She was the brightest thing in that white room.

Warm brown eyes locked on mine. She peered out at me from behind an oxygen mask, a small woman hidden under a cloud of brown hair. Usually, when I came into the room to examine her, she was lying flat on her stomach, her chin propped up on her hands in benediction like she was reading a Bible. As soon as I entered the room, she would twist her body around to greet me, and a brilliant smile broke across her face, lightening the room with its energy.

But today, she sat upright, her shoulders curving forwards as if to lessen the effort of breathing. Her chest wall muscles sucked in over and over rapidly like she was running somewhere she had been expected but was already too late and too tired. She stretched out her right hand and gestured for me to come closer. Earlier that week, she had told me earlier that she did not want to be connected to a breathing machine because she saw her sister die of coronavirus on a ventilator. Now her body was shutting down despite the highest oxygen levels that I could provide. As her doctor, I tried to help her body heal itself, hopeful that she would recover, even as she came closer and closer to death. Stroking her hair back from her face, I told her what she already knew. Her hand squeezed mine as if she were comforting me.

Even as the coronavirus infection destroyed her body’s last defenses, she grasped my hand with a final strength that seemed untouched by its wrath. Coronavirus drowned her in her own fluids. Virus filled the lungs, expelling air and replacing it with fluffy clouds of fluid and mucus. The inflammation caused by the virus could cause all manner of deadly effects. It inflamed the heart muscle in some patients, causing fatal heart attacks. In others, it caused massive lung clots that killed without warning. The high oxygen levels needed to keep patients alive could rupture the lungs. In still others, the virus traveled around unchecked, attacking the kidney and liver, and brain. When the virus attacks the brain, it causes a patient to become profoundly confused, minimally responsive, unable to swallow, too weak to move on his or her own. My patient was spared this indignity. Still, the virus broke down her body, trying its best to dismantle who she is.

Like her, hospitalized patients face one of the most challenging times in their lives alone. Due to the virus contagious nature, visitors are generally not permitted in the hospital. Instead, patients lie alone in their rooms, the stillness of their day interrupted by blue and yellow gowned masked individuals walking in and out, health care workers whose faces and bodies are hidden behind masks, gloves, and gowns. Some patients become agitated from loneliness and altered sleep cycles. Some develop delirium requiring restraints to keep them from hurting themselves. Hospitalization often stretches in a long swell of days to weeks to months. If recovery comes, it happens slowly, with struggle and setback. For every patient who gets better and can go home, there are ten more who crash. The few patients who do get better keep the hope alive that things will improve. The wave of death will eventually recede.

But right now, death keeps crashing in waves that overwhelm me and everyone else. Every morning, every two hours or so, the loudspeaker rings with “rapid response” or “airway team” or “code blue,” and I know someone else is trying to die. Patients doubled up in rooms, and lying in beds at all levels of the hospital and emergency room. So many need astronomical levels of oxygen, and so few get better. Even the last resort, a ventilator, often doesn’t save the patient’s life. It does, however, give the patient’s family more time to come to terms with the likely outcome.

When I saw my patient struggle for every breath, I cried for her and myself. Her strength was in how she lived her life and the knowledge when her suffering had gone far enough. She reminded me that living well is also embracing the end of life when it comes. While she desperately wanted to live, her body was ready to rest. I had to let her go. I remember the details of that moment, the curl and color of her hair, the warmth of her fingers, the opal-like quality of her eyes, her effervescent smile, and the flutter of her hands gesturing for me to come back when I was about to leave the room.

My patient knew she was dying. She wanted it to be a good death. Clasping my hands, she thanked me and told me she loved me. When nothing seemed redeemable, her empathy graced me. Her strength lifted me above our sorrow. She shared something of herself that we seldom share with one another. She lives on through me.

Cindy Mong is an internal medicine physician.

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