Ms. Miller is a fading star. At first glance, I begin painting an elaborate picture in my head of Ms. Miller in her brilliant shining glory. Young. Stubborn. Beautiful. Loved. I have no way of knowing if these things are true, but in my head I must believe them because it’s just way too sad to accept the truth. Old. Inert. Defeated. Wrinkled. Alone.
Ms. Miller was brought to the ER from her nursing home because she was having trouble breathing. When I greet her, she holds onto her breathing mask with one hand, her eyes focused on something infinite and far away. I quickly learn that she cannot communicate with words, so I begin a physical exam. Normocephalic, atraumatic, signs of respiratory distress. Although she appears lethargic, I sense that she is acutely aware of person, place and time. She is Ms. Miller. She is in a hospital, and it’s the end of time.
Her pupils reveal cloudy lenses and constrict slowly to the light that I shine in them. She’s thin. She’s using extra muscles to breathe. I examine her round abdomen. Her legs are swollen, but I can still feel a pulse in both of her feet. I check her arms to make sure her IV is still in place. In her right hand she is clutching something. She’s holding on to it so tight that her long nails have dug into her the palm of her hand. I unfold her fingers one by one. She is clutching a rosary and three one-dollar bills.
Initially I don’t understand, but then suddenly I do. She’s armed for the afterlife. I let go of her fingers and they snap shut around her possessions. She met my gaze and silently pleaded to keep them.
I walk away. I present the case to the attending. We obtain a chest x-ray, a full set of labs, and call the nursing home to obtain a more complete medical history. Ms. Miller is admitted to the hospital but not to the ICU because, per a piece of paper, we cannot resuscitate her if she should come crashing down. Covered in snuggly white blankets, her fingers tightly coiled over her dollar bills and rosary, she disappears through the double doors of the ER in a flash of dazzling light. Really, she was just wheeled to the inpatient ward upstairs, but my imagination clearly gets the best of me sometimes.
On the train home after work, I remember that when my grandma died, my family made sure to bury her with the same three things she always carried in her purse: tissue, gum and some one-dollar bills. I imagine my grandma carefully choosing these items in life and how they might suit her in death. The dollars stump me because in my version of heaven, everything is free.
I hear the conductor announce my stop. I step out of the train and onto the street. It’s cold and cloudy. I complain to myself that it’s impossible to see the stars. I know they are nearby though, some bright and some fading away. I know that in my career as a doctor I will meet many Ms. Millers, many fading stars, and someday I will fade away myself. Until then, I will try to live as pulsating life as possible, knowing that I will only need to save a few dollars to take with me in the very end.