Daughter's bedside vigil.

A flat red line, blinking numbers on a black cold screen. I watched the vitals-monitor intently as his blood pressure continued to crash and his heart rate became a line as flat as the horizon. In the background I was vaguely aware of the resident calling out orders to give glucose, bicarb, check an ABG. Crinkling plastic wrap as the nurse fumbled to open a syringe, in a flurry of purple scrubs. “He couldn’t be crashing,” I thought in disbelief. He was supposed to be a simple congestive heart failure exacerbation who we would diurese and send home to his brownstone in Brooklyn. His family was filling the room: his daughters, his only son, his grandchildren, and a rabbi. I could feel their cumulative body heat huddled behind me as I stood awkwardly at the end of his bed, rubbing his sheet between my fingers, a sort of primitive reflex of comfort, from my childhood of rubbing a silk baby blanket. His oldest daughter had been sitting by his side throughout his entire hospital stay. In fact, I could recall only one time that I had visited the room when she was not by her father’s side. I glanced at her only momentarily, breaking my gaze from the vitals-monitor. She looked tired, her eyes hollow, her hair falling out of her loose ponytail. I had talked to her only hours earlier when I was prerounding. She had slept in a yellow vinyl chair by his side, stooped over the metal air conditioning unit, but she did not complain when I asked her how she was doing. She asked just one question: do you think my father’s going to be ok? She said that he had always been the center of her world. She had always been a daddy’s girl. I told her she was a devoted daughter and that I too understood the power of a father–daughter relationship. I felt my throat tighten, my eyes fill with pressure, tears pool, and I looked back up at the monitor, partly because it prevented my tears from falling down my cheeks and partly because I felt overwhelmed and close to breaking down should I continue to think about this daughter and her father. My thoughts of the family were disrupted when the resident turned to me and asked if the whole family was in the room. I was suddenly snapped back into the real world. “Umm...,” I answered as I composed myself. “Yes, the entire family is here.” The resident then turned to the family and told them it was time to say goodbye. The son, who had been stolidly standing in a grey pinstripe suit behind his sisters, suddenly gasped for air and started sobbing. He leaned forward, grabbing his brother-in-law’s shoulder for support. I looked at my patient’s blank stare, his glassy eyes, his gaping mouth, his gold wedding band on his finger. The room was moving in slow-motion around me. The nurse was cleaning up the mess on the crash cart. The resident had already left the bedside to go document the events in the chart. I stood there at the end of my patient’s bed, frozen, still grasping the sheet. I was recalling watching my grandmother die of a ruptured aortic aneurysm. My family had stood in the hospital room much like my patient’s family. My grandfather broke down holding her hand as we unplugged her ventilator, repeating “Sixty years. We’ve been married sixty years. What will I do without you?” I glanced out of the Tisch Hospital windows at the people running around like ants on 34th street, unaware that this man had just passed away. What were they doing running around like that? A surgeon briskly walked into the room, grabbed the vitals chart from the patient in the next bed and walked out. In the face of my patient’s death, every day activities seemed meaningless; the purpose of it all seemed questionable. Unfortunately it takes situations like this to step back from the chaos of everyday frenetic life and reflect on the purpose of this perplexing existence that we call life. I often wonder why we work so hard and run around like we do. All for what? As I looked around the room that day it became clear to me. The daughter had slung her body onto her father, giving him one last big hug. Being a daddy’s girl myself, I understood when she said that he was her world. This is the meaning behind all of the seemingly minor details of life. The strength of close relationships, be it with family or friends, is what matters when it all the ends. The daughter stood up and turned to me. She took my hand, her tears streaming down her face. I let go of the sheet and embraced her tightly, as she whispered in my ear, “I will miss him very much, but I was lucky to have him. Thank you for loving him as well.” That night I sat in my apartment on the 10th floor, looking down onto 1st Avenue, watching the taxi cabs race by filled with business men, housewives with their kids, teenagers going out for the evening. In the past, this birds-eye view had always elicited existential thoughts about the meaningless nature of life. But tonight I didn’t have this thought. Tonight I sat on my windowsill and picked up my phone. “Hi Dad,” I said with a quivering voice, “I wanted to let you know how much I appreciate and love you.”