The Letter

Pen with flowers, letter

            Michelle’s lungs were bad, and the machine that kept her alive only made them worse. I stepped into her intensive care room with little more to offer than my name and a handshake. Her husband, Mark, took them both with a nod of his furrowed brow. Questions lingered in the wrinkles of that forehead that he dared not ask. I answered them anyway.

            “Right now, all we can do is support her,” I said. “It’s up to her body to fix itself. If that is going to happen, she will eventually let us know.”

            The next morning I waved to Mark in the hospital lobby. He postponed his coffee run when he noticed my coat, a green camouflage jacket I had picked up from an Army surplus store. It was just like the one that Mark had worn in Vietnam.

            “Those things will keep you warm,” he said with a grin. His clothes were familiar and wrinkled. He had slept in them all night, upright in a chair, in the hospital waiting room. He had slept there all week.

            Mark dismissed with a shrug my offer to arrange him a hotel room. He didn’t want to be far from his wife.

            “Besides,” he said, “I don’t sleep much anymore.”

            After that conversation, Mark smiled every time I entered Michelle’s room and, for just a moment, the worry evaporated from his eyes. When Michelle heaved against her ventilator during a coughing fit, I stroked her arm while Mark told me stories about her. I pictured the two as a couple, kind and strong. The tales of her compassion complemented his stoic devotion.

            Michelle and Mark officially left my care the next week when I moved to another ICU team. I still visited them. I would wrap my arm around Mark’s shoulder and carry his burden for just a moment, before my pager stole me away.

            One day Mark was gone. Two women stood in Michelle’s room: her sisters. They told me they had forced Mark to finally go back home and rest. I turned to leave but one of the sisters stopped me.

            “Are you Harrison?” one of them asked, and I nodded. “Oh, we pictured you being much older. Mark has talked so much about you. He has so much respect for you.”

            I smiled. I felt the same respect for Mark. “Michelle is lucky to have a man like Mark by her side,” I said.

            The next time I saw Mark, his eyes quivered. He told me the medical team wanted to have a meeting.

            “A big one,” he said, “to make decisions.”

            I pulled Mark away from the waiting room packed with his family and we walked the hallways together. We talked about hearts and lungs and life.

            “Are you ready for this?” I asked him.

            “I think I am now,” he said.

            Michelle died at 1 a.m. Mark stood at her bedside, alone. I knew he would have wanted to see a familiar face before the life support switched off, hear some reassurance of his decision. But he could watch her suffer no longer. If I had been there, I would have told him that he did the right thing, that he was a good husband.

            Surgeons, I hear, find satisfaction in their ability to manually repair the human form. The quick fix brings instant gratification. Their hands heal.

            My hands had patted Mark’s arm that day and fixed nothing. I wanted to reach out and heal his pain. I wanted to use my hands to practice my art.

            After Michelle died, I decided to do just that. I picked up my instrument and went to work.

            My strokes lacked precision but held purpose. My pulse thudded with each little line as my pen splashed ink on paper. Manual labor is hard work.

            “Dear Mark,” my letter began. It told him how I respected Michelle’s strength, how I admired his dedication, and how lucky Michelle was to have the love of a husband like Mark. I signed it in the most honest way I knew: “Your friend, Harrison.”

            I never saw Mark again. But I hope, through the work of my hands, he knew the truth. That even though Michelle was gone, someone in a white coat still cared.


The Letter was originally published in JAAPA. But there’s more to the story. In his New England Journal of Medicine In Practice blog, Harrison Reed discusses why medicine needs the letter of condolence and the physician who inspired him to pick up his pen. You can read that story here.

Author: Harrison Reed

Harrison Reed is a critical care physician assistant (PA-C) and an assistant professor at the George Washington School of Medicine and Health Sciences. He is the clinical editor of the Journal of the American Academy of PAs (JAAPA). He is the creator and editor of The Contralateral.

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