Never underestimate the power of a smile

He was a young patient with AIDS and Pneumocystis jiroveci pneumonia (PJP). Maybe that should have scared me from the start, but it didn’t. In hindsight, I keep wondering when the fear really set in. But downstairs under the glaring lights and the swooshing bustle in the ER, I only remember that he looked slightly bored as he took shallow, quick breaths. There was no blood, no screams of pain. No alarm bells rang in my head.

He seemed calm at first. But with each passing day he asked the same question: “Mejor?” Better? And each day I tried to look for a silver lining, even as his oxygen requirements increased and his ABGs remained troubling. A week later, when we discussed moving him to the ICU, his eyes sparked a fear that I’d never seen. Told by the nurse that he was refusing the transfer, I went down to reason with him.

“Porque tengo miedo,” he answered when I asked. “Because I’m afraid.”

I felt cold as I explained to him that he was requiring a different high-flow oxygen machine, one that only the ICU could provide, and he required closer monitoring from ICU nurses.

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