The Masks We Wear

Your voice was strained from a week of disuse, nearly inaudible amid the familiar din of the intensive care unit: the twittering of alarms, the delirious cries of the sick and the dying. The words came out in a grating whisper, one-by-one between labored breaths.

“I’m. Just. So. Tired.”

Stepping into your room, I put on my gloves and paper gown. The heavy air transported me back to the sleepless summers of my childhood, those rare nights that just refused to cool down. As I walked toward you, my eyes fell upon your face, the skin chafed and bleeding from the CPAP mask you had worn continuously for days, a red ring around your mouth and nose like a bull’s-eye target.

I too wore a mask, a small, flimsy thing that did little to conceal my growing unease at the sight of you. When I asked how you were feeling, you stared, unanswering, your vacant eyes saying more than your lungs would allow. Stupid question, I thought. Unsure of what to do next, I found myself looking aimlessly around your room, searching for an answer among the machinery that kept you alive. My eyes fell on a photograph on your bedside table, a picture of you and your three children, four smiling faces full of ambitions and dreams.

Your children were having trouble letting go of those dreams. For of all the countless possible futures they had imagined in their youth, none of them included the early death of their father. Despite the inevitability of dying, the ubiquity of impermanence, we never include death in the stories we write for ourselves and our loved ones. It is a crucial detail, a critical plot point that we always seem to omit.

“He’s a fighter,” your son, the youngest of the three, told me later that same day, the four of us huddled around a long wooden table, sitting in leather chairs with tall backs and padded armrests like bigwig corporate executives. His face was a mask of determination.

I was a just nervous intern—a first year trainee in an internal medicine residency—and yet here I was leading a family meeting at this major turning point, perhaps the most momentous occasion of your family’s collective lives. If this were indeed a corporation, I thought to myself, and I were its CEO, we would all be doomed. But I pushed forward nonetheless, driven by the pain I had seen in your eyes.

Earlier that day, when I had urged you to tell your son and daughters your true feelings, my plea was met with silence. You said that you were scared—not of dying, you were ready for that—but that your children would think you were abandoning them. I asked instead for your permission to tell them myself, and the almost imperceptible nod was all that I needed.

I took them to see you. Your hair was a sweaty, tangled mess beneath the elastic strap across your scalp. I wetted a washcloth, and handed it to your eldest daughter, who placed it upon your forehead; we could just make out your smile hidden beneath the mask. I told your children what you had said to me, not just once, but time and time again, as I spent my days at your bedside for the past week of your life—the last week of your life.

“Is it true?” they asked you, now huddled around your hospital bed rather than the conference room table. My heart leapt when I saw you nod, and I was humbled by your courage and your strength. I met your children’s eyes one-by-one, and saw your pain reflected in each of them.

Your son took it the hardest, still not ready to give up on those dreams, that future he had envisioned for you. “Don’t you want to keep fighting, Dad?” he asked with desperation. He was a big man, full of intimidation and girth, but as he took your hand in his own, staring into your sunken eyes as you slowly shook your head, I watched his brave facade melt away, his determination replaced by acceptance and sorrow. Suddenly he looked much smaller, standing there beside you.

You died that day. You went quickly, and comfortably, your son and two daughters at your bedside as we withdrew that oppressive mask from your face, finally freeing you from its painful grasp. Do you remember those final moments? Do you remember the tears that your children and I shared, standing above you as you drew your last, unlabored breaths?

After everything we went through together, I was so afraid that your children would blame me as the harbinger of your death, hate me for forcing them to hear your pleas. But in the end, they thanked me. They thanked me, and I will never forget it. Or you. I will never forget the words that you said to me as you lay in that tiny room, day after day, kept alive against your wishes, shackled by that mask to a hospital bed that had become your prison.

“I’m. Just. So. Tired.”

We all wear masks. Sometimes to protect us, sometimes to conceal our fears. In my case, conviction masked the uncertainty of an inexperienced intern, a new doctor who was in over his head, struggling to help a grieving family come to terms with their father’s mortality. Your son kept his fear hidden beneath layers of obstinate determination, fooling me with his counterfeit bravado until the moment those tears filled his eyes. And you, you were silenced by the mask which kept you alive, but despite temptation to hide behind it, you found the strength to cast it aside—to share your true feelings with your loved ones, and to find peace in your final days.

This story is based on true events. Details have been omitted and/or modified to maintain confidentiality for the patient and their family.

Compliance with Ethical Standards

Conflict of Interest

The author declares that he does not have a conflict of interest.