Little Orphant Annie’s Come to Our Unit to Stay

By: Iain Drew, MD

He had a first name the MICU used with reverence, rather than the usual surname or room number that is often used in passing. He always made jokes. He always made others feel at ease. He advocated for his care and insisted on being informed. He directed his health, all the way to the end. 

Maxed out on high flow oxygen, weak, pale, exhausted, and seemingly more life exuded from his body with every heave. When asked what he wants out of his remaining time he replies he wants a million dollars. Me too, actually. He wanted to make it to the election. He wanted to earn a living and provide for himself and his family. Then, the facts were made clear: that he was not going to survive without a ventilator, that even with mechanical ventilation the large tumor that had eroded his lung made infection more hospitable and increased the risk of sepsis, respiratory failure, and shock. Ultimately,  there was nothing we could do about it. Even palliative radiation was days away and despite this, we would not save him from this fate.

But he wanted a chance. He didn’t want these minutes to be his last. Even with all the pain and suffering that would ensue, he desperately wanted  hope and still had the capacity and right to make that difficult decision. 

With operators working about, sound echoing through his room, motion filling his space, his affect turned to fright as though he had come to the realization that these moments may be his last. That nothing comes after this. Trepidation likely filled his head, I go to sleep and then what? Such terror. The residents sensed this – it was imminently palpable. 

“Sir, we’re very worried you will not survive this. This is the time. This is the time to connect with those you love.” 

We guided the phone into his shaking hands. 

“Your son?” 

“No, I haven’t remained connected to him during this time.” 

“Your wife?” 

“Yes, she’s my partner, not my wife, but yes okay.” 

He pulled her up on his phone and the contact read Picasso. A story I will never learn. 

“They’re putting a tube down my throat. I may never wake up. I’ll talk to you soon, or I may not. I want you to know that I love you.”

In the silence that followed, filled with the deafening shuffle of tasks in preparation of intubation, we stood by him. 

“Do you have a favorite song? No. A favorite band?” 

“No. But I do have a favorite poem.” 

“Really? Which poem?” 

“Little Orphan Annie.”

The nonrebreather went over his face – pre-oxygenation. A brief grimace. 

“Can you tell it to us?” 

Pushing through his breathlessness, he began.

“Little Orphant Annie’s come to our house to stay,

An’ wash the cups an’ saucers up, an’ brush the crumbs away,

An’ shoo the chickens off the porch, an’ dust the hearth, an’ sweep,

An’ make the fire, an’ bake the bread, an’ earn her board-an’-keep;

An’ all us other childern, when the supper things is done,

We set around the kitchen fire an’ has the mostest fun

A-list’nin’ to the witch-tales ‘at Annie tells about,

An’ the Gobble-uns ‘at gits you

             Ef you

                Don’t

                   Watch

                      Out!”

We applaud and thank him, washed with the sincerity of the situation. Silence ensues, as the deafening shuffle of tasks continues. He flips the television remote, searching for comfort, for distraction, perhaps for control.  

“What do you want to watch? Saturday football?” 

Oh yes. We remember that it is Saturday. 

“Arizona?” 

“What do you take me for?” 

“What’s your team?” 

“Purdue.” 

We flip through without success of pinpointing the black and gold, and ultimately settle on ESPN basketball highlights. 

Then, unexpectedly and inexplicably, the television begins flipping channels. One after the other, so fast the screen remains black, then white, then black. Is he leaning on the remote? No. The television is doing it on its own. Like an incarnation of his racing thoughts, mind flipping so quickly it is unable to focus on one thing, inundated. We manage to turn it off and turn it back on again, it appears: Purdue. We cheer, the nurses join in. His eyes don’t leave the screen. Grasping. Living. Finally, our fellow says, “okay sir, we’re going to give you medicine to go to sleep.”

“Well, it’s about time,” he replies.

Iain is a current PGY-3 in Internal Medicine at OHSU. Initially from Boston, MA, he has found a home in Portland, OR and plans to establish his career here as a Hospitalist. When not in the hospital, he loves spending time with his young niece, making art, and adventures outside.