Death and Hope in the ICU

Sitting down, looking strangers in the eye, and talking about death is part of the poetry of critical care. I sheepishly explain to friends that this is something I crave, to reach out and smooth the waves of tragedy sweeping over a family. At first I thought that I had a talent for these discussions, that they were something others avoided that I could do. But that isn't quite right. In fact, these are opportunities for performance, and I seek them out like strong coffee or difficult procedures. I like to talk to people who are reforming their lives in front of my eyes, who need certain bits of information to piece together sense from chaos. I'm not empathetic—I don't suffer with them, but I watch closely, looking for clues to what they need, doling out the little packets of information that they can use to build a framework of understanding of the future. As in poetry, an economy of information is key, and you can't rush delivery.

Hopelessness is our great topic. I know that death can be a good answer to a bad life, and I understand better than most that too much money is spent on intensive care in the last days of life. But I'e also grown less trusting of certainty, and like others, I have fallen prey to a faith in numbers: How many people can walk away from a 5% chance …