Abuela squeezed my hand, finding them for me.
“Give him some time. He’ll come around,” she said, giving me a wink. Then she patted my hand. “Go home and sleep, Doctor.”
I swallowed, regaining my voice.
“I’ll be back tomorrow,” I said.
“I know,” Abuela said, and then she closed her eyes.
Twenty-Seven
On the fourth day, everything went to shit.
I arrived in the ICU to find Bethany, Gabriel’s resident, typing in orders bedside. There was a new machine present, this one unfamiliar, with several huge bags filled with clear fluid. I followed the blood-filled line from the machine into a large catheter in his neck—Dialysis, then. I stared at the new setup for a long time, then made eye contact with Abuela over Gabriel’s hospital bed. Her eyes were shining, but her lips were thin with resolve. Next to her, Mr. Gutiérrez snored, clearly wiped from an active night.
“Angie! Good morning,” Bethany said. She glanced at Abuela, then toward the door. Understanding, I gave Abuela a solemn nod and followed Bethany out. She slid the door shut, then rounded on me.
“It’s been a rough night,” she admitted.
“Sure looks like it,” I said, my stomach sinking. I wasn’t overly familiar with critical care, but during our last lesson, Dr. Milner had explained to me what pressors* were. I knew enough to know that one was okay, two bad news, three almost always fatal. Gabriel was on six. The max, I remembered, feeling sick.
“He went into cardiogenic shock overnight,” Bethany said. She had her red hair tied up in a knot on the top of her head, and some errant strands had escaped and hung into her tired eyes. She held out her phone, scrolling to a video of the cardiac ultrasound that she’d taken earlier in the night.
“What chamber is this?” she asked, apparently not too tired to pimp me.
“The right ventricle,” I said. “But . . . it looks weird. Is it just the angle, or . . . ?”
Bethany nodded.
“You’re right. It’s not supposed to look like that,” she said. “It’s huge. His lungs are toast, and they’ve done a number on his heart. His kidneys haven’t shown any sign of recovery. That’s three major organs down, not even counting the pressor requirement.” She tucked her lips into her mouth. “You’re close to the family, right?”
I understood what she was saying, but her unspoken request still sent me into a panic.
“Yes,” I said in a small voice.
“I sent an email to your attending this morning,” Bethany said, suddenly gentle. “I cc’d Dr. Milner. We asked if he didn’t mind you missing rounds upstairs today. Figured all of this could still count as part of your education.” She gave me a sympathetic look. “I’m sorry. Are you familiar with goals of care discussions?”
I nodded, my mind racing as I tried to put together my plan of action. Abuela already understood that her son was dying, but did she understand that the next step—the manner in which he died—was up to her? That she could accept him as gone and allow the team to switch their focus to alleviating his suffering . . . or hang on till the last possible second, pummeling him with drugs to raise his blood pressure, dialysis to drag out his fluids, compressions to bring back his heart when it inevitably stopped? Suddenly, I felt like an imposter, a wee medical student playing doctor. None of my shelf exam practice questions could have hoped to prepare me for this.
“Can we get an interpreter?” I asked.
Bethany shook her head.
“Not an in-person one. They don’t work weekends.”* When I groaned, she added, “You can still use the phone one?”
I could have laughed. The grainy telephone line? To deliver news like this?
I texted Ricky. The old thread had long been deleted, and our new one was formal and impersonal （Are you here? Yes. What do you want from the cafeteria? A grilled chicken sandwich, please. Thanks.） and my new addition was no different.
Where are you? I typed.
I found Ricky sitting alone in the family room, his laptop balanced on his crossed legs. When I opened the door, he looked up, greeting me with a grim nod.
“What’s up?” he said, lowering his headphones from his ears. He had bags under his eyes; I doubted he’d slept much all night. I sat down on the couch diagonally from him, trying to formulate the words. How did you tell the man you loved that his father, estranged or not, was dying? Where was the guidebook for that? Thankfully, Ricky seemed to understand why I was there, because he snapped his laptop shut and put it on the cushion next to him.