Nothing

It was the first time I had ever heard nothing -- the pin drop silence of stillness.

It was the first time I had ever felt cold -- a cold that makes you want to wrap up in sweaters. 

It was the first time I had witnessed an entire body reduced to a solitary purpose. 

It was the first time I had witnessed someone slowly and inevitably die in front of me.

I sat in front of him as he died. Everyone knew he would, it was just a matter of time. An infection ate away at his lungs, but it was too late to do anything about it*. He chose not to be intubated but wanted treatment, so the best we could do is force breaths into his airway through a mask.

Yesterday, he could talk. Today, he could not. Yesterday, he said he wanted to see his friend, Chip*, who was now en route. Today, he was slumped in his gurney and could not respond to his name or even pain.

I sat next to him as he died. Every breath he mustered was a monumental Sisyphean task. His oxygen saturation, a measure of how concentrated blood is with oxygen, dipped between breaths. His body was gasping for air and it was tired of doing so. Medications flowed through his IV line to make him as comfortable as possible. His lifespan was measured in minutes. 

Sitting in a chair next to his bed, I held his hand. It was deathly cold and unmoving. His body had clamped down its peripheral blood vessels to preserve cardiac and neural blood flow. If his lungs gave out, his entire body would be starved of oxygen, and his heart would shut down, quickly followed by his brain. His life hinged on a mask delivering volumes of air anytime he attempted to breathe in.

I sat with him as he died. I barely knew him, having assumed some responsibility over his care just two days prior. I filled in the details of his life through his diagnoses; chronic hepatitis C, history of IV drug abuse, schizophrenia, lives alone with his cat, has no friends save for Chip. It sounded rough and isolating. His oxygen saturation dipped lower. The minutes were ticking.

My eyes watered as I watched a man, once thriving, reduced to a simple ventilation mechanism. Memories of my grandfather dying, a death I was absent for, flooded me. I cried on the floor the night I had heard, curled up in a ball, as my grandfather withered 8,000 miles away. It had been years since, but it felt like yesterday in mortality's presence. It hurt.

It felt selfish to cry in front of this dying man whom I barely knew. It felt like I was using his death as a version of perverted self-therapy. I collected myself and started talking to him about things I thought he might like -- the fall was turning trees red, the Portland Timbers aren't performing so well, that Chip was on his way. God, Chip, please come soon. I was holding death's hand and telling it stories.

Chip arrived two hours later. Miraculously, the patient was still breathing. I offered Chip my seat and quickly stood outside the room, closing the windowed doors as I did. Since Chip would matter more than I ever would, I had little right to be in that room. I stood outside watching Chip say his last words. He would pull out his phone and show him photos. His friend would heave his entire chest in response.

Ten minutes later, he stopped breathing. He had waited until he could see Chip one last time before giving in. Chip looked at me, back to his friend, then back to me. 

I nodded. Chip cried.

We went in to do a final exam.

It was the first time I had ever heard nothing when I expected a heart beat.

It was the first time I had ever felt cold when I expected warmth. 

It was the first time I had witnessed a being reduced to biology.

It was the first time I had witnessed someone slowly and inevitably die in front of me, and, yet, somehow, hang on until just the right time.

*Names, circumstances, and other identifying details have been altered to preserve patient privacy.