I pushed the tip of my finger ever so slightly into Mr. N's open eye. He did not blink. He now had a doll's eyes, fixed and dilated. The friendly intern spoke to me across the bed, over Mr. N's naked body. "I hate doing this," her face genuine. "I feel like I'm hurting them." I copied her, my teacher; I took Mr. N's limp hand and squeezed his thumb, straight down on his thumbnail, as hard as I could. He did not flinch.

He was gone, although we had just shocked his heart back into rhythm. I bagged him as we waited for the ICU nurse to take him downstairs. I grew accustomed to the spontaneous breaths he took every 15 seconds. Deep cyclic heaves lifted his chest, filling his lungs. They meant nothing.

Two days ago Mr. N was sundowning. He had broken free of his restraints. His spasmodic arm flailed behind the curtain and nearly shoved my resident into the neighboring bed. I stood in my usual position. Over his familiar shoulder, my teacher; his steady assured hand, its extension a 16 gauge needle that pierced through young Mr. O's stomach. I was jealous. I wanted to relieve his ascites. I wanted to drain five liters out of Mr. O's protuberant belly, from sterile needle to clear plastic tube to glass bottles, five of them. The fluid was amber. It was beer, down to the frothy head at the top of the jars. Young Mr. O. saw it too. An alcoholic, I wondered if he was reminded of beer as well. I couldn't help but chuckle over the irony of it all. I no longer felt guilty.

Two days ago Mr. N broke free of his restraints and tried to climb out of bed. I held his arms down and gently pushed him back. No Señor, you have to stay in bed. No si puede. I couldn't remember what to say, how to say it. He couldn't understand me anyway. I turned back to my resident, and waited.

We didn't catch the Klebsiella in his urine. The computer held the secret from us, a mouse click away. Too late. Mr. N was already lost in delirium, his blood soaking the white sheets of his gurney. He didn't know that he ripped his foley out from his penis, he didn't know that it had torn his flesh open, easy access not for us but for the Klebsiella to venture into his bloodstream.

My resident thinks that's what did it, the event that led him to crash. My attending says he had urosepsis all along, and it was inevitable. I should think as they do. This is Medicine, this is what should become as mechanical as squeezing air into lungs. They are detectives, and I am no more than dear Mr. Watson. No matter. Mr. N is dead by now. The first code in a night of four. My last and best call, by far.

Karen is a member of the Class of 2007