Humanely told stories of lives saved and lost

For doctors, there are patients, and stories, that stick with us. They linger in the corners of our minds, stain who we are, shape what we become. Some give hope and perspective, others haunt. All doctors have such tales but not all can tell them this well.

“You Can Stop Humming Now: A Doctor’s Stories of Life, Death, and In Between’’ is a collection of vignettes culled from over a decade of Daniela Lamas’s training in intensive-care medicine, where she learned to care for the sickest of the sick. It casts a steady, unblinking eye on the triumphs, failures, and blind spots of modern medicine: the seemingly miraculous extent of what we can now do for our patients and the crippling disappointment that comes with the realization of what we still cannot.

In her introduction, Lamas, a pulmonary and critical-care doctor at Brigham and Women’s Hospital, recounts a patient she took care of as a resident, a 90-year-old man hospitalized for life-threatening anemia due to an intractable gastrointestinal bleed. It was a medical problem she approached with a young doctor’s zeal for checklists, algorithms, and the unflinching trust that medicine could almost always eke out a fix. She and her team found themselves unable to solve the problem. The patient was getting no better, but still, they were keeping him alive, weren’t they? And that, surely, was some version of a win?

“The days went by until one morning, my patient told me he was done. You can’t be done, I thought. You’re still bleeding,” Lamas recalls. “I needed him to understand that if he stuck with us a bit longer, then maybe we could make him better.” Gently but persistently, the patient insisted on being sent home. “He didn’t want our kind of better. He missed his home and his bed . . . and the way it was quiet at night and the sunlight crept through his bedroom window each morning.’’ And, “[h]e understood the consequences.’’

The patient died at home shortly thereafter, and months later, Lamas was surprised by a heartfelt gift from the family, thanking her for the care she had provided. The discouraging outcome she had written off as a bewildering failure on the part of the medical team turned out, in the final analysis, to be the resolution the patient wanted for himself.

Lamas’s work is an elegantly written, intimate examination of the very nature of life itself and the qualities that doctors fight to preserve. As medical advancements allow us to keep sicker patients alive longer, it has created a murky liminal space where the various costs of doing so don’t always justify the mere fact of survival itself. In caring for critically ill patients, she asks herself, what constitutes a failure? What is a success? And how do we determine the difference between the two?

In a series of chapters, Lamas relates more such cases, like that of a weakened 28-year-old investment banker hooked to machines to bolster his failing heart, and who asks her over Facebook: “Can I stop the humming yet?’’ The grandfather so hungry for more time with his grandson that each night, he dutifully plugs in to charge the battery-powered cardiac-assist device keeping him alive. The young woman who outlives her cystic fibrosis prognosis to an unanticipated adulthood.

Physicians learn early on to walk a fine line in the care of their patients. Get too close, identify too much, become too invested, and run the risk of clouding objectivity and letting each story consume you. With open warmth and an attention to the fine-grained details, Lamas struggles with it all and turns those in her stories from patients back into people. Her account makes a compelling case for getting closer, identifying more, and above all, listening.

Ultimately, the book is a love letter to her patients. It is a wondrous testament to the strength and tenacity of those under our care who fight to live another day under unthinkable odds. Patients awaiting transplants that they will almost certainly never receive. Patients battling severe chronic illnesses, their days numbered but uncertain. Patients living in the shadow of death and the quiet grace that accompanies it, making the smallest pleasures of everyday life seem unimaginably precious. It is a celebration of those lives, an acknowledgement of what medical professionals can and cannot provide, offering some patients “possibility and time, opening and extending longer than expected,” and asking when, if ever, that time is enough.

YOU CAN STOP HUMMING NOW:

A Doctor’s Stories of Life, Death, and In Between

By Daniela Lamas

Little, Brown, 245 pp., $28

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