She was gray-haired, mid-60s – a grandmother. She was sweet, with wrinkles around her eyes as she tried to smile despite the pain. She made sure to express gratitude for everything we were doing for her. But she couldn’t hide that she was terrified. I remember her voice shaking as she tried to describe the symptoms that led her to the ICU, taking gasping breaths despite the high-flow oxygen attached to her nose.

I remember every last detail of her medical history, every last hole in the Swiss cheese that she tragically slipped through, every step where the medical system failed her. I can recall every unfortunate twist of fate that led her to the doors of our ICU. How her local ER wrote off her hip pain as a simple injury and missed her brewing prosthetic joint infection earlier that week. I remember the sound of the voice of the clinician on the other end of the triage call before she arrived at our hospital, as he explained the institutional problems that led to many hours of delays in getting her started on the appropriate antibiotics when she came back to that same ER a few days later, in septic shock this time.

I remember the fear in her eyes as she was wheeled into an ICU in a city located hours from her home, and the relief on her face as she saw that her loving husband had arrived to sit with her.

I remember which room she was treated in, and I remember what time it was – 2:15 a.m. – when I started to realize that she might not make it through the night.

I remember how many rounds of CPR we did when she died, and I remember how kind and understanding her husband remained, even as we told him that there was nothing more we could do. I remember the grief on his face as I tried and failed to hold back my own tears.

But most of all, I remember the way that he explained why this particular date was even worse than we could have imagined. It was their 30th wedding anniversary. He would never be able to think of their wedding without thinking about how he watched her die.

All of this I can recall in vivid detail. But I don’t remember her name.

She will follow me forever, shadowy and nameless, as I contemplate how the medical system failed her.

And each time I think of her, I also think of the countless others I have seen in their final moments, almost none of whom I remember in quite as much detail as her. Some of those deaths were peaceful, and some not so much. Some were expected, comfortable, and almost beautiful; some were brutally tragic. And I can’t help but wonder whether I have the right balance between connecting authentically with these patients on the most difficult days of their lives, while also stepping back enough to protect myself from the recurrent, overwhelming grief.

Which impactful patient encounters do you remember the most? Share in the comments!

Monica Knaack is a third-year Internal Medicine resident at the University of Iowa. She is interested in end-of-life care, as well as physician burnout and self-care.

Illustration by April Brust