It was December 2008, my third Christmas at the hospital. As a single person with no family nearby, I had made a point of always trading my Thanksgiving shift for Christmas so that a mama or a papa could have the day off to be with family. This year was no exception. I had Thanksgiving Day off to be with my chosen family, in this case, my cycling team, and Joanie got to spend her youngest baby’s first Christmas at home. It was a win/win for everyone. It also helped that Noah Goldstein, the lone male Jew in a sea of shiksa surgical residents currently rotating through the trauma service, would be on call at the hospital that day. It meant there was at least some chance of a little bit of flirtation and fun to punctuate what would be, just by nature of the calendar date, twelve heavy-hearted hours in the ICU.

My first Christmas in the ICU was spent on the neurosurgical express train—get a crani, recover a crani, discharge a crani, get a crani—I can’t remember a single thing about it except that it was uneventful and I ate too much. Our ICU was famous for their stellar potlucks—the envy of other units—and Christmas was no exception.

My second Christmas was a heartbreaker and one I will remember for the rest of my life. I spent six shifts in a row, including Christmas Eve and Christmas Day, caring for Loretta, a cherub of a woman in her early fifties who had had a stroke while at work as a hotel concierge for a resort on the Big Island of Hawaii. She and her husband, Don, were med-e-vaced to Stanford by airplane from the main hospital on Maui, but by the time she arrived into the care of our neurosurgical team, she was nearly, if not entirely, gone.

The neurosurgeons performed an emergency hemicraniectomy, where they removed part of her skull to allow room for her brain to swell, and placed a drain in her ventricles to allow the blood from the burst artery to drain, but Loretta never woke up.

Don was alone and grieving in a foreign land for the holidays, their two twenty-something sons still in Hawaii, and his wife barely clinging to life. I brought him a care package of cookies and Christmas dinner, a hand-knitted scarf, and listened to their life story unfold—how they met, their courtship, their marriage, the births of their children. I listened to their hopes and dreams as a couple, some realized, some thwarted.

For six days, I bore witness to his telling of their love story. And it was very much a love story, with equal parts hearts and flowers, loneliness, questioning, and pain. Don’s way of grieving didn’t leave room for sentimentality. He told me about his time in Vietnam, and the ghost he was when he returned, how Loretta held him for months and months until he came back to life again. He told me of their youngest son’s struggle with addiction, how he once thought Loretta was having an affair, how he had considered having an affair himself when they accidentally allowed too much space to form between them. And he told me, too, about how close they had become in these last years together, the sheep farm they bought on the Big Island, and their plans to grow old there. I felt honored to get to know them this way—a privileged guest in their intimacy.

But I was also privy to Loretta’s bleak prognosis. The odds of her recovering into any semblance of her former self were slim to none, if she ever awakened from this comatose state. The Christmas miracle I quietly prayed for waxed and waned between let her awaken and recover, and take her swiftly so he can remember her how she really was.

Don chose to withdraw life support on New Year’s Eve, shortly after their sons had arrived from Hawaii. He wanted to end this most terrible year and start anew in the next. I was not on shift that day, but we spoke by phone, something I had never done before with a patient’s family member, and something I haven’t done since. He told me she passed swiftly, without complication, and he was going to try his best to not follow suit, for his sons, even though it’s what he most wanted in the world—to leave with her.

Season’s Greetings from the ICU.

“Merry Christmas, beautiful!”

“And a Merry Christmas to you, Annie!” Annie as charge nurse on Christmas meant the chaos would be gift-wrapped in the perfect amount of dark humor.

“You’re nice and early this morning.”

“Santa dropped me off on the roof on his way over.”

The truth was I had spent the night at Noah’s apartment, a five-minute walk from the hospital, and his shift started an hour before mine. I was awake and coffee-less, so I headed into work early to caffeinate.

“Well, you can name your pleasure for the day, then,” Annie offered. “Do you want crazy or heartbreak?”

“What? No happily ever after?”

“Not here, my friend. Maybe not anywhere. Sorry.”

“Well then, let’s see. I have in my hands a pan of lasagna and two dozen cookies, but no wine or gin. I’m also on for the next three days, so there won’t be any real chance for wine or gin anytime soon. I think I choose heartbreak.”

“An excellent choice. And, that way,” she said, penciling my name on the assignment board, ”when he passes, I’ll close off that room and make you a float.”

“Oh no! Dying? Today? Really?” I scrunched up my nose. “Is it too late to choose crazy?”

“You can have crazy.” She reached for the assignment board again.

“No, no, forget it. Heartbreak is fine. Crazy requires gin.”

“Room thirty-three. Pinkerton. Came in last night from Lytton Gardens. He’s a stroke, but he’s DNR/DNI.”

“Why’s he in the ICU, then?”

“No beds. They were going to take him to the cath lab to try to evacuate the clot, but apparently the CT showed he wasn’t a candidate. And they just got a hold of the family—they refused surgical intervention. He’s 93 with baseline dementia.”

“Well, thank heaven for the little things anyway. How are they?”

“Don’t know. They’re not here.” Annie’s face coiled up oddly.

