The 12-year-old girl wasn’t feeling well, so she stayed home from school. Curled up under a blanket on the couch, which is where her mother found her in the afternoon, her skin hot to the touch and her breaths coming hard and fast. They rushed to the emergency department. The local emergency department quickly realized the girl needed more help than they could provide. The ambulance taking her to the large tertiary hospital flew so fast, the girl’s mother lagged behind in her car, and the girl arrived alone.

I was the junior resident who met her at the tertiary hospital ER. She arrived sitting bolt upright but sagging, tired, respiratory muscles unable to stop their work in fighting for her life. I hurried to assemble the tools we would need for intubation, to give her the rest she needed before she was too tired to continue the fight. Her opaque, clouded lungs on the x-ray frightened me. This was no typical respiratory infection.

As I checked and double checked my equipment and medication dosing, Mike, an experienced respiratory therapist I knew well, stood by the head of the bed with me. His tools were ready, too, but his focus was on the patient. He leaned his head of curly hair close to the patient’s face, the corners of his eyes crinkling in a smile while hers stood wide with terror. Her mother wasn’t there, but we could not wait. He took her hand. “It’s going to be all right,” he said. “Don’t worry. We’ll take good care of you.”

As we moved on to administering the medications, and her eyes closed, I considered his words. What he had said did not seem accurate, and that bothered me. Why had he told the patient that it was going to be all right? To me it seemed entirely unclear that it would be. In fact, this was the sickest child that I had ever encountered, and I felt sure she was in grave danger. I believe it is important not to mislead, and choose my words carefully. She was a child, and she was scared and alone, and Mike's attempt at kindness was understandable. Still, was it right to tell her a lie about her prognosis?

After we transferred her to the pediatric ICU, I watched her story unfold in the coldly technical prose of the medical record. Sepsis immersed her, and the oxygen levels she needed grew further and further away. The team caring for her tried to arrange for her to undergo ECMO, but she was too fragile to be transported. The progress notes grew increasingly frequent as the systems of her body struggled and failed. It was only 2 days later that I saw the last notation in the chart pronouncing her death. My heart was heavy each time I thought of her. My face was the last face she saw, my voice the last she heard. This should not have happened. Why couldn’t her mother have been there with her? I thought again, regretfully, about Mike’s words. It wasn’t all right. It was terribly wrong.

It's been many years since my young patient died of necrotizing MRSA pneumonia, but I remember her still. Now when I am faced with a patient gasping desperately for air, or when I pull up an x-ray to find lungs submerged in a sea of white clouds, I’m all too aware that mine might be yet again the last face they see. I feel the weight of wanting to tell them something before they go. When they look at me with terror widening their gaze, I want to tell them something that will bring them peace. As I wrestled with the best way to approach this situation, a friend said something that made me think of Mike. “Everything will be all right in the end. If it’s not all right, it’s not the end” (attributed to Fernando Sabino, Brazilian writer and journalist. “No fim, tudo dá certo. Se não deu, ainda não chegou ao fim”). The more time goes on, the more I see the truth in these words. The more I need to see it.

While battling through waves of the COVID-19 pandemic, I’ve seen more patients than ever who come to me struggling for breath. Their oxygen levels fall, and I fear they might never rise again. When I tell them that a ventilator is the only way through this, I can see fear is coursing through their vessels as quickly as blood. Their faces are already asking me “Is this it? Is this the end?”

I’ve stopped doubting the right thing to say. I pause amidst the chaos. I take their hand in mine and I tell them sincerely, “It’s going to be all right.” And I truly believe what I’m telling them. I’ve got to believe it, for my own soul as much as for theirs. If it’s not all right, it’s not the end.