Perhaps I have a strange appreciation for the
beauty which exists in darkness. I see miracles where others don't,
and if that makes me a little bit weird, oh well. This is my story of
Christmas miracles. (The story is based on real experiences, but all details have been fictionalized to protect patient privacy.)
It was Christmas day, exactly one year ago. I was working as a nurse, and it was my very first day on my own in the Intensive Care Unit. I just finished three months of training in critical care, so I had been preparing for this day. I was nervous, excited, and happy to be finally taking on full responsibility for these critically ill patients.
The day began as this story begins: with birth. I stepped on to the elevator, as I do every morning. Following me on to the elevator was an attractive young couple who must have been in their early twenties. The woman was quite visibly pregnant.
“How wonderful,” I thought to myself. “It looks like they are having a Christmas baby! What an amazing gift for the holiday.”
As I looked closer, however, it seemed strange that the woman was standing comfortably and not revealing any signs of labor. “She doesn't look like she's about to have a baby,” I thought as I began to imagine this couple's story in my head. (An elevator ride is an excellent time to think up stories about my fellow passengers.)
They didn't press the button for the labor and delivery floor, so now I knew something was out of the ordinary. Instead, they got off the elevator early and we parted ways. “Well, they must be visiting someone who is sick,” I concluded.
I continued the elevator ride to my floor and soon clocked in for work. Upon arrival to the unit, I got the news that I would be admitting a young man who had arrived to the Emergency Department with a severe cardiac arrhythmia. “He will be coming to the unit in about 30 minutes,” I was told.
The second part of the story begins here: with sickness. The man arrived on my floor. His youthful adventures had finally caught up to him, leaving him now vulnerable and naked under a thin hospital gown in a lumpy old hospital bed. He had come to town on a holiday vacation. He had never had any obvious health problems before, and these frightening symptoms had caught him and his family all by surprise. Perhaps you might imagine waking up early on Christmas morning to chest palpitations, and profuse sweating.
It wasn't long before his family started trickling in to visit. This moderate sized crowd had been patiently sitting in the waiting room. As I looked, I was startled to see before me the young couple from the elevator. Their radiant youth, an image of fertility, stood in contrast to the sterile and quiet halls of the ICU. They entered my patient's room and shared their love with him, confirming the stories I had made up in the elevator. They were indeed there to visit someone who was sick.
As that patient was settled, the next part of the story begins: with aging. I walked across the hall to return to the other patient in my assignment. This was an older woman who had been found at home unresponsive. The quick response of paramedics had kept this woman from dying, but she was old and her brain function was simply not going to recover. After many days of following the top protocol, she was still not showing any signs of improvement. An MRI showed diffuse damage to the tissue of her brain, and it was time for the family to make a decision.
Her husband would be making the final decisions regarding any plan of care. They had been married for 52 years, and he had spent every day at the hospital since his wife had arrived. He sat with her and prayed, and sometimes begged her to wake up. After he arrived on this particular morning, the doctors sat him down and gave him the very real and very unfortunate prognosis. Her chance of recovering to any meaningful level of health was almost zero. We had tried weaning her off of the mechanical ventilator, but she did not tolerate it. The machine would be necessary to keep her alive.
We sat in silence, as he absorbed the news. He was calm as he gave it thought. Then he began to explain, “You see, today is a sort of anniversary for us. It's Christmas. I just think... well, if we could just keep her comfortable for two more days, then I'd be ready to say goodbye. I just don't want her to die today. Not today.”
“Unfortunately,” the doctor compassionately explained, “we can't keep her alive and also keep her comfortable. The tube in her throat is uncomfortable, the machine is forcing air into her lungs. If you want her to be comfortable, or if you want her to stay alive, those are two different goals. It is your decision what to do, and we will support you with whatever you decide. It's ok if you want to take some time to think about it.” He took his time, he talked with the rest of the family, and within a few hours he had made a decision.
The final part of this Christmas story now begins here: with death. The decision was made to withdraw care and provide only what treatment was necessary to make this patient comfortable as she passed. As the afternoon grew late, I began the morphine drip, giving time for it to circulate through her system and ease any possible pain that her brain could still register. Soon after that, we pulled the breathing tube from her throat and removed the last devices of life support. She was on her own, to breath or not breath as her body could tolerate. She gasped for air, and her gasps were eerily similar to the first gasps of a newborn still drenched in the fluids of it's birth. These dying gasps continued, and just as a baby grows stronger with each gasp, this woman grew only weaker.
The family prayed, and spoke gently to her. The husband grabbed her hand and reminded her: “remember this day? This is the day I proposed to you.” The memory seemed as though it was still crisp in his mind, as though he was talking to the young woman he once loved while looking into the eyes of his aged and dying wife.
She passed peacefully soon after that. The family said their goodbyes and it was over. His final Christmas gift to her was to comfort her as she died. Their gift to me was to allow me into such a vulnerable and touching moment in their lives.
I was new to the ICU, and although I had seen patients die before, this was the first time in which the family officially made the decision to withdraw care. It was a first which I will remember for the rest of my life.
Working in the ICU, I am often confronted with the cost of dying. There are the monetary costs: more than $50 Billion dollars each year paid by Medicare on doctor and hospital bills for the last two months of patients' lives. A stay in the ICU alone can cost over $10,000 a day.
But, there are other costs as well. Had the family continued with full treatment for this patient, she would have eventually started to decline. Perhaps an infection would start, or her breathing would worsen. Her skin would begin to break down. The delicate balance of life would become harder to maintain. More medicines would be needed, more forms of life support. It would have only prolonged the inevitable.
Being human, we are inescapably bound to these four stages of life: birth, sickness, aging, and death. People recognize birth as a miracle. It is easy to imagine the maternity ward on Christmas day, so full of smiles and so full of love. Birth is the beginning of life, but life also ends with death. Birth and death do not exist without each other. This is the miracle which I will honor this Christmas, not just birth, but the entire cycle from birth to death. Life is what gives us this brief and momentary glimpse into the great mystery of being human. We awaken into the world to explore, to discover, to participate and to stand in awe. Then, our eyes close shut one final time. This brief glimpse ends.
For me, it was a miracle to be a part of these people's lives on Christmas. For me, it was a gift, and a blessing. Amid the awareness of death, the experience itself was so fully alive.
I feel grateful, and in gratitude I share this Christmas tale with you. This is for you who are also basking in the mystery of it all and embracing the inevitable. This is for you who do not run from our nature, but love it even when it hurts. This is for you who value truth, and honesty, and realness in a world which often encourages denial.
Even if you don't celebrate Christmas, well, Merry Christmas nonetheless. May you appreciate this miracle of life, death, and the whole human experience.
From me to you this Christmas.
“Just as mountains of solid rock,
Massive, reaching to the sky,
Might draw together from all sides,
Crushing all in the four quarters—
So aging and death come
Rolling over living beings“
- The Buddha
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