I had a patient in my icu, who wasn’t unknown to us, she first came to us, then went to a skilled nursing facility, where she’d get sick, come back to my icu, get better enough to go back to her SNF, a few months later get sick and come back to us, rinse and repeat.

(I want to be very clear, it was not at any fault of the SNF (skilled nursing facility/ long term acute care facility), it was her disease process and was expected and unavoidable)

And one day she’s my patient and the doctor has already arranged her discharge back to the SNF again, she’s decently with it, a lil pleasantly confused but still can tell me where she is, why she’s here, what year it is, all the things, but still gets a lil confused.

I’m chatting with her and she says “I’m going home today.” And I clarify that she isn’t going to her house, she’s going back to the SNF, and she waves me off and says “no, I’m going HOME. Not back there, I’m going HOME.”

Her family comes in and it’s the same convo, they’re trying to make her understand that she isn’t going back to her house, and she’s like “yeah I’m not going to my house, I’m going HOME.”

Strangers walking past her room, she’d wave them down and joyfully tell them she was going HOME today, come say goodbye and give me a hug, I’m going home.

And in the middle of me trying to explain AGAIN that I’m not sending her to her house, but to her SNF, transport is on the way to come take her back to the SNF, and that’s why I’m packing up her things, her eyes just roll back into her head and she goes asystole. She straight up died on me.

I should have known, she was devoutly Christian and growing up in the church, dying was often referred to as being called home. I should have caught that nuance.

She was serious, she went HOME. She knew and was trying to tell us. But she wasn’t scared, she was happy telling everyone and saying her goodbyes, even to strangers, she was done, and made her exit.