Fred was the cool guy.

Back in the 1950s and 60s, smoking cigarettes was considered movie star quality. That circling of smoke in his parked car with the girl of his dreams.

He started smoking at the tender age of 15.

Fred had it figured out. Cigarettes were glamorous. Cigarettes were cool.

Doctors advertised that smoking was good for you. It helped you keep weight off, and it relieved your anxiety.

In 1965, the Surgeon General came out with a warning that evidence had linked smoking to diseases of nearly all organs of the body. Smoking causes cancer. The Surgeon General mandated that all cigarettes carry a warning on their packs: “Cigarette smoking causes lung cancer, coronary disease, and pulmonary disease.”

The Marlboro Man could no longer be seen on TV, and they were also mandated to stop all TV advertising.

But it didn’t matter to Fred. He was hooked—literally. Fred knew he was cool, and the girls loved him.

He religiously smoked two packs of cigarettes a day. He was young, athletic, handsome, and had his girl. Eventually, they married and had an adorable baby girl.

Alicia was the light of his life. They did everything together. He taught his baby girl to horseback ride, help build a campfire, and go to father-daughter dances. They were a team. Though Alicia’s mom was the backbone of the family, it was her dad who was wrapped nicely around her finger!

Momma started to have physical complications, and while Alicia was in college, her mom developed breast cancer. Though everything possible was done to keep her mom alive, Momma sadly died of breast cancer with metastasis to her lungs.

Now Alicia and her dad were the only family team left, and they stayed beside each other through thick and thin.

Fred never let up on his cigarette smoking. If he tried, he’d get the jitters. His hands would shake, he’d get anxious, he had heart palpitations, and although he was developing a harsh cough, he kept on smoking.

By the time Fred was 58, he would get short of breath just climbing stairs. And then he’d cough up blood.

He went to the doctor. X-rays of his lungs, esophagus, and trachea were done.

Diagnosis: squamous cell carcinoma of the trachea.

His cigarette smoking finally took its toll. Radiation therapy and chemotherapy were the courses to possibly keep the cancer from spreading. But radiation therapy and chemotherapy, along with the cancer, ate away through his trachea … and with that, he was emergently admitted to our ICU.

Poor Fred. Very lethargic, floating in and out of consciousness.

Our ICU intensivists called a conference. Fred was not going to survive this. They told Alicia that they couldn’t fix this. Fred had a hole in his trachea from the cancer, and the radiation and chemo started to profusely pour out blood from the site.

We had to tell his daughter that her dad was not going to live, that he was basically going to bleed to death.

And here he was in the ICU, buckets of 4×4 gauze boats brought to his room to suppress the bleeding, but there was no way out.

Our Code Blue was initiated, but there was no hope. By now, Fred was unconscious and bleeding to death.

Alicia, his daughter, refused to leave his ICU room, and we allowed her to stay. She watched us pour IV fluids through his veins. She watched us deliver oxygen. And she watched us pack 4×4 gauze to his neck.

And she watched her daddy die while he profusely bled through his neck.

She bent over the sink, crying, and crumpled to almost a fetal position.

I saw there were enough nurses with Fred, so I went over to Alicia to comfort her.

I patted her back, hugged her, and whispered words to her to soothe her.

It was a sad, tragic death that Alicia witnessed, but she couldn’t leave his side.

When we finally pronounced Fred’s death, Alicia walked over to her dad and held his hand. “Daddy, I’ll always love you—now and forever.”

We are stoic ICU nurses. Sometimes we are robotic … for the sake of survival.

But not a dry eye on this night.

We were flooded with tears and grief.

Debbie Moore-Black is a nurse who blogs at Do Not Resuscitate.