He’s young. Just 49 years old. A long life ahead of him. He was hospitalized a week ago and doing okay initially on the medical floor. After his saturations were consistently in the 80s on the highest level of supplemental oxygen, he needed to be intubated. We asked him if he wanted to call his family before intubation, just like we do with all our COVID patients… because we know it might be the last time. He declined, said he’s not in touch with his family and has no friends to call. He was adamant that he didn’t want his estranged parents or brother contacted for updates while intubated.

For a few days, he was stable on the ventilator. His oxygen saturations were okay, his labs were okay. Then, he started down the common pathway to death for our COVID patients. He was anemic. His kidneys were failing. He was started on dialysis. We waited in anticipation to see if he might be an exception.

One morning, about a week into his intubation, I walked into the ICU, ready for another day. The overnight nurse told me his pupils were dilated, and a CT scan showed a massive brain bleed. His reflexes are gone. He’s brain dead.

And for the first time since the COVID surge started, I cried. Another life lost. So young. So healthy. High-quality ICU care. Yet he still died. We terminally extubated him, surrounded by his nurses, respiratory therapists, and physicians. We held his hand throughout it all. We talked to him. In our ICU, no one dies alone. We honored his life… because he had no one else. I read a poem for him.

It’s becoming all too much for me. Why him? Why so young?

He was Latino. He was homeless. He lived on the streets. He didn’t have healthy foods to eat. He hadn’t seen a doctor in decades. He had no health insurance. He was alone in the world. And he had no help.

These are the social determinants of health. These are the things our country has abandoned when considering what actually makes people healthy. This is largely why he died. And it’s also why so many other young, healthy people of color are dying at disproportionately high rates from COVID.

It’s not fair. It’s not right. It’s not just.

This shouldn’t be happening in America. I struggle to find the words, the solutions.

This experience has activated me. It has impressed upon me the importance of political advocacy as a physician. As a leader. Because the social determinants of health are not within silos. The larger concept… the political determinants of health. As a physician, I know we must elect leaders who are focused on health equity. Because if we don’t, my patients will continue to die at alarmingly high rates. And as a physician, I’ve given them my word that I’ll help them, I’ll protect them, and I’ll advocate for them. So, that’s what I’m doing now. Between my ICU shifts, I run an organization that advocates for political candidates who are truly committed to our nation’s health. And days when I feel discouraged, I re-read the poem we read as we terminally extubated my patient, to honor his life:

Do Not Stand At My Grave and Weep

By Mary Frye

Do not stand at my grave and weep
I am not there. I do not sleep.
I am a thousand winds that blow.
I am the diamond glints on snow.
I am the sunlight on ripened grain.
I am the gentle autumn rain.
When you awaken in the morning’s hush
I am the swift uplifting rush
Of quiet birds in circled flight.
I am the soft stars that shine at night.
Do not stand at my grave and cry;
I am not there. I did not die.

**Feature photo by Anna-Louise from Pexels

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Rebekah L. Rollston, MD, MPH, is the Affiliate Editor-in-Chief of the Harvard Primary Care Blog, Founder of Doctors For A Healthy US, LLC, and Family Medicine Physician at Cambridge Health Alliance. Her professional interests include social determinants of health & health equity, gender-based violence, sexual & reproductive health, addiction medicine, rural health, homelessness & supportive housing, and immigrant health.