I was on call in the intensive care unit on the day that my grandfather died.
That morning on rounds, our team had snaked slowly down the narrow hallway, a close-quartered caravan of clattering computer carts and clacking keys. We rattled to a halt at closed door after closed door, treating COVID after COVID after COVID. It was before the vaccines—before we had much hope for anyone who got sick enough to end up in our unit. After months of monotony, the routine had gone from morbid to mundane.
The nurse gave the vital signs. The resident reported the labs. The pharmacist read the medications. The intern stumbled through a plan.
The kidneys were always failing. The blood pressure was always falling. And everyone was always dying.
To add some levity to the proceedings, our attending physician had proposed a quiz game: every patient got a question, and every question got a point. All around me, dull eyes sharpened behind plastic goggles, gloved fingers tensing in anticipation.
It kept up morale. It kept us moving.
After lunch, we had a teaching session on breaking bad news. Five minutes in, I got a call from my grandfather’s urologist. He’d had a heart attack, and then a cardiac arrest. And now he was bleeding into his bladder.
“Is it operable?”
The urologist was kind—kind enough to spare my feelings, but too kind to conceal the truth.
“No,” he said. “It’s too high-risk to operate so soon after his arrest, especially now that he’s got stents in from his heart attack.” After some hesitation, he added: “You’re a doctor, right? Internal medicine?”
“Yes,” I replied mechanically. And then, returning doggedly to the point at hand, “You say the bleeding might tamponade off, right? Stop by itself?”
“Maybe.”
I understood his tone. I’d used it enough times myself, whenever I wanted to temper hope. The tight bands that had formed around my chest began to contract, squeezing the air out of my ribcage.
“It’s looking really bad, isn’t it?”
“Well.” The urologist paused. “You’d really get a better answer from the intensivists about that. Things could look up. Things could get better after his heart recovers.” He paused again. I could almost picture him weighing his words on the other end of the line. Maybe fidgeting with the phone cord. Maybe taking a steadying breath. “But last I saw him, he had a really low blood pressure, and they were having trouble with his dialysis. So…I don’t know.” He trailed off.
I thanked him and hung up the call. I’d never known my brain to be so silent. The ceaseless buzz of background tasks—the reminders of unfulfilled follow-up items from rounds, the casual cataloguing of the sights and sounds of the busy unit around me—had completely subsided. Even the continuous hum of music that habitually filled the space between my every thought had abruptly shut off. The emptiness was oppressive. My feet, at a loss for conscious input, stumbled me back into the teaching room.
“There you are.” My attending smiled at my return, not registering the blankness of my expression or my trembling gait. “We were just talking about how to approach the topic of death with a grieving family member.”
My legs carried me to a chair and I collapsed into it. I could feel them shaking against the seat.
“It’s important to use the word death—or dead—when giving them the news,” she continued. “Euphem-isms like ‘passed away’ can sometimes muddy the message, preventing the relative from absorbing the reality of the loss.”
I felt myself nodding, an automaton of an attentive student. And then the emptiness overtook me again.
It was all over before my call shift had even ended. My grandfather’s bedside nurse had braced me, as best he could, for the inevitability of the news that would meet me in the morning from a thousand miles away. His dialysis line—his tenuous tether to life—had clotted off. He was bleeding out from his bladder, and his blood pressure was low enough to starve his brain. His nurse didn’t have to tell me that this wasn’t what my grandfather would have wanted. I already knew.
“You know, he asked me, years ago, how long he would live once he started dialysis,” I told the nurse, my fingers flattening and re-crumpling the wrapper of the Twix bar beside me, the only dinner I had managed that night. “What kind of life he would have once his kidneys had failed. He was tired of it. Tired of it even then.”
“He’s been through so much,” he replied, kindly. Kind. They were all so kind. “And we can do so much to make sure that he is peaceful, in the end.”
“I know.” My eyes began to overflow, spattering large, cold drops onto the thin sheets of the call room bed. “Thank you.” I didn’t want the call to end, but I didn’t have a reason to keep him any longer. “Goodbye for now.”
