’m holding a piece of woodwork while my Dad fits clamps to it.  “It is kind of funny, isn’t it,” he offers.

“Dad, it was fucking hysterical.  It could have been sad, I guess, but it just wasn’t.  It was time for her to go, and she did so without fear and with such dignity she was capable of.”

“Maybe you should write something about it.”

“Yeah, maybe I should.”


I’m still post-call.  I go home to bed and strange daytime dreams about work.