In Internal Medicine training, there is one month for ICU rotation for the 1st year. ICU rotation is mentally and physically demanding. I remember in March the ICU census is really high, up to 16, and there is not enough residents to cover, we have 2 residents and 1 intern on the team, and I am that intern. One time, we have 4 pts crashing at same time, one needs intubation, one is actively dying, one have massive GI bleeding and wants to withdraw all treatment, one is chronically ill but is bradycardic (low heart rate). We have to split the team to monitor these critically ill pts.

Mr. H is the one that has massive GI bleeding and wants to withdraw all the treatment. He is a veteran that has volunteered in the hospital for over 20 years. When he was in ICU, lots of people came to visit him. Dr. F is the attending I know very well and I will be working with her for the next 2 years. I received the email from her talking about a pt and asking for prayer, I did not make any connection with Mr. H, until very late or after he died, I finally realized it is him.

He has always been stable, except keep refusing BiPAP, the last few days of his life, we noticed his white count is a little bit high, Hb is low but not at the criteria for transfusion, until he had a large bloody bowel movement, the Hb dropped significantly, we have to call in IR to do embolization procedure emergently. We gave him massive transfusion and the IR can not stop the bleeding either. The morning when I came in, the nurse ran into me and asked me to talk to the pt because he is talking to his sister to withdraw all the treatment. I rushed into the room, there he is, calmly but firmly talking to her sister, "No, I do not want any treatment, let me go!" The sister is crying, holding his hand, "you have massive bleeding, you do not want them to treat you, is that right?" he shook his head, firmly, "No!". I can not control my emotions anymore, and I cried, the bedside nurse cried. This is a live pt requesting the medical team to let him die. I told the sister and the nurse, I need to talk to the attending before stop all the pressors. I walked out the room, called Dr. C and he is intubating a pt in SICU, he told me wait until he finish in SICU and will come to MICU asap once he is done.

I stood at the computer outside the room, crying and waiting for Dr. C. For Mr. H, we can continue to transfuse him aggressively to keep him alive, IR can attempt one more time, it might stop the bleeding. But he DOES NOT want it. Up to today, I still remember that day. Dr. C finally came to MICU, he is trying to persuade pt to let us try one more time to save his life. But he refused, calmly, firmly and with dignity. He is quite awake, he knows what is going on. This is 1st ever I am witnessing a live person giving up his life. Finally, all the care are withdrawn, and he died, surrounded by his family and Dr. F.

Dr. F posted his picture right in front her office, I always see it whenever I pass by, over there, a nice, smile gentleman. I do not know why I have such a mixed feeling. I took care of him for almost 2 weeks and I can not forget him. I still cried when I wrote this.

May peace be with you, Mr. H.