The hunger didn’t hit me until hours after I’d received the final, confirmatory call. I had lain motionless on my mattress until the early afternoon, my discarded boots trickling sludge at the foot of my bed, hair still damp from the swirling snow I’d encountered on my way home. I’d been thinking about the afternoons I had visited my grandparents after school. I would be greeted at the kitchen entryway by a pickle—sour, never salty—and something sweet my grandmother had smuggled away. And always, before I’d even had the chance to put down my bag, I’d been offered the same snack. Khleb s maslom i ikroy. Bread and butter and caviar.
“Isn’t caviar expensive?” I had often asked my grandfather, as the little translucent orange spheres burst beneath my tongue and soaked into the soft, buttered bread.
“Yes,” he would reply, a smile playing at the corners of his mouth. “Nu i chto? So what? I want to have something nice for you to eat. Although,” he admitted, never one to exaggerate, “it’s not like it’s black caviar. I’ll wait for you to become a doctor and buy me that.”
I’d never bought the caviar myself. It had always been his special treat, the food I associated with visiting his apartment. But suddenly I was seven again, and I was salivating at the mere memory of that sea-salted smell.
I scoured the websites of every store within delivery distance. Nothing seemed quite right. There was pitch-dark caviar that would have put a heavy strain on my resident salary, and amber caviar that looked more like mustard grains. I finally settled on a crimson color from the Russian store that I thought might be lighter in the flesh. When it arrived, I ripped the small container from the plastic bag and readied the slice of white bread. I knew it was wrong before I had even begun to layer it onto the wedges of yellow butter. The eggs were small, much smaller than I remembered, blending together in a bright red sheen. My first anxious, impatient bites bore no resemblance to the weekday afternoons I sat perched at the knobby wooden table beside my grandmother’s china cabinet. The tears began to flow again, soaking the rough slab with even more salt. I cast it aside furiously and ate nothing the rest of the day.
I walked into my weekend call shift with the same robotic sense of duty that had carried me back into my lecture. The ventilators, whose steady hum had become a source of comfort and stability amid the chaos of the ICU, now cast menacing shadows over the lives they sustained. My grandfather had been attached to one, just hours before. His lungs had been expanded and deflated the same way. His veins had trickled with the same steady drip of medication. He had lain just as motionless and unaware as every paralyzed patient before me.
Person—I realized. Not patient. Person.
My attending began the quiz game again. For once, I didn’t have the heart to play.
Close to midnight, I was paged to see a woman in respiratory distress on the oncology floor. She was in her early forties, receiving chemotherapy for a newly diagnosed cancer. When I arrived at her bedside, she was already being placed on high-concentration oxygen, and her face was slick with sweat.
“I don’t—know—why—this is happening,” she gasped, one hand grasping mine as the other steadied her mask. “It—came on—all—of a sudden.”
She had a high fever, and her bloodwork blared red on the computer screen beside me. She was developing sepsis—a severe, life-threatening infection—and her chest X-ray already showed all the early telltale signs of impending respiratory failure.
“Anna,” I said softly, swallowing hard against the banging of my heart in my throat, “Anna, we need to take you to the ICU. You have an infection, and your lungs are very inflamed.”
“She needs to be tubed,” my fellow muttered to the nurse behind me. Intubated. And rendered unconscious. “Let’s get set up here, I don’t want to wait until we get to the unit.”
“I don’t—” she whispered, her eyes widening in fear, her shaking fingers closing even tighter over my own, “I don’t—know where—my phone—my husband—Robert—at home—”
The hammer beat against my chest intensified. She wanted to speak to her husband.
“We can call your husband later to update him,” my fellow told her, gentle but firm. “We really need to—”
“No,” I interrupted, panicked, the sweat from my own palms beginning to intermingle with hers. “No, wait, I see your phone, let me call him, it’ll only take a minute.”
I hadn’t been called before my grandfather had been intubated. I had never spoken to him again.
My fingers slid clumsily against the screen. After several missed taps and rapid backspaces, the call connected.
“Anna?” Her husband’s voice was tense and tired. “It’s late, what’s wrong?”
“This is one of the doctors from the intensive care unit,” I said, the words racing each other out of my mouth. “Anna is very sick from an infection and will need a breathing tube soon. I have her here, do you want to talk to her?”
“Yes,” he said quickly. “Yes, please. Anna, hello? Are you there, hello?”
