The sleepy intern nodded, "It was okay for me, but Tom was busy. He's still in the crash room."

My spirits sank. Mondays in the emergency department are never easy, and starting one with a train wreck was not a good omen. I entered the crash room and reached for the chart, but Tom held it back. "You don't want to see that yet. It isn't pretty. Let's talk outside while you finish your coffee."

"Nineteen-year-old male found down ... Damn, the syringe was still in his vein! Intubated and transported in full arrest ... We got him back ... well, briefly. Triple pressors and still his systolic is only 60. He began to bleed from all his lines around 6:00 a.m., and the DIC screen is positive. It's not going to happen, man ... and you have no unit beds, again! He won't last long. I'll hang out and see this through if you want."

Soon I was busy with salvageable lives. Around 9:00, Tom told me it was over. "Listen, Rob, there's one detail left. His mom. She's driving down, and I guess she's stuck in traffic. I don't mind telling her, but I have got to get some sleep."

I did owe Tom, and this seemed trivial compared to the effort that he had expended. I didn't (and still don't) like this part of the job, but it comes with the territory. Besides, I reminded myself, several chaplains and nurses had complimented me on my "gentle style" with families. They seemed impressed with my attempts to explain complex topics in simple terms and with the time I spent answering any questions that a family might have.

It was about 10:00 a.m. when I saw the charge nurse lead a very anxious middle-aged woman to the "quiet room." This was where psychotic patients waited for the psychiatry resident and where we took families to break bad news. It was seldom quiet.

It was still early, and the room was eerily silent. As I mentally prepared my speech, I surveyed the familiar surroundings. What must they look like to this woman? The tan waterproof wallpaper was meant to be soothing, but it seemed only dreary. Directly opposite the door, an industrial white sink was firmly anchored to the wall. The furnishings had never been fashionable, even when installed 20 years earlier. The sofa and matching love seat were both covered in thick blue Naugahyde. These were the only moveable pieces in the place, and someone had carefully shoved them as far apart as the walls of the suffocating room allowed.

I drew a deep and dramatic breath. Before I began, she asked the only question she would ever direct to me. "He's dead, isn't he, Doctor?"

She didn't cry. She sniffed and dabbed the corners of her eyes. All the while she held her proper lady's posture, and her eyes never left my face.

"I'm sorry. Is there anybody I can call? No? Would you like me to explain what happened?" She did not interrupt as I recounted the tale that had been told to me just hours earlier. Her breathing was barely audible across the narrow but unbridged chasm that separated us.

The door opened. I turned to see which professional had arrived to help. It was the cleaning woman.

I stared in disbelief as she moved to the sink and began to wet a wash cloth. She sat down on the arm of the chair in which the mother was sitting. Murmuring quiet reassurances, she began to wipe the cool cloth across the mother's face.

It was as if the cloth were wiping away a mask. The more the cleaning woman wiped, the more the mother cried. Her quiet discipline was replaced by a flood of tears and sobs so deep that my soul ached.

"I just know he's not going to be with Jesus! Oh God, please give him another chance!"

"Just leave it in his hands, child," whispered the cleaning woman. "He's good, and he's just."

I sat impotently and watched. As her cries diminished, she began to regain her composure. For the next 20 minutes, the cleaning lady and I listened to her son's story.

There was little else to do. The necessary papers were produced and signed. As the mother walked out through the sliding glass doors, the charge nurse joined me. "Her life will never be the same," Chris murmured.

Neither would mine.