“Oh. Are they far away?”

“Nope. San Jose. But they’re not coming. It’s Christmas. Apparently, they have a busy day planned.”

“Seriously?”

“Yep. That’s why I wanted either you or Natalie in there. He really needs somebody to be with him now.”

“It’s so hard not to judge.”

“Oh, feel free. I know I am. Merry frickin’ Christmas, sister.”

“Yeah. Right.”

I was sitting on Berkeley’s Indian Rock drinking a beer with my ex-boyfriend when my father passed away. I wasn’t there to escape his death, or because it was the better thing I had to do. I was there because I had been trying to get home all day by flying standby—my aunt, a pilot for Continental Airlines, had given me a buddy pass to get home with—but I kept getting bumped from flights. After nine hours at SFO, twice boarding and then having to disembark from airplanes, I finally bought a full-fare ticket, the cheapest one I could find, yet still more than I could afford—a red-eye out of Oakland. James, my ex-boyfriend, who had been with me at the airport the entire time, drove us across the bay and into the hills, as he had often done when we were still together. He had lost his mother when he was my age (I was 24 at the time, he was ten years older) and I asked him to tell me the story of his journey home when she was dying. So he did.

He eventually stopped at a corner store and bought us each a beer, then started up toward Indian Rock. He held me as the sun set and I wept and wept and wept believing I was about to lose my father, not knowing he was already gone.

For Christmas this year, Santa brought me a dying man with no family.

This was the text message I sent to Noah after I finished and documented my first assessment of the day.

A few beats passed before my phone buzzed with his response—Where are you?

E233

I’m coming up.

Mr. Pinkerton was close to leaving this world. His heart rate was hovering in the low 40s, his systolic blood pressure, which had initially been elevated when I came into the room an hour earlier, was starting to dip down into the 70s. His respirations were irregular and shallow, with an occasional impossibly deep breath.

Theoretically, he could last like this for hours, but my gut told me it wouldn’t be long. He seemed comfortable, at peace. I pulled a chair up next to his bed, sat down, and took his hand.

In my three years as a nurse, I had grown quite comfortable with what I liked to call the "Celestial Discharge," so comfortable, in fact, that I was often chosen to attend to them, and even volunteered. It usually entailed sorting through family politics, deciphering the dynamics and teaching family members how to be with their loved one and manage their grief rather than acting out all over each other.

But occasionally, as with Trini, as with Mr. Pinkerton, I was asked to be the lone guide into the next world.

“Mr. Pinkerton, I’m a nurse, your nurse. My name is Dana. I’m here with you now and I’m not going to leave you. But you can go. You can leave here whenever you’re ready. It’s okay.”

I thought of my father on his deathbed. He wasn’t alone. My mother, his mother, my aunt and uncle, my brother—they were all with him.

But I was not.

That was eight years ago, in February, not December, but I hadn’t been home to celebrate a Christmas since. I had my reasons.

And yet I wondered what would keep this man’s family away today, what he could have done, or not done, to keep his loved ones from interrupting their Christmas morning long enough to say goodbye? I tried not to judge. If my mother called to tell me my drug-addled brother was dying, I don’t think I’d move to change so much as a pedicure appointment. My job was to transition this man to the next world, not to judge him or his family in this one.

But it was hard not to wonder.

The sliding glass door glided open and Noah stepped in. “Hey there,” he said softly, as he closed the door behind him, “what’s going on?”

I gestured toward him to remain in the doorway, that I would come to him. I wanted to be out of Mr. Pinkerton’s earshot when I explained what was happening. He didn’t need to know, in any part of his psyche, that he was dying and his family wasn’t coming to be with him. And if he already knew, he didn’t need to be reminded of it now.

“Mr. Pinkerton, I’m going to let go of your hand for a moment but I’m not leaving you. I’m still here in the room with you.” I walked over to Noah and whispered, “He’s a hemorrhagic stroke from the nursing home down the road. His family knew enough to refuse surgery, but they’re not coming in to say goodbye.”

“Too far away?”

“San Jose.”

Noah’s brow furrowed and he cocked his head to one side.

I held my hands up. “I don’t know. I’m trying not to judge, but it feels pretty awful.”

“It is awful.”

I nodded. “I’m gonna go sit with him.”

“Wait.” He reached for my shoulder and pulled me into an embrace. “I’m sorry you have to do this today.”

“Me too.” I hugged him back. “Thanks for coming up.”

He followed me over to the bedside and pulled the chair out so I could sit down. For a brief moment it felt as though he were the nurse and I was the patient’s family member. He stood behind me with his hands on my shoulders.

“Mr. Pinkerton, I’m taking your hand again. This is my friend Noah, he’s here with you, too.”

“I feel like we should say a Kaddish.”

“A Christmas Kaddish?” I smiled, though he couldn’t see it. “Mr. Pinkerton, you know it’s a pretty special day when you’ve got a Jew and a crooked half-Jew praying for you on Christmas. “

“Is that a yes, then?”

“Sure, why not? You’ll have to do the work though. I’m good for a few Hail Marys and Our Fathers, but lightning bolts might ensue.”