I left the phone on speaker against her pillow and followed my fellow to the other end of the room. He had busied himself with the intubation tray and was running the plan with the respiratory therapist. I averted my gaze from Anna, training my ears only on the descending blip of her oxygen monitor as my heart continued to pound.
Anna already needed one pressor medication to maintain her blood pressure once we set out for the unit, and by the time we arrived, she was already on three. Her blood oxygen dropped lower and lower with every check. By the time her husband had made it into the hospital, her kidneys had failed completely, and she had to be started on dialysis. Less than an hour later, her dialysis line had already clotted off.
“Robert?” It was nearly time to hand over to the morning team, and I had come to check in on Anna one last time before my shift was over. Her husband sat stiffly upright against the uncomfortable plastic chair, his hand massaging hers. “Robert, how are you doing?”
Robert’s eyes remained fixed on his wife. They were wide and still, the whites shot through with red. I’d seen eyes just like that yesterday, when I’d glimpsed my reflection in the bathroom mirror.
“She’s going to die, isn’t she?” he said. His voice was thick and cracked. It wasn’t a question. “She’s getting worse and worse every minute. She’s going to die.”
“I’m so sorry, Robert.” I wracked my brain for something—anything—else to say, anything that could alleviate some small measure of the grief that sat suspended between us. But my mind was as empty as it had been the day before.
A lilting melody lifted out of the silence, emanating from the phone beside their intertwined hands. Soft and muffled as it was, I knew it instantly, and Robert—and the hospital room, and the heave and sigh of the ventilator—evaporated.
I was seven, playing the clarinet in my living room as my grandfather sat on the sagging brown leather sofa beside me. He nodded approvingly as I completed my exercises, rifling through the music book propped up on the table.
“Play this next,” he said, pointing to the song he had selected. “For me.”
“It’s too hard,” I protested, glancing over the page. “I don’t know it.”
“You can do it.” Seeing that I had opened my mouth again to object, he added, “Please? It’s my favorite.”
He had never told me what music he liked before. I softened, and my hands traced through the first few fingerings as he settled back into the sofa.
“‘Strangers in the Night,’” I said to Robert. He nodded, ever so slightly. “Did—does Anna like that song?”
“Yes,” he replied. He blinked twice, fast. “We played it at our wedding. It’s her favorite.”
I reached my hand out and settled it, feather-light, against his shoulder.
“It must be such a comfort for her to hear it,” I said quietly. “And to know you’re here, right beside her, no matter what.”
Robert closed his eyes. His wool sweater was soft, the fibers shifting against my skin as he took a deep, uneven breath. I felt his exhalation flutter against my fingers, a whisper of warmth in the cold, sterile air.
I gave his shoulder the smallest of squeezes before retreating from the room.
“What’s going on with bed three?” my attending asked as soon as I walked into the conference room. “I saw she was really active overnight.”
“Yes,” I said, struggling to keep my voice steady. I gave the summary of her clinical course overnight, updating the team on every failing organ. “Robert—her husband—knows her prognosis is very poor. He understands—” The words caught in my throat. “He understands she may pass away soon.”
“Die,” my attending prompted.
“What?” I stared at her.
“Die,” she repeated. “Remember we talked about this yesterday? I hope you remembered to tell him that she would die, not that she might ‘pass away.’ It’ll be better for him to hear it, better for it to sink in now.”
“Yeah.” My eyes, which had re-mained dry all night, began to leak hot tears beneath my mask, coating my lips and nose and throat. “Yeah. Right.”
On the walk home, I received the text from my fellow letting me know that Anna was gone.
You did your best. We really did everything we could. Don’t take it too hard.
Is her husband okay? I texted back.
The whole family will be here soon. They’ll take care of him.
I thought of Robert, alone in the room, his grip still tight around his wife’s limp hand. I thought of the phone on her bedside table. Was it still playing “Strangers in the Night”? Or another song from their wedding?
I wondered what music would play at Anna’s funeral. I wondered what her family would eat together now she was gone—what they would remember her by.
I wondered if she liked caviar. I wondered if it would ever taste the same again.
Leah Kosyakovsky is a physician living in Boston. “My Grandfather’s Caviar” is her first published essay.