I fear that I’m not doing the right thing. You’re trusting me with your life. I hear you telling me that you don’t want me to do what I am about to do. I see it in your eyes, the resentment as you look toward your family. And hatred for me, your physician.

You trust me to care for you as you enter the unit. I tell you I will. You say, “Yes” when I ask if I could listen to your chest, the stethoscope linking us together. You say, “Yes” when I ask if I could make you more comfortable, holding my hand as you gasped for air. You, nearly an adult, confide in me that you don’t want a breathing tube. Because your parents ask me to place it, I plan to do so—against your wishes and my ethics. The levels of carbon dioxide rising in your body is intoxicating and you become tired and then incoherent. Medically, you no longer have the capacity to tell me you don’t want something to be done. But I cannot unhear what you said to me, loud and clear. You rest your eyes, and then wake up minutes later agitated, yelling, gasping, and then falling back to sleep again.

Your parents aren’t ready to let you go, even if you are ready yourself. I try to reason with them, to advocate for you. I try to get your parents to hear me when I say that we can’t cure your cancer. They don’t want to hear me or possibly can’t with all the commotion in the room and in their heads. I try to tell them that a breathing tube would only prolong your life. I tell them that they may not ever hear your voice again if I place it. This gives them pause, but only briefly. I advocate for medications that would allow you to breathe more easily and struggle less. I encourage your parents to lie in bed beside you as you pass away in peace. I know that’s what you want.

I told you I would take care of you, and I fear I am not. Your plea to die is humbling. I feel inadequate that I cannot respect your wishes. I feel inadequate that your parents want more and I, who have been entrusted with your care, have nothing more to offer.  With all the advances in technologies and medicines, we are still not limitless. I stand beside you powerless against life’s natural course, despite every toxin and tube placed to prevent it from happening. In this moment, we all lose.

Your parents kiss you on your head as they leave the room and I prepare to place the breathing tube. Nurses are bringing medications to your bedside to ease your suffering. Respiratory therapists are preparing the ventilator and tubes.  Monitors are silenced behind you.  Like before, you jolt upright in bed, yelling that you don’t want a breathing tube. I am next to you, holding your hand, speaking quietly, telling you to rest. Your nurse administers a medication for the anxiety. As your nerves settle, I slide behind your bed against the wall preparing myself to place a tube in your body against your wishes.

I stand behind you, our eyes locked together. I can see your eyebrows furrow beneath the mask I am pressing against your face, my fingers lifting your chin closer towards mine in an abnormal embrace. You hate me, and I can’t blame you. I order more medications for your suffering.  Finally, your eyes close and my own suffering eases for just a moment.

I fear that I’m not doing the right thing and I do it anyway.

Lauren Rissman is a pediatric critical care fellow.

Image credit: Shutterstock.com