Dear Mother of My Patient

You were silent when he first came to the ICU.

Worried, not asking questions, not engaging but thinking.

hope you were OK with me leaving the room after you didn't answer my questions; I thought you wanted space.

Two weeks later, you were back with your baby.

Now he was worse; he was jaundiced and breathing hard.

No visible tears, no visible smiles or frowns, you were flat.

Just like you probably felt.

You listened during rounds without questions, but I could see that

You knew every detail and every team member's face.

The days were long, and the news was not good.

We called palliative care.

described them as an extra layer of support, which was true.

But I also called them because I was worried.

We asked for a family meeting, and you agreed.

You sat with 16 faces, all half-covered with masks and all looking at you and his father.

Words came from the ICU doctor.

Words came from the oncologist,

Then the gastroenterologist,

Then infectious disease,

Then palliative.

The words flowed in circles:

“I wish we had more, but this chemo is the best that we have.”

“We will keep doing our best to support him, but there will reach a point when we run out of options.”

You listened carefully.

You asked pointed questions while your son's father cried.

He needed tissues, not you.

The doctors have yet to see you cry.

When can this meeting end?

Then it was done, complete.

The most familiar voice then started to ask “what other…?”

“No,” you said as you looked at the father of your child.

“If we do nothing, he dies. If we give him chemo, it can help him… or it can kill him.”

Then your tears started to flow.

At that moment, I saw all of your strength.

You knew.

All of your quiet understanding, your love for your son, your fear, was wrapped up in that response.

My eyes welled up with tears as I watched you reach for a tissue, and I thought back to the first morning when I met you,

When you didn't want to talk.

You must have been so scared.

You both decided to proceed with the last-ditch chemo.

Who could blame you?

Forty-eight hours later, we had another long discussion.

“Things are not going well; we are afraid we are approaching the end.”

“We will return in a few hours to talk about how your son's last moments would be.”

The discussions you and his father must have had are unimaginable to me.

But when we came back, you knew what would relieve his suffering.

You made a loving and compassionate decision.

You didn't want him to suffer or to be in pain in the last moments and opted to forgo chest compressions to gain peaceful time with him.

After I described the option of print making, you asked us for the disposable stethoscope in his room.

wish I knew what it meant to you.

As I adjusted his medicines and checked on him during the day, I was rooting for you.

thought he would hear us and push through until after midnight.

thought he might know that leaving you on this particular day would amplify family heartbreak.

thought God would give you a miracle.

hoped that a higher power would prove us all wrong.

When I left for the night, I said I would see you in the morning.

couldn't bear to part with any other expectation.

When I awoke the next morning, I immediately checked to see whether your baby was still with us.

took a deep heavy breath and then got ready for another day in the ICU.

lit a candle for him that night—my own tradition to commemorate my patients when they pass.

am sorry that we couldn't control his disease and his immune system's overwhelming response.

am sorry that you have been forced to mature beyond your years.

am six years older than you.

am in awe.

am sorry that you are leaving the hospital without your child.

am sorry that we are living in an era in which we had to limit the number of visitors that came to say goodbye.

hope you cry as much as you need to.

hope you can heal, although I know there will be scars.

hope you find joy in your memories of him.

hope you consider having more children.

Our world will be lucky to have them.

Sincerely,

Your son's doctor