By Alvin Tng
Year Three Internal Medicine Resident
SingHealth Residency

I first met you that Sunday night.   You arrived in the ICU on a hospital trolley, motionless.   The ICU staff moved like clockwork - transferring, cleaning, dressing - all that time you kept your eyes closed. My penlight peered in, but there was no one home. 

Your wife peered anxiously through the ICU room glass door.   When the door finally opened she rushed in with your elderly parents in tow. 

Your mother grabbed your motionless hand, willing you to open your eyes at the sound of her voice.   Your silver-haired father caressed your forehead in the gentle gesture that only all parents could do. 

I stepped out. 

Your wife followed me out, her eyes looking at me with that single unspoken question.   I dispensed with the formalities. 

"I'm sorry;  the situation doesn't look very good.   The scan shows signs of irreversible brain damage due to lack of oxygen.   The chances of him waking up are very slim."

A tear drop rolled down the side of her cheek.   "Was it because my CPR was wrong?   Or was I not good enough?" she quivered. 

They always start by blaming themselves. I reached for a tissue.   "You couldn't have avoided this situation.   The choking was an accident.   You really tried your best, which was important. In fact,  your CPR was probably the only thing keeping his heart alive until the ambulance came." 

The next few days must have passed in a blur for your family.   The flood of visitors didn’t seem to abate.   Your wife put on a brave front as she handled the questions and concern from your well-wishers.

"What would you want if you could have decided for yourself?"

In the end, we sat down for our final family conference.   Your sister sat with your wife, who seemed decidedly smaller and more withdrawn.   Your parents couldn't bear to sit in to hear the bad news. I couldn’t blame them.

So we began.   Nothing we learnt from medical school can ever fully prepare a doctor for this.   My heart went out to your family.   There was no stopping the tears.  

Their minds were in a state of confusion.   They were sad, shocked, guilty and clueless at what to do with your care.

You left no previous indications.   No preferences.   No discussions.   No will. 

A young man in the prime of your life working on your career and family, the thought of death never crossing your mind.   What would you want if you could have decided for yourself?

In the end, your family knew you best.   On that fateful Saturday afternoon, we removed your breathing tube.   Your closest family was with you at your side. 

I left, being post-call and all, but a small part of me probably didn’t want to face up to your imminent passing.   It has been a privilege to journey with your family in your final days.  I hope that they will live their days in peace. 


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