I reminisce about him, a decade old memory, from time to time. He was in his early thirties. He was a father to three little girls, married to his high school sweetheart. She stood by his side throughout, a faint frown furrowing her brow. She knew that the stakes were high. She watched, as did we, his struggle. His nostrils flaring, his breaths shallow, his ribs retracting with effort. He needed supplemental oxygen when his lungs became saturated with fluid. 

He had come to the hospital a week ago. He tested negative for flu and other common respiratory viruses. He had pneumonia on both lungs. His lung images worsened daily as the infection consumed them, and his oxygen levels deteriorated simultaneously. 

He had a constant stream of visitors, he was never alone. His wife, his parents, his siblings, his friends. They kept up a steady banter, and the mood in the room was always upbeat. Their laughter and camaraderie masked the looming specter of death. There is a ‘gut instinct’, a ‘sixth sense’ a ‘foreboding’ that I have learned to recognize, which warned me to ‘beware’. His smiles became weaker, and when his breaths became labored, we had to place him on a ventilator. It had been a somber discussion. He had been sitting up in bed, holding onto his knees, as his breaths became grunts. He had had a sudden turn for the worse. His wife held his elbow and rubbed his back. She was quiet, there was a lull in the banter, we had asked everyone to leave the room, to give him room to breathe. The decision to place him on the ventilator was as swift as his breaths. It was smooth, the tube going into his windpipe, the medication relaxing him. It seemed to bring him instant relief. His oxygen level improved, and we all took a deep breath.

His wife cried when she saw him on the ventilator. He was still, lifeless, the laughter in the room replaced by the mechanical hum of the ventilator delivering oxygen into his lungs. She stayed by his side all day. She held his hand, she winced, looked away, shut her eyes, as we poked and prodded, for blood draws, placed tubes in his nose to nourish him, catheters in his bladder to monitor his kidneys. He held his own, that day, his body relieved of the work of breathing. He was like a marathon runner, who had collapsed just short of the finish line, and needed help to finish the race. We encouraged his wife to go home that night, to get some sleep. We reassured her, and she believed us. 

He must have felt her absence that night. His oxygen levels that had held steady all day, began to dip. He started showing signs of effort, trying to breath ‘against’ the machine. We administered more sedatives, and when that was not enough, we paralyzed him. We had to force him to relax so that his body would accept oxygen, to make him stop ‘fighting’ against the machine. That seemed to do the trick. His body relaxed, his oxygen levels improved. We took a deep breath. They rhythm of our breaths melding with his. 

His wife came back in the morning. We updated her, and she cried again. That was short lived, she composed herself, and went back to his room. She held him, and I am sure he felt her presence. Even though he was paralyzed, and sedated, his laborious breaths relaxed, his oxygen level improved even more. He had a good day, and we were able to remove the paralyzing medicine, and he maintained a synchronized breathing pattern. He managed to hold steady for a few more days.

Then, it was as if a switch flipped in his body. He had consumed the last of his energy reserves, and he was spent. We paralyzed him again. We increased the oxygen delivered to his lungs. We did more scans. His lungs looked white, there was no ‘good lung’ left. He was drowning in his own fluid and pus. We decided to flip him onto his belly, to help his lungs aerate. He liked this position. The tiny air sacs that had collapsed with the weight of his heart, were given a chance to inflate and sustain him for another night and a day.

When I came to work that evening, a crowd was gathered in his room. My colleague, who had taken care of him all day was talking to them. There were tears all around. I glanced at the monitor and saw his oxygen level read 82%. He was on his belly, the machine had reached its limit, and it was not enough. We watched, his oxygen level, drifting into the seventies over the next hour. There was not a dry eye in the unit. I kept entering his room, adjusting knobs on the ventilator, fiddling with pumps that delivered his sedation. It was all to no avail. His mother came to me later that evening. She showed me a picture of her son in happier times, sitting on his porch, the sun illuminating his eyes, his cheeks bright with vitality. She wanted to remind me off who he had been. The blue, bloated figure laying on his belly, with tubes coming out of every orifice, his eyes shut in an induced coma, was not her son. She recognized this before we did. Her courage was astounding. She informed us that it was time to ‘let him go in peace’. She was resolute. She spoke for everyone in the family. 

They formed a protective circle around him as we flipped him onto his back. We left the room after removing the life sustaining machines. His heart continued to beat. He held on for another hour, as his family mourned. His daughters were brough in to say their last good-bye. I heard them crying, their plea for ‘daddy come back’ rings in my ears.