The Refusal

74/F

She had said no.

No tubes.

No needles.

No humming machines.

No more strangers touching her wrist

like a thing to be counted, not held.

A year ago, she had looked us in the eye and said:

We wrote our notes.

Adjusted her meds.

Watched her walk away with her daughters,

the kind who made sure to double-check every instruction,

and said thank you.

But time passed.

As it does.

And she returned.

Not walking this time.

Not even sitting.

Carried in.

Breathless.

Burning.

Altered.

Flooded.

Skin paper-thin.

Bedsores blooming on her back like rot through ripe fruit.

Uremia signaling advanced kidney failure.

Blood like poison.

Lungs drowning in their own flood.

Eyes, half open.

We knew what was needed.

Dialysis.

Maybe intubation.

ICU.

One more war.

So we called the daughters.

Laid the numbers bare.

Held nothing back.

Explained her uremia and respiratory distress.

as if her mother’s ghost was already listening.

The younger daughter said nothing.

Just rested her hands on the bedrail,

her silence carrying the weight

of her unspoken grief.

A Gentle Exit

So we did what they asked.

No central line.

No dialysis.

No ICU.

Just antibiotics to ease the infection.

Oxygen to lighten her breath.

Frusemide, dripping like slow forgiveness,

to reduce fluid and comfort her lungs.

And quiet.

She was moved to the ward under Nephrology.

For palliative care.

A room with a cracked window and no monitors.

A space for dying that didn’t feel like dying.

A day later, they asked to take her home.

And we said yes.

Sometimes the bravest thing medicine can do is step aside.

The Last Promise

Her departure was as she wished,

unfolding at her home.

A day later, the ambulance call.

Found unresponsive.

Not breathing.

No pulse.

A cold body, in a warm room.

We went.

Confirmed.

Declared her passing.

The daughters stood on either side of the bed,

her hands under theirs.

They teared up,

but they held her like an ending.

Most people don’t die like this.

They die inside machines.

Tubes in throats.

Arms strapped down.

Monitors howling.

The final breath not even theirs.

But she died with the fan spinning.

The window open.

The light low.

And her daughters beside her,

keeping a promise.

Lessons in Letting Go

What the dying know is what we often forget.

That dignity has a sound. Not silence. Not peace.

But something between a sigh and a release,

like the rustle of leaves,

or the last note of a song,

the soul letting go of its memory.

She knew what she didn’t want.

And somehow, they honoured that.

Even when it broke them.

And us?

We stood in the space between what we could do,

and what we shouldn’t.

We had the tools.

The skills.

But she had the will.

And they had the love.

She left the world not with a fight, but with a whisper.

Not in panic, but in prayer.

Not in our care, but in their arms.

That, too, is medicine.

That, too, is healing.

Even if it doesn’t look like survival.

If this made you pause, forward it to someone who might need it.

Or invite them to join our growing community here:

More soon.

Another moment.

Another reminder that we are still, somehow, human in all of this.

Yours,

Dr. Adarsh Nath,

Letters from the ER

Disclaimer:

Patient details have been changed to protect confidentiality. This is a personal reflection, not medical advice or substitute for professional care.