I was a 2nd year resident in Idaho and barely able to put one foot in front of another for the 3rd night in a row on ICU call. I took care of Leo that night.
An older Indian couple (in southeast Idaho, the Indians were mostly Shoshone but they called themselves Indians not “native Americans”) had anxiously brought him to the ER in late afternoon. After the initial ER flurry to bring his O2 sat over 88% (which is mostly acceptable at altitude in Idaho) he was deemed stable enough to go to the floor. His friends wanted to stay with him until visiting hours were over but Leo insisted that they go home and take care of his little dog, Shorty. They left and promised to see him in the morning.
Leo was stable all evening and since there was a lull in my busyness I had sat and listened to his story . He had been a sailor and a ranch hand and then a drunk. He told me how he had been freed from his hard-drinking days and loneliness by the love of this Indian couple. They had helped him get sober and had taken him into their home to live for the last 5 years as a brother. He had a Bible on his bedside table and from it he produced a rumpled photo of Shorty – a wired-haired dachshund with an overbite and cataracts. He fell silent and it was obvious that he treasured both the Bible and Shorty. He drifted off to an agitated sleep and I placed the Bible and picture back on the bedside table so he wouldn’t drool on them. I got paged and left.
Sometime later Leo started crumping and I was called back to his room. As I was drawing a blood gas he told me he didn’t want to be intubated. For several more hours the floor nurses worked with him but finally, when the O2 was consistently 85% or lower they paged me and requested I do something.
I came back to his room and saw the rough skinned, slightly jaundiced, balding white guy with grey lips sitting upright in the bed smiling but struggling for each breath. “Hey doc!” The Bible and photo were in his lap. We had our discussion about going to the ICU and what could be done short of intubation. Agitated, he agreed to bipap in the ICU and I began the transfer process. After finishing up the orders, I went in his ICU room to “tuck him in for the night.” He grabbed my hand and lifted the bipap mask to speak to me. “My, gasp, Bible, gasp, is still, gasp, downstairs. Bring it to me?” I didn’t think lips could be more grey in a living person. I squeezed his hand and said I would look.
Several admissions, multiple diet cokes and 2 or 3 swigs of Maalox later, I remembered the Bible. The floor nurses had found it and so I carried it up the stairs noting it seemed well-read with a shabby brown cover that smelled of dog. I placed it in his lap and while he wasn’t really awake, he immediately grasped it in his hands. I left and collapsed in the call room down the hall.
At 5 a.m. I came to sudden consciousness and realized I had missed several pages. Terror jolted me out of bed and down to Leo’s room. He was dead. His Bible was clutched to his chest and they had removed the bipap mask because his friends were on their way in. Leo had been the only ICU patient that night. Because he was a “DNR” there was not much the nurses, Connie and John, could do for him so they had just sat quietly with him during the final hours of his struggle.
When I entered his room they told me of his passing. All had been quiet and he seemed to be slipping away when suddenly, with an O2 sat of 79-ish Leo had opened his eyes. Both nurses had gotten up as he removed his bipap mask and said clearly “Do you see them?” Connie and John said they had tried to put the mask back on but he pushed their hands away and pointed to the corner of the room and said again more excitedly, “Do you see them?” The nurses looked at the empty corner of the room and said, “No, Leo, we don’t. What do you see?” No longer gasping or struggling to breathe he hugged his Bible closer to his chest, eyes fixated on the corner of the room for several intense seconds. “They are absolutely beautiful!” he said to them. ” And it’s so bright!” He smiled and died.
Connie was LDS, John a Lutheran and I was an atheist. Standing in the room over his body in the dim light that morning, the three of us were silent and still, thinking our private thoughts on the matter. Finally, Connie said, “I know he saw angels.” John answered, “He certainly saw something that was glorious to him.” They squeezed Leo’s hands and went to the nurses station. The hairs on my body tingled and shivered electrically. I said nothing, patted his balding head affectionately and slowly left the room with the niggling idea that perhaps I was wrong.