– Intensivist on shift: “Prepare a bed to put a patient a BiPAP with acute lung edema”.

At the beggining, it was not a complicated admittance.

After the anguish of the first moments, the patient had very good response and could withdraw respiratory support. It is then when I return to explore him and an interview begins, asking about history and symptomatology of previous days. It becomes a conversation, and I realize, that a medical history, it is the story of a life.

There is a special feeling with that patient, an old and serene man, affectionate, with a great sense of humor. He makes entering his box as take a break, a chat between friends. I feel satisfied, everything goes well.

In a few hours, everything becomes complicated.

That calm atmosphere in his box has dissapeared: Coming into and out, BiPAP, catheters, echocardiography. The mitral valve is broken. Acute heart failure. Phonecalls, preparations…

I try to keep approaching him with the same calm that hours before, when we talked of life and family, his small garden. I try to keep smiling while I explain that things are not going well, the need of sedation and intubation to assist him. But he notes the lump in my throat, and then he stares and tells me:

“Doctor, if I die, I don’t want you to worry, I know you have done everything to help me.”

What amazing courage, what dignity, that generosity in thinking about the feelings of an unknown woman when your life escapes in each breath. At that time I replied: “I don’t want to talk about that”. I think my answer is not correct. That is not my time, because his time is. I have also to be generous, take his hand, look him in the eyes and I say with a smile: “José, let’s fight together, we are going to do everything”.

Fentanil, midazolam. He closed his eyes serene, in peace.

Then, you can imagine, intubation, mechanical ventilation, intraaortic balloon pump counterpulsation, transfer to another hospital for emergency surgery. “I wish you have luck”, I thought.

Two days later, walking down the street, I read in a wall. I come back to read several times. Jose, named black print on white paper, with a simple cross leading the note and with the dreaded acronym R.I.P in the footnote.

I took a deep breath and I kept walking. Tears of shame, of emotion.

What a great lesson of generosity has given to me, José!.

You must be always generous with word, with the eyes, with a smile.

The crying intensivist