The Last Greatest Act

Midnight in an intensive care unit is not an easy time to find a vodka and orange juice. This was his request, or at least something that resembled it, and not an unreasonable request from a man facing down the last hours of his life. Far less demanding than the IV pumps beeping, the call bells ringing and the alarms of the ventilators causing nurses to rush in and out of rooms. Yes, this was an easy request from this gentle patient, Telling him I would do my best, I went to the break room to see what I could find. The offerings were pretty sparse. Graham crackers and a few stray packs of Saltines were tossed on the counter. A half dozen diet Shasta and one or two lemon-lime sodas were in the refrigerator. Generic Sprite, so to speak. That would have to do as a substitute for the vodka - at least it would have some fizz. I searched behind the sodas and brightly colored jellos, but no luck finding a carton of orange juice. They had probably all been taken at breakfast and would not be stocked again until the early morning. It was a skeleton crew working at night, when the cafeteria was closed and meal trays had come and gone and most in an ICU weren't eating and drinking anyway. There was one more place I could check and I quickly walked to the small staff kitchen on the other side of the unit. A pot of coffee from the start of the shift still warmed on the burner. The early eaters, those nurses that ate before 11 pm, had finished up and the late 1 am lunch crew would be making their way in soon. The room was empty, except for the man stocking sugar packets in the caddy by the sink. Pink, white, then yellow, he neatly stacked each one in its respective slot. I checked the refrigerator but there was only more Shasta, no juice of any kind, and closing the refrigerator door I commented on the difficulty of finding orange juice this time of night. He chuckled and continued stacking his packets. I turned to walk back to my side of the unit but his soft, low voice stopped me. He remembered something from earlier in his shift. He was pulling out expired milk cartons from the patient refrigerator in the pediatric ward and remembered seeing some orange juice. One carton, maybe two, pushed to the back. He was almost finished here and would go back down there and get me the orange juice. A kind gesture, and I told him the circumstances of the request. He understood, and would leave it in the staff refrigerator for me as soon as he could.

I saw him pass by when I went back to chart and check on my patients. His face was dark and worn. He moved slowly, with his body slightly bent to the right side, as he pushed the large dietary card through the automatic double doors that closed behind him. Another ordinary night on the graveyard shift for him except for the extra trip to retrieve orange juice.

I did not see him return but when I went back to the refrigerator, there it was, a carton of orange juice so cold that ice crystals had formed on the top. I filled a plastic cup with ice, the cold juice and just enough lemon-lime soda to give it some spunk. I proudly carried it into my patient's room and he and his wife started to laugh. She gently pulled the mask away from his face and I held the cold drink to his drying lips. The sips had to be short and quick, for more than a few seconds without oxygen caused his breathing to become labored. His lungs were damaged and scarred. There was no coming back from it, no chance for a transplant and no hope for improvement. The disease had progressed for years and now his quality of life was such that he could not be without the high pressure mask delivering continuous oxygen. He had made the decision that he did not want to live like this any longer. He had made his peace with it, as had his wife, and tonight would be the night he took the mask off for good. When he was ready.

For the next hour, I was in and out of his room and the wife and I took turns holding the mask or the drink for him. The drink seemed to relax him, almost as if it really did contain vodka. Perhaps it took him back to better times, dinners with friends, poolside drinks, or simply unwinding after a day of work. But for now, the last hours of his life, it was just them, and me, a stranger just hours before but now sharing the last delicate moments of a life. There would be no more research trials, no attempts at novel treatments or new medications. All his medication orders had been discontinued except for something he may need for pain or the air hunger that would ensue. The specialists had stopped coming by to review his latest CT scan with him. There were no more heroic measures to take. And yet....I knew the heroes that had been there that night. The man brave enough to choose when to end his fight. The woman with the grace to sit by his side until the very end. And the solitary figure stocking the break rooms all night. Nothing in his pathway from one floor to another would have stood out that night. But those slow steps had completed a journey, one that would grant a dying stranger his last request on this earth.

His call bell did not ring for me again. As morning broke, I gently pushed open his door. His wife was gone. The mask sat on his bedside table. A circle of water had formed under the plastic cup as the last cubes of ice melted away.