2 Nights at 2 A.M. on Call

Maggie, the girl in Bed 4, is eight days older than me. 

She was admitted last Friday after collapsing on the bus ride home from work. The CT scan of her brain revealed a massive intracranial haemorrhage from a ruptured aneurysm. How could anyone have guessed? She was 28 years old with a clean bill of health. Her family was healthy. She loved bubble tea, hiking, and anime, and she had been planning her upcoming holiday in Korea with her friends the night before. Nobody could have predicted this. 

She was rushed into the operating theatre, and the bleeding was controlled. Her blood pressure was lowered, her intracranial pressure was normalised. Yet she remained comatose and 5 days later, two sets of tests have confirmed brainstem death. Maggie has passed away.

Her father, with trembling hands, tucks a lock of hair behind her ear. He turns away from the beeping monitors and the flashing lights of the ventilator, and tells the nurses that he consents for her to be an organ donor. He only asks for a fresh towel so he can wash her face for the last time. 

Oliver, the boy in Room 1, is one year younger than me. 

I first met him 22 months ago, when he came to the hospital because he had ankle swelling for two weeks. At first he had ignored it, thinking it was simply from stress and a lack of sleep, or because he hadn’t been doing enough exercise. It was only because of his girlfriend’s nagging that he came to the hospital, where his serum creatinine was found to be 900 μmol/L. He was started on peritoneal dialysis, and since then, we’ve been seeing each other every 2 months in the clinic. He has been managing alright, trying to see if he can go to work again. He smirks when I tell him to be careful of his daily salt and fluid intake. 

He picks up immediately when I call him at 2 a.m. about being waitlisted for a kidney transplant. He goes from shock, to excitement, to apprehension, and apologises for yawning when I walk into the hospital interview room. He still cannot believe it, he hasn’t been able to sleep all night. He signs the consent forms and is prepared for surgery. He walks out of the hospital six days later, and he has not been on dialysis since.

I think of how fleeting and unpredictable life can be — how good people can, for no apparent reason at all, suddenly have their entire lives upended — and that despite our best efforts, nothing more can be done. A dancer will need to re-learn how to walk, this time with one leg. A parent will leave the hospital with a void in the shape of his daughter. 

An intern once asked me, what was the point of everything if, ultimately, the patient could not get better? Even now, this question isn’t easy to answer. Loss is everywhere in the hospital — the loss of health, of function, of a loved one — yet knowing its inevitability does not diminish its sting. Most of the time, a full ‘recovery’ is not possible and we cannot revert life to the way it was before.  

Yet, as Paul Kalanithi wrote, “even if I’m dying, until I actually die, I am still living”.³  We cannot live a perfect life, but we can strive for the fullest one, with its highs and lows and even the monotony of each day - because we deserve the freedom to experience it in the first place. Physicians have the simultaneous privilege and task of returning that freedom to our patients: to find a way, as Florence and the Machine puts it, ‘to exist in the face of suffering and death and somehow still keep singing⁴’, to find a defiant joy despite the odds against us. 

Two years later, it is 2 a.m., and I am on call again, about to assess the patient in Bed 4. I find myself thinking about Maggie and others who have left earthside — not with guilt or regret, but with the knowledge that they walk with me and shape the fabric of how I practise. I also think of Oliver, whom I saw last week in the clinic. He is doing well; he can play basketball again and is about to go on holiday with his girlfriend to celebrate his “second birthday” — what he calls the day he received his kidney. That night, like a thread connecting the three of us, reminds me that every season of life should be savoured, and every loved one cherished. Life is not to be taken for granted.

I call my parents and tell them I love them, before going inside to see the patient waiting for me. 

References

1: ICP: Intracranial Pressure

2: Reference range for serum creatinine ranges at around 60 - 110 μmol/L

3: Kalanithi P. When breath becomes air the ultimate moving life-and-death story. Random House; 2016.

4: Florence + The Machine. Free. On: Dance Fever [music]. Polydor Records: 2022.