February 2009 Archives

The trees in front of the hospital were filled with crows.

Shifting, flapping black shapes huddled on the bare branches, silhouetted against the glowing blue of a winter pre-dawn. There must have been hundreds, weighing down the branches, their harsh cries shattering the silence. Cries, crying, crying.

I walked out of the hospital parking lot that cold sunday morning and stopped short in the middle of the street when I realized that all of the crows in the city seemed to be converging at the entrance to the hospital. No one else was around. No cars. My breath curled in little clouds in front of me. It was just starting to get light - that beautiful light when black transforms itself into blue just above the horizon. The TCF bank tower flashed "6 degrees." I walked past the restless, cacophonous trees and into the hospital.

A few hours later, I found myself in the burn unit, touching the distorted face of a dying man, saying "its ok, its ok." I had given the order to stop the blood pressure medications that were keeping him alive, and remove the endotracheal tube that was connecting him to the ventilator. I had given the order to let this man die. And he died. His organs had failed, he was bleeding internally, his skin had been completely degraded, and the phrase "medical futility" had been scattered through his hospital chart for days. Futile. That complicated, heavy word. The simple answer: discontinue. We discontinued. And he took his last deep slow gasping breaths - breaths originating from the most ancient part of the brainstem, disconnected from all consciousness. He ceased to continue. He was surrounded by sterile strangers, in a cold city, with crows filling the trees outside.

Two of my patients died that day.

The crows were beautiful against the sky.