The day I knew would come...

So today it happened. I watched a man die. I didn't just see him die, but I saw him alive nearly 3 weeks ago at the beginning of my surgical rotation. My surgeon had asked me to see him in the office one afternoon, and there he was, a cachetic sliver of a man with sunken eyes full of hope. Hope that he would live- despite his 119 pounds of flesh whittled away by radiation and chemo over the past 8 months due to esophageal cancer. He confided in me he was scared to death about this surgery, but it was his best chance at getting the chance to raise his boys. I didn't participate in his surgery, but I returned from K.C. to find this man in respiratory failure, in shock, intubated and with total anasarca- he now weighed 180 pounds because of the fluids we were giving him to keep him alive. I saw him each day since I returned, confiding with the surgeon, intensivist, oncologist and ID team about his status, which grew worse and worse. He grew bugs that he shouldn't have... he leaked from holes he shouldn't have... he crashed when we thought he was doing better... he grimaced when we thought we had his pain under control. We even set his airway on fire when we put in a tracheostomy. He was a wreck. And after 3 weeks, today we held a conference with his family, who showed up in the boatloads with boxes of Kleenex as we told them that we did not see him surviving this ICU stay let alone recovering and living a productive life until his cancer returned, which was found to be metastatic. His family decided to withdraw all life support, so after tears, morphine and ativan, we stopped everything. And he lived... for hours. I stayed in the ICU until I heard the alarms and watched as his heart through the monitor as it went into torsades and then VFib and then flat line. I caught a glimpse of his face through the ICU doors as his family clustered around his broken body. What a life- and what chances we take as doctors to try and do the best for those people around us. We succeed and we fail. Today was the latter- and I hope he is in a better place now. I certainly learned a lot from this man- maximum resident experience. Time to sleep.