In the ICU, it is sometimes easy to forget that we are dealing with people. There are tubes and machines and alarms, and somewhere in all of this is a human who can't talk, can't move, and can't proclaim to us their humanity.
I had a patient during my residency who was in such a predicament. She was without any family or friends. She had no visitors. She was in severe septic shock from pneumonia, unconscious and barely clinging to life. Her legal guardian told us, "If there is any chance of recovery, you should proceed. If it is futile, then stop."
Futile? Who's to say what is futile? Is futile a 5% chance of survival? Is it 1%? Is it 10% but with permanent, neurologic damage? We settled on some criteria and proceeded. If she showed any improvement, we would continue aggressive measures.
She only worsened. Each day I came to the hospital hoping for some sign, but every day was worse than before. Finally, the day came where we all agreed her care was futile. That day happened to be her birthday.
There was no one there to celebrate or wish her well, no cards or decorations. The nurses got some cake from the cafeteria, and we sang happy birthday. Then I wrote the orders, the nurses turned off the vent and pressors, and I closed her eyes and declared her dead.
That afternoon spent with the nurses was such a special moment. Without friends of family or anyone to mourn, we took a minute to celebrate her life, even as it ended. Because being a doctor means never forgetting that life is beautiful, and although no one else treasured this life, we did.