Every Easter, I’m reminded of the call that I took 20 yrs ago now, as an intern @umichmedicine. It was Good Friday & I was headed into the evening admitting patients to gen med. it was April, I was burned out, exhausted & tired of spending another holiday in the hospital 1/11

The ER paged next with my next admission. 60 some old lady with a history of cancer. Short of breath. New interstitial markings on her CXR. Was told it was “pneumonia” but clinical picture didn’t quite fit. She arrived on my service on antibiotics and I went to see her. 2/11

In her room, the movie The Ten Commandments was playing on the tv and I felt a pang of sadness as it was tradition that each year growing up I would watch that movie with my sister and parents and I longed to go back to those days, but my life was different now. 3/11

I asked my patient about her symptoms & examined her. As the intern, it was my job to ask her about her code status. We discussed what her wishes were if she were to stop breathing or her heart were to stop. She said “if I die, no one would be there to take care of my mom” 4/11

I explained that we didn’t know exactly what was going on in her chest, but I was concerned she may have lymphangitic spread of her cancer. She said she wanted to be “full code” and I marked this down on her chart and went to admit my next patient. 5/11

An hour later, I was paged to her room for worsening dyspnea.She was on 6L & clearly in distress. Portable CXR looked dramatically worse.Had she had flash pulmonary edema from the piggybacked fluids on her antibiotics? I tried diuresing her etc to no avail. She was fatiguing 6/11

She needed to be intubated. I was thankful we had had the discussion about what she wanted to have done before we were in this crisis. I thought of her mom. I called anesthesia. She was intubated. I had to transfer her to the CCMU & looked to see who the fellow was on call 7/11

My heart sank. The fellow was known as the “mean one” who was known to be rough with trainees. I called him to explain the situation & he did not spare me. He raked me over the coals asking me why I would use resources on an older patient with potentially an incurable cancer 8/11

I did the best I could defending my decision.She was transferred & left our hospital a week later to go home to take care of her mom. At the time, if you had asked me if all lives had value, I would of course have said yes.If u would have asked if they all had equal value..9/11

I’m not sure I would have agreed. I had thought she “mattered more” cause she was a caretaker. If you would have asked me *why* all lives matter I wouldn’t have had a clear answer. I was not a faith based person then. I am now. 10/11

How much “value” can you put on how ever many days she had left to take care of her mom? If she had been disabled, 99 years old, not a caretaker etc—her life would have mattered just the same. The *why* that I see now is that all people are made in the image of God. 11/11

P.S. whenever I see that former fellow at grand rounds or in the hall, I maybe glare at him still. Just a little. I’m getting better..