There are always those patients you carry with you and that’s why I started “Letters from an ICU nurse.” The patients I remember tend to run parallel with tough times in my own life. I might remember them so much because I am subconsciously seeking answers or maybe it’s just because they are unforgettable. Either way, it takes me a few years to write about them – I guess because I like to fully process and reflect. The story of Dani is in my top five most memorable patients. I don’t know if it was because she was my namesake or because of her unwavering positive outlook on life, but either way, I will never forget her.

I met her intubated, sedated, and almost dead after being taken to surgery emergently. When I read the report sheet, all I knew was that Dani was in her 40s and had a tumor pressing on her heart caused by metastases from previous breast cancer. The surgery was extensive and radical, especially for her extremely small frame. Every time I touched her, I felt she might break beneath my hands. In fact, when I removed her surgical dressing from a gaping hole in her left side, I could physically see her heart beating ­– her lifeline, pumping vigorously, right before my eyes.

I was working night shift at that point and she was my only patient for her first three nights on my unit due to the severity of her illness. Her husband and mother-in-law were by her side at all times. This is where I learned some about her background from their perspective. She was one hell of a fighter; she was supposed to die 20 years before I met her. I don’t really know the specifics, but according to her family she was diagnosed with a rare form of breast cancer that had a 100% reoccurrence rate. She had already been through over 30 surgeries and before she went to surgery this time, she perceived it as another walk in the park. In the beginning, her husband and mother-in-law would alternate night watch. I got to know them both very well.

Her mother-in-law talked about how strong Dani was, nothing could ever get her down. Anytime someone would complain, Dani would tell them to suck it up, learn from mistakes, and move on. Sulking was never allowed. Her mother-in-law showed me pictures of Dani and her family and four-legged children on an iPad they kept at her bedside. Dani was a lover. She loved her husband, daughters, pets, and friends, with every aching piece of her petite frame.

Dani’s husband told me stories of how they met and their adventures with breast cancer. Dani was diagnosed in her mid-twenties and happened to meet her husband at the same time. Very early in their relationship, she knew they could have a future together, and she told him she had been diagnosed with breast cancer. She gave him the option to leave, but he never did. For twenty years they lived through surgeries, doctor’s appointments, disappointments, wins, and losses. Her husband also showed me family videos and videos of just the two of them. Dani’s favorite word, also happened to be my favorite word – fuck. I found this so hilarious. I never heard Dani speak, other than in videos, because she was intubated and trached while I cared for her, but when she finally opened her eyes, they proclaimed nothing but, “fuck this mother fucking cancer.”

Maybe it was all the “fucks” that helped her live so long. To be honest, she was a tough patient to care for. She never made it off the ventilator and ended up getting a trach and a peg tube. She was anxious and it was difficult to communicate with her. She had strict rules about where she wanted her pillows and how she wanted her oral care done. Even with an endotracheal tube in her mouth, Dani had the most infectious and sincere smile. I asked her how she kept her teeth so white. She told me great smiles were genetic in her family and her grandma taught her to brush with baking soda and peroxide. Under my care, she was always impeccably groomed, because she wouldn’t have it any other way in normal life, no matter how bad she felt. She was constantly on the call light, but I was fine with it. I loved all of the “fucks” she gave because I knew I would be the same stubborn fucking way.

After she got her trach placement I could see her genuine smile even more. We spent time flipping through pictures on her iPad, working on physical therapy, making sure her skin stayed intact, and battling the recurrent infections she kept getting. I could tell Dani was typically a protector of people in her life; she was tough as nails. But weirdly, I felt a strong protective instinct over her.

