Excerpt from Internal Medicine by Terrence Holt, plus links to reviews, author biography & more

"Yeah," I said. "Nurse? Bring me four of Ativan. And another four of morphine."

I knew the risk: knock her out too far and her respiratory drive would suffer; she'd lose her airway; she'd suffocate. But she was going to die this way, too. I watched, holding my breath as the drugs went in, trying to remember the doses of naloxone and flumazenil that would reverse these, if I had to.

Her breathing settled still more. Her eyelids fluttered and fell. "Get a mask on her," I said.

In a minute the tech had her fitted with an elaborate device that gripped her face like a diver's mask. There was no protest. The pulse-ox rose steadily to ninety, ninety-one, settled at ninety-two. I let out a sigh.

This time I did sleep. I must have, because my pager woke me from a dream of too many inscrutable objects, none of them fitting together, a puzzle I had to solve.

"Doctor? Twenty-six. She's fighting the mask."

SHE WAS SITTING UP, crouched as if clutching some secret to her chest. The mask was pushed up onto her forehead. Her shoulders rose and fell, rose and fell. She didn't look up as I entered; her gaze lay burning on the opposite wall.

The pulse-ox was eighty-two.

I laid a hand on her shoulder, could feel her bones working as it rose and fell.

"Mrs. B."

She shook her head.

"We've got to do something."

She shook it again.

"What can I do for you?"

Her hand waved me away.

I stood beside her, watching her breathe, for a very long time. She lay on the bed within reach of my outstretched hand, within the sound of my voice, but behind the wall of her fatigue and her breathlessness, sunk deep in her adamant gaze, she was unreachable. Unreachable by me. I wondered if she even knew I was still there, and felt suddenly a revulsion— not at her, but at my own presence in her room.

Her pulse-ox was eighty-two.

"Call me," I said to the nurse, "if she changes."

AROUND SIX A.M. I was sitting in the call room, trying to shake myself awake. My pager went off. It was the eighth floor. The room was different now. Light was striking in through the window, a dozen rising suns reflected off the opposite tower. The room was bright and still.

Fast asleep, even comatose, a living body moves. The chest expands, the nostrils flare, the eyelids twitch; pulses stir the skin, and over all of these there hovers an inarticulate hum of life. But a dead body is only that: dead, a body, given over to gravity and decay. The muscle tone that lends expression to the face is gone; the face is slack; the skin gone gray-green with the absence of blood (underneath, if you turn it over, you will find pooled at the backside a livid bruise).

I went through the motions of declaring death. Her eyes took my flashlight passively, the beam falling into the cloudy darkness of her pupils without a sign. I laid a stethoscope on her chest: only sporadic pings and creaks, sounds of a building settling in the night. Her flesh was cold, malleable, inert. There were papers to fill out: organ donation, autopsy permission, the death certificate. I puzzled over "Cause of death," wondering just what process I had failed to reverse.

Respiratory failure, I finally wrote, secondary to pulmonary fibrosis, secondary to systemic sclerosis. The last line asked if any underlying medical conditions (diabetes, hypertension, for example) had contributed to the patient's demise. I looked at that a long time, and finally left it blank.

By the time I was done, the hospital had come to life around me. The intern who had signed out Mrs. B to me scratched the name off her patient list.

Keith, the resident, appeared on the floor just before rounds got under way. "How was your night?"

I told him. He listened to the story, pulled his lower lip, shook his head.

"You should have called me."

I flinched. "What would you have done?"

Excerpted from Internal Medicine: A Doctor's Stories by Terrence Holt. Copyright © 2014 by Terrence Holt. With permission of the publisher, Liveright. All rights reserved.