Her name was Grace
This was a real patient, but some details (including her name) have been changed.
"Grace" was a petite 59 year old woman with a past medical history significant only for breast cancer. Until her diagnosis fifteen years ago she had lived a very healthy life. She was treated into remission with an aggressive combination of radiation, chemotherapy, and surgery. In the intervening time she raised her daughter, re-married, and traveled the world.
A year before I met her she began to tire easily and began losing weight. Her clothes stopped fitting. Her food lost its taste. Her doctor gave her the news which, by this point, she already knew: her cancer was back, this time metastatic. Her oncology team re-initiated treatment, which slowed the cancer but couldn't stop it.
Six months before we met, fluid gathered around her heart, and she came to the hospital to have it drained. Two months before, it happened again -- and that episode sent her to the emergency room. A surgical team placed a tube to drain the fluid. She was transferred to the Cardiac ICU, which is where we met. She was my first patient on the rotation.
She made great progress during her first four days with us. The cardiac surgeons were satisfied with their work and planned to pull the drain. When I left on a Thursday evening, we expected to transfer her to a step-down unit. When I told her this, she said that she'd miss us. I told her that I'd miss her too.
That night she experienced an arrhythmia which progressed into cardiac arrest. She was resuscitated after defibrillation, epinephrine, and several minutes of CPR. When I saw her on Friday morning, she was intubated, being ventilated, but coming off sedation. She was following commands. She could still recognize me, I think.
We had a long talk with her husband and daughter that day. They had been optimistic, perhaps unrealistically so (for her sake) but her cardiac arrest had brought the reality of her condition into sharp relief. When Grace was extubated, the three decided together: this would be her last hospitalization. She wanted to preserve some quality of life.
Over the subsequent days she was moved to one of the general medicine wards, and I lost track of her. Ultimately she was discharged to hospice care. I learned of her death several weeks later.
I'm not sure why I remember Grace so well. Maybe because she was the only patient on the unit who was alert enough to talk to me. Each morning, stepping into her hospital room was like stepping into her living room. We'd have a conversation after I'd asked about her symptoms but before I completed my physical exam. I'd ask her about her night; she would tell me to take a seat and ask the same. She told me that she was the middle child of seven siblings from a large Catholic family. She had one daughter, of whom she was immensely proud. She told me about her husband, and what a faithful caretaker he had been. She was not afraid to die, but she was worried about how her death would affect them both.
I also remember that she was rarely alone. There was always a sister, or a brother, or a nephew, or a niece. She was very blessed to have so many people who loved her. Everyone should have the same, at the end.