Mind the Gap

Sometimes what goes unsaid matters most

This post is a poem I wrote several months ago. It’s not about a specific patient, but an amalgamation of people I’ve met over the course of my career. It’s also not how I feel all the time in the ICU. Perhaps it’s telling that I wrote it in winter in Pittsburgh, when light can be fleeting, and dark nights are long.

Mind the Gap

We stood in the hallway outside his room.
You asked me about the sodium,
and the white blood cell count.
But I did not say
he’s dying.

We discussed the culture results,
the bacteria growing in him,
and antibiotic selection.
But I did not say
he’s dying.

I was told you had heard it before.
We told you he was dying,
or I thought we did.
What did you
hear?

I rationalized my vasopressor choices,
and I explained in each one of
the ventilator settings.
But I did not say
he’s dying.

You told me you wanted to hear about all the options,
but only the hopeful ones. No bad news.
You knew he would recover.
So, I did not say
he’s dying.

I hold hope, too, tempered by years in the ICU. I hope that beneath the questions,
behind the medical minutiae, implicit in the detailed notes written
out in perfect print on your notepad, you see what I see.
Your notes and questions, they cannot save him.
Neither can our medicines or machines.
I hope you know what we do.
He is dying.

His body, it is tired.
Burning out.
As am I.
I am exhausted in silence.
He is your brother, father, husband, son.
And he is dying.
But I do not say it.