Noah laughed. He moved from behind me to the other side of Mr. Pinkerton’s bed to take his free hand. I stood up. He reached across the bed to take my hand as well, and began to pray in Hebrew, “Baruch, atah, Adonai, Eloheinu, malech, ha’olam, dayan ha’emet. Blessed are you, Lord, Our God, King of the universe,” he looked up at me.

I met his gaze.

“The True Judge.”

I nodded.

He paused before concluding, “Amein”

“Amen.”

As if on cue, Noah’s pager went off.

He reached into his pocket for it and sighed. “Aaand, I’ve gotta go.” He came back around to my side of the bed for one more hug, “You’re an angel,” he whispered in my ear.

“So are you.”

“We’ll catch up later. Mr. Pinkerton, sir. It was nice meeting you. You’re in good hands here. The best hands.”

He turned toward the door, and as he did, it slid open. Annie’s face appeared.

“Dana? Oh, hi Noah.” She paused for a moment, puzzled, but quickly moved on.

“Dana,” she stepped aside to reveal a blonde woman in her fifties. “This is Ginny. Mr. Pinkerton’s daughter.”

“Welcome. Merry Christmas,” I said, “please, come inside.”

Mr. Pinkerton was gone within the hour. I didn’t learn a thing about his life or his daughter’s. I was just glad for the both of them that they were able to be together in his last minutes.

I spent the rest of the morning helping Natalie with “crazy”—a homeless man with a head injury who also happened to be detoxing from alcohol—an extremely volatile combination. We had him physically and chemically restrained, but he was still spitting, swearing, and heaving his torso off the bed, making me glad I had chosen heartbreak after all.

Shortly after three o’clock in the afternoon, after all thirty nurses on the unit had enjoyed the potluck lunch, I ducked into a stairwell to place a call I had debated making all morning.

An answering machine picked up and a woman’s voice chimed in, “Aloha! You’ve reached Don and Loretta. We can’t get to the phone right now, but if you leave your name and number, one of us will get back to you as soon as we can. Mahalo!”

One of them, indeed.

“Hi, Don. This is Dana Freedman from Stanford. I’m guessing you remember who I am. Anyway, I’m calling to let you know I’m thinking of you and your sons today. I have been for days. And, of course, Loretta. I haven’t forgotten about the two of you. I don’t think I ever will. Merry Christmas. I hope it’s a better one this year.”

My gut told me it was the right thing to do.

As the shift drew to a close, the night staff began pouring in. Cheers of Merry Christmas erupted again, and hugs abound. I sent Noah one last text message.

Getting ready to leave. Where are you?

In the ED but it’s quiet. Don’t leave! I’ll come up. Where can we meet to say a proper goodbye?

I don’t know. E233 is still empty…

No, I’ll have to walk by the main desk. Too awkward.

Hmmm. How about the equipment room just inside the main doors? No one should be going in there at shift change.

Perfect! What’s the door code again?

1234—very sophisticated.

Ha! That’ll keep out the riff-raff. See you soon.

I said my requisite Merry Christmases, and made like I was heading out the main doors, then quickly ducked around the corner and slipped into the equipment room. I pulled out my phone again and held it to my ear just in case someone other than Noah should surprise me. A minute later there was a knock at the door, and he entered.

“Merry Christmas, Doctor,” I said, wrapping my arms around him.

He kissed me on the forehead, then scooted a bunch of IV poles aside to give us a little room. “Could we get anymore Grey’s Anatomy right now?”

“Well, we probably could,” I smirked, “but unlike television, if we get caught, we might actually lose our jobs.”

“Sometimes I feel like that wouldn’t be a bad thing.”

“Rough day at the office?”

“Not too bad. I shouldn’t complain. Eartha Kitt died today.”

“Here?”

“No. No. I read it in the news online. Talk about terrible timing.”

In my best lounge lizard voice, I crooned, “Santa Baby, put a casket under the tree, for me.”

He laughed and bit at my nose, “You are so…mordant.”

“Now there’s a good word! Woefully underused.” I bit him back. “I’m afraid it comes with the territory.”

“I suppose.” He leaned into me again and began to sway. I draped my arm around his neck, allowed myself to be led. He began to sing the bass line, “Ba ba ba dum.”.

“Santa baby, slip a sable under the tree, for me.”

“Ba dum, ba dum.”

“Been an awful good girl,”

“Ba dum,”

“Santa baby, so hurry down the chimney tonight.”

His pager went off. Of course it did.

“Groooaaan,” he said, “Trauma 97, ETA 7 minutes.”

“Grandma got run over by a reindeer?”

“Now that would be a Trauma 99—major trauma. A 97 is minor.”

“Ah ha. Grandpa’s knife slipped while carving the Christmas goose?”

“Mordant.”

“Guilty as charged.”

“Okay,” he said, rolling an IV pole into my hands, “Rest in peace Eartha. Irving here will have to finish off this dance for me. I gotta go.”

“Merry Christmas, doctor.” I said, exaggerating my lean into my new dance partner, then turning a circle.

“Merry Christmas,” he said, then added, just before the door closed, “angel.”