In residency, a “while cloud” is someone who brings good luck to work – patients always get better, call days are never capped, and workflow goes smoothly. A “black cloud” is one who meets angry nurses, has terrible call days, patients keep crashing, and has general bad luck all around. These are all self perceived of course, but residents are superstitious folk.
I was a white cloud on MICU. No code blues for the whole team and no deaths on my side for my whole month … except for one, on my very last day.
Mr. M was the first patient I pre-rounded in my first day of MICU, and he passed on my very last day.
A young man in his late 40s with the bad luck of progressing heart and lung failure by genetics, his mind was completely untouched as he was dying. Right up to the end, he could sketch in his art book, surf on his iphone, and stroll about the unit, hooked up to life sustaining machines and medications.
He “felt great” despite his illness – asymptomatic, except for occasional shortness of breath. Over the month, I got to know him and his lovely family, who were full of hope he’d get out despite many dismal goals of care discussions.
He looked astonishingly well, but his oxygen support requirements and heart tests told us otherwise; he was tied to the ICU with 3 pressors to maintain his shock and fully depending on his oxygen mask, unable to be off more than 30 seconds without fainting. He could never leave the ICU.
And there comes a point where ‘life’ is no life at all, but how do you tell a dying young man who doesn’t feel like he’s dying at all that it’s his time?
Normally I talk to the family of dying patients about letting the patient pass away; but it’s rare to talk to those dying themselves that it’s time for you to let go. I can’t imagine more stressful decision in one’s life – when are you ready for death? – with your family waiting for your answer.
Several hours later, while I was in another patient’s family meeting discussing hospice care, I was paged multiple times in a row by Mr. M’s nurse requesting me to come urgently. After our discussion on his life that morning, Mr. M had chosen “it was time,”; his family and friends had come and gathered around him. His father insisted the we take a photo together on his ipad, and I stood next to his bed smiling in one of his last pictures.
Once the oxygen was off, he quickly passed peacefully.
And while it was truly for the best, it was a poignant feeling to pronounce my first death as a doctor on someone whom I had grown so attached to. Through her own tears, his sister joked, “Doctors aren’t supposed to cry,” but I couldn’t help it. It was so final to sign the official death certificate, when I had just sketched his in artbook with him a few days prior.
While I did enjoy MICU and matured a lot as a doctor, it was a demanding rotation – mentally, physically, and emotionally – and I’m relieved to be done and have some time to recharge. I’m sharing this Almond Banana Smoothie Bowl recipe – something quick, easy, and beautiful to prepare when you (or someone else) needs a quick pick me up.
Almond Banana Smoothie Bowl
2 small ripe bananas, frozen
2 cups almond milk
1 cup ice
1/2 cup roasted almonds
toppings: blueberries, cacao nibs, banana slices, almonds
Cut the frozen bananas into thirds to make blending easier. In a blender, blend the bananas, almond milk, ice, and almonds until smooth. Adjust ingredient ratio to desired consistency.
Pour your almond banana smoothie into a small bowl. Top with blueberries, cacao nibs, banana slices, almonds. Enjoy!
The ICU is such a tough place, especially when a young and mentally sharp patient passes away. Makes life seems so cruel. Hope you feel better, sounds like you were a wonderful addition to his journey. Yummy smoothie, I have not tried cacao nibs, but heard they are healthier than chocolate chips!
What an incredible story. Thanks so much for sharing…gives lots to be grateful for. I've pinned the bowl to my healthy snacks board.
What a powerful story, thanks for sharing:)
Wow, what a moving story. Thank you for sharing it, and this wonderful recipe.
I never wanted to be a doctor for fear that I would have to watch someone die. You are so brave and caring! On the high note, that smoothie bowl looks absolutely delicious. I am looking forward to trying it out!
What a sad story =/ Cheers to Mr. M
Wow! What a story!
How sad. 🙁
Oh dear. When you shared that little snippet on IG I didn't realize he was so young 🙁 You have a hard job there hun, but continue to be a white cloud! And yes, this smoothie bowl is just the thing to make you feel better (I hope you do!)
fab looking smoothie bowl. what a sad story
Your pics are so nice & I'm sure the bowl's delicious!!
An incredibly moving stru thanks for sharing. Looks like a delicious snack
This sounds creamy and delicious. I would add cinnamon to mine and maybe a 1/2 of vanilla. I love how pretty the bowl looks!
I love what someone said about adding cinnamon and vanilla….all of this sounds yummy!
how heartbreaking. i'm not sure i could endure it and i appreciate you for taking it on!
what a simple yet flavorful dish. awfully pretty too!
This looks amazing. I need to make more time to make breakfast a priority.
Wow, I have so much respect! That sort of job must require a lot of emotional stamina. And the recipe looks great!
This is going to be delicious. Can't wait to make it.
This looks so divine! Adding to my meal prep list for next week! Thanks!
A lovely post and a beautiful smoothie bowl. Most of us docs remember the first time we had to pronounce a patient. For me, it was a patient in the ER whom I had never met before. You had the good fortune of having a relationship with your patient, although in the end, that surely made it so much tougher. Residency is a roller coaster ride but hopefully your white cloud days will far outnumber the black ones 🙂
This smoothie bowl looks delicious. It would make a perfect healthy dessert or evening snack. I'm definitely going to be making this soon!
This was a good read. I have been seeing more and more smoothie bowls lately. I keep saying I will make one! -breyona sharpnack
Yes they're much less sweet! You'd love them. Hope the rest of medical school goes well for you – it's tough but rewarding, both the good and bad
Thanks for the pin and glad you enjoyed the story
Thank you for reading it!
Thanks for stopping by to read it and see the recipe
It's really surreal when you see it happen and makes you think about life when you know you'll go through it too one day
Cheers, indeed :/
Thank you for stopping by. Yeah, it's always sad when they're young – why I couldn't do pediatric ICU
it was a great pick me up snack
that's a great idea – those are winning flavors to any bowl
agree with the additions 🙂
Thanks Grace. They say you build up an armor in residency
I can't last the morning without breakfast!
It definitely requires emotional stamina indeed. Having good food helps the stamina overall too 🙂
Hope you enjoy!
Enjoy it! It's delicious
Thanks Sonali. The ER is a totally different world from internal medicine but the very first death I saw (as a 2nd year med student) was in the ER shock room, so y'all are definitely in the front lines
It's a good snack for New Years resolutions
I'm glad you enjoyed the story. My hope is to have readers see the physician side when they're in the hospital
nice recipe but quite a sad story I'm not sure I'll b able to make a decision like that. I imagine for you it will not get easier as every life is precious but maybe you will better be able to cope outwardly. thanks for sharing.
they say as time goes on accepting death gets easier – it's a delicate balance to maintain humanity without letting it overwhelm your wellness / burn out