One of the most important jobs of a nurse is to advocate for patients. In large, academic, hospitals, teams of residents swarm over patients with tunnel vision depending on their service. In Dani’s case, the plastic surgery team hovered daily, hoping she would recover enough to flap her gaping side wound. Realistically, I knew Dani would never recover enough to survive a flap surgery. However, every day, plastics would come in, wake her up, assess her wound, and emotionally stress her over the flap. Just to clarify, they did not want to hurt her, they wanted to help her, but didn’t recognize the big picture. Dani would never get the flap surgery and discussing the possibility of it stressed her to the point of needing medication to calm her. I can only imagine the thoughts it triggered. If she couldn’t survive a flap surgery, she knew she wouldn’t be able to survive the cancer, a fate she had never questioned before. Therefore, I would herd the team outside her room and tell them she was the same as she was the day before. Then, I would nicely coerce them to leave her alone.

Her mother-in-law went home after a month, but her husband was always by her side. As I ask all of my patients, I asked her what the secret was to staying married for so long. She told me never to sweat the small stuff. She liked to buy shoes, lots of them, her husband confirmed. He liked to golf obsessively, she rolled her eyes and laughed at him. Those quirks were never worth fighting over in the grand scheme of things. She also had her own life. She stayed busy despite her illness and was an active mother. She had loads of friends and seemed to be the one who lit up every room she entered. Actually, knowing her, it was more likely that she ignited every room with roman candles and sparklers; you could feel her vibes from the doorway, even at her weakest.

I was caring for Dani at a time of my life when I was beginning to burn out. I was burning out from school, work, and just life in general. She was such a motivator for me to keep going. On days I was on the unit, but not her primary nurse, I would always stop by and say hello. After she transferred off the unit to intermediate care, I would visit her. She was the only patient I ever visited after leaving the unit. I typically try to keep an arms length from patients to protect my emotions, but I just couldn’t with Dani.

I brought her large, vibrant, pictures of flowers to hang in her dull hospital room and sometimes her husband would take a break when I would arrive to see her. We never talked about her cancer or how she felt in general. I never had to ask because I already knew. Dani had used denial as medicine up to this point and it had worked, but she knew it wasn’t going to work this time and it scared her. Doctors and nurses, including myself figured her care was likely futile, but she refused to let go. She would not entertain the thought of death and would shut down any attempt at the conversation. Therefore, death remained the elephant in the room while we talked about how much we loved our dogs, our travels, and the beauty of life despite the inevitability of death.

As the weeks progressed, Dani began the pattern of infection, then respiratory distress, transfer back to the ICU, recovery, transfer back to intermediate care, then back to the ICU again. On our last visit together, she talked a lot about her daughters and how much they meant to her. She had been in the hospital almost two months at this point and her best friend had flown in to be at her bedside. Once again, they showed me more pictures on the iPad and told stories of their relationship. I hugged Dani goodbye, not knowing it would be the last time I saw her.

The day after I saw her, I completely burned out and had to take time off work. Dani had always promoted self-care. Even though she had multiple lung resections and countless rounds of chemotherapy, she was a runner, ate healthy, slept as much as she needed, and made no apologies. Dani recognized that she was as responsible for her own health as her doctors and other providers were. She was constantly telling me to take care of myself, so I did. I thought about her every day I was away.

Once I returned, I learned Dani had died almost three months after her admission. I don’t know the details of her death except I imagine her loss to have been felt deeply by many. She was just the type of person who affected everyone she met in one way or another.

Years later, I still think of Dani frequently, especially when times are tough. I learned so many lessons from her. As a nurse, I learned that everyone has her or his own way of dying even when it may seem obvious the care we are providing is futile. Sometimes you will never understand your patient’s internal struggles, so you just have to be there to support them along the journey.

As a person, I constantly strive to live the way Dani did. Make no excuses, take care of yourself because you only get one body. If you’re going to love, take it seriously – love deeply and truthfully, and appreciate every minuscule, beautiful, aspect of life. Be honest with people, because sometimes you have to break a heart to save a heart. And although it sounds simple, it takes more courage than most have these days. Finally and philosophically, Dani arrived with a bang, a paranormal sort of force, went out with a jolt of reassuring silence, and radiated life to everything in between. What better way is there to live than that?