No other significant events overnight.

During our surgical team’s morning rounds, she would half-audibly mutter sentence fragments and odd phrases: things we couldn’t hope to understand. Her cognitive function was declining, a result of her advanced liver disease. She spoke at length about things that no one had time for. So on rounds we would mime patience and comprehension, squatting down by her bed and tilting our ears toward her, pretending to listen to her complaints, questions and musings. At the next opportunity—perhaps a pause for thought or a moment of confusion—we would thank her and rush out, leaving her and her befuddled words alone in the room. On Friday afternoon, our team made another of many attempts to assess whether that little old lady was ready for discharge. She was not. She wondered aloud whether her family, visiting the next day, would know what gowns are, how to put them on, and how to enter her room. I watched as my team took this cue to hurry out to see another patient. I lagged behind, stopping for a moment to ponder our abrupt and inadequate encounter. As I smiled, half-turned, and excused myself from the room, her eyes captured mine. She blurted, “Hey kid…the moment you lose that shock, you don’t belong in this business anymore.” Not quite sure what she meant or how to respond, I smiled and agreed. Exiting her room, I considered the moments through which I have quietly, unassumingly stood during the first 4 weeks of my first clinical clerkship. A frail, cadaverous woman, sprawled nude on the operating table, slapped awake by the anesthesiologists trying to extubate her. She awoke, sputtering, shivering, choking, to four unfamiliar, masked, hooded figures nonchalantly surveying her barren skin, her breasts, bruises, wrinkles, and tuft of pubic hair. We cut into a patient’s chest cavity to operate on his heart and lungs. I marveled at the privilege of laying naive, tentative, uncertain hand and tool inside his body, of touching the organs that gave him life. A young woman was delivered to the operating room, soon to undergo a dangerous procedure that could cure her of her cancer. The surgeon sat in the corner, typing at a computer. The patient lay nervously on the operating table and silently wondered whether she would open her eyes again. I looked in her eyes as they darted about fearfully, and I asked myself what to say, how to say it, whether she would be scared of my mask and gown, what she would think, but by then she was asleep and I had been hopelessly mute. I hoped she would wake after the surgery and give me another chance to find my words. Ten of us: fellows, residents, nutritionists, nurse practitioners and medical students, nameless, in sweeping yellow “contact precaution” gowns, faces hidden beneath our masks awoke a boy and his family at 5:30 a.m. They were confused and disoriented. What’s going on with our child? We huddled around him, surrounded his bed, wordlessly poked and prodded his wound dressings and pushed on his belly. What happened during the operation yesterday? “Everything looks fine,” we coaxed the family, “we can come by later if you have questions.” Who are you all? At 5:33 a.m. we filed out, as nameless as when we entered. I met a man in clinic with mesothelioma who would almost certainly die before he celebrated his next birthday. We chatted—I asked him about his pain and the other discomforts that he experienced from this cancer that would take his life. I held his hand and braced his body as he underwent a painful thoracentesis. We exchanged smiles, brief biographies, and goodbyes. Three months later I recall the man whose hand I held, whose pain I tried to ease, whose life briefly intersected with my own, and I wonder whether his biography continues. While completing an operative note in the post-anesthesia care unit, I heard behind me a hoarse voice, gurgling and crying incoherently for help. The nurses seemed to know that this patient was just beginning to recover from anesthesia—that she was not yet mentally intact; they did not respond to her pleas. I turned around, looking into her unfocused, drugged gaze. She looked back into my skepticism, my questioning, and asked once more for help. I sized her up for a while longer and then looked slowly away. She’s not thinking straight, I pled to myself, yet I stood there horrified by my ability to turn my back on another human being begging for help. I continued my operative note. A patient had sustained internal injuries in a car accident. Shortly after her arrival in the trauma bay, her heart suddenly stopped beating. I watched as a group of 20 people squeezed frenetically into the small room. They wormed their way amongst each other to fetch drugs and perform chest compressions; they stood on tiptoes to better view the spectacle. When the patient was pronounced dead, a mass exodus ensued. The patient was abandoned—left alone on the stretcher with the janitorial staff, who entered to wipe the floors clean of her blood and life, any evidence of her final moments. I walked into the room for the first time to look at her eyelids, gently veiling her lifeless eyes. I searched desperately for meaning in this moment, in her sudden departure, in her isolation. I’m sorry. What is your name? Do you have a family? Where were you going in that car? Perhaps one progress note I wrote captures some of the gravity, the poignancy, the horror, the absurdity, and the humanity of the moments to which we bear witness as healers: “Patient is overwhelmed by his new diagnosis with this rare cancer and has many questions and concerns he would like addressed. Specifically, what does it mean? Why him? And how many months does he have left with his children? Patient is shocked. I am shocked. No other significant events overnight.”