The first time we met, I was standing and he was laying down. He didn’t acknowledge me when I walked into the room. He didn’t respond when I said his name. He didn’t react when I touched his arm. When I pushed down on his breastbone, he didn’t flinch.

He had more wires and tubes sticking out of his body than fingers on his hands. His wrists were wrapped in foam and tied down to the sides of his bed. Strips of tape on his face kept the breathing tube in place. A short section of tube snaking out of his nose was plugged with a cap above his forehead; the interior of the tube was caked with brown-green sludge.

The machine blew a breath in; his body blew it back out. His body was limp, a wilting plant in this sterile garden.

I reintroduced myself, told him the reason for my visit, informed him of his medical condition, and expressed my hope that we would soon have a conversation. I then said good-bye.

The second time we met, he was sitting up, gripping the sides of his bed. The breathing tube was no longer in his body, but his breaths were noisy: wheezy, crackly, uncomfortable. The tube trailing out of his nose was now taped to his forehead, an unglamorous “J” that announced his inability to eat. His eyes followed me as I walked into the room, though they could not keep up: His right eye soon trailed off of to one side while the other tried to remain focused on me. He soon gave up and his eyelids drooped down.

“Hey,” I said, hoping to recapture his attention. That failed. His jaw hung loosely from his head, his fat tongue protruding forth like the foot of a clam.

“Hey,” I said again, touching his arm. Foam was still wrapped around his wrists and his wrists were still tied to the rails of the bed.

His eyes flickered open. Looking up at me, he said, “Mmmrph….”

And then he was gone again.

I reintroduced myself, told him the reason for my visit, informed him of his improving but still critical medical condition, and expressed my hope that we would soon have a conversation. I then said good-bye.

During our third visit, he looked at me with suspicion. His brows furrowed.

“How are you?” I asked.

“Fine,” he answered. His gaze returned to the far wall. His entire torso moved with each breath. It wasn’t that he was working hard to breathe; it’s as if he was practicing to breathe “right”.

I asked him about his health (orientation), where he was (orientation), when in time he was (orientation), how staff was treating him (paranoia), visitors (hallucinations), and if his physicians had shared any news with him today (orientation and memory).

“I don’t know,” he flatly answered each time. He weakly moved his hand, no longer attached to the bed, as if to wave me off.

“I understand that you might like cookies,” I persisted. One of the housestaff had told me that the first thing the patient said after the breathing tube was removed was “Cooookies….” The housestaff officer found this amusing.

“Yes. Cookies,” he said a little more energetically.

Building upon the shared fondness he and I had for cookies, I continued, “What kind of cookies do you like?”

A small puddle of saliva was collecting in the corner of his mouth. He was unaware of this.

“Cookies,” he responded.

“Do you want a cookie?” I asked, realizing that my attempt for eliciting more thought content was not particularly working.

“Yes. Cookie,” he said. “I like cookies.”

“Yes,” I replied. “So do I. And, hopefully, you’ll soon be able to eat one. You’re getting better, but there are still a few things to take care of.”

He shifted his gaze towards me and, the puddle of saliva beginning to ooze out of his mouth, repeated, “Cookies.”

I smiled, said, “I am going to wipe your mouth, okay?”, and then removed the trickle of drool from his chin with a tissue.

I hope he’ll get out of the ICU soon so he can have that cookie.

The next morning, I gasped loudly when I opened his chart on the computer.

“What?!” I exclaimed. The chart unceremoniously reported his location as “expired”.

The last note in the chart was a death note. It was four sentences long. The on-call resident was succinct. I read the note again.

I felt a pang of sadness. And then relief that I was still capable of feeling that pang.

I walked through the ICU later to see another patient. The man’s room was unoccupied. Fresh linens were neatly folded on the bed. The floor gleamed from the sunlight that was filtering in through the blinds. Two chairs were symmetrically arranged around the bed.

It was as if nothing had happened.