On Its Own Terms: An ICU Nurse Considers Human Adaptability

By Marcy Phipps, RN, a regular writer for this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN. Some of the patient’s identifying details in this post have been changed to protect privacy.

by ashraful kadir/ flickr

by ashraful kadir/ flickr

I caught an airing of The Shawshank Redemption the other day. It’s one of my favorite movies—full of irony and rich with messages of hope and perseverance.

There’s one line from the movie, in particular, that I love:

“Get busy living, or get busy dying.”

It’s one of my favorite movie quotes, and one that plagued me at work recently as I took care of a woman who’d suffered such a high-level fracture to her cervical spine that her injury was compared to an internal decapitation.

Her doctors had talked with her and her family at length about her injuries and prognosis, and although she’d initially indicated that she wanted to withdraw aggressive care, as time passed her directives became inconsistent—she’d tell her husband one thing, her medical team something else. On the day I was her nurse, she looked at me and very clearly mouthed the words “I don’t want to die,” then shut her eyes tight, ending our brief conversation as effectively as if she’d stood and left the room.

I think that most of the time, at least in the ICU where I work, people aren’t “getting busy” living or dying, but instead are taking very small steps in one direction or another, having been forced by illness or injury into a stillness that looks like limbo.

The more I considered exactly what my patient had said, the more significant it seemed that she hadn’t actually said she wanted to live, but that she didn’t want to die. I’ve come to interpret her words as an acknowledgment that the life terms she’d been left with were unacceptable—but that she’d take them, nonetheless.

She didn’t die. She’s been in our unit for some time, and neither she nor her family members discuss her directives anymore. I wonder if she’s at peace with her decision, although it may be too early to say. It’s not something I want to ask.

We pull her into the cardiac chair and position her in front of the windows. As I look past her I see the birds fly by and the summer clouds building into beautiful lofty thunderheads. I watch her devoted children tend to her during their visits; they bring her paintings and read her lips with ease.

And I know that if I were in her shoes, I’d grasp just as tightly to this life.

Bookmark and Share

Chief flight nurse at Global Jetcare.


  1. shelly December 11, 2013 at 11:31 pm

    Very insightful article. I too am an ICU nurse and have encountered numerous situations like this and the self reflection it induces. The precarious nature of life is ever present especially when you work in the hospital setting. However, sometimes i think in this society, ppl are so afraid of death that they are willing to cling to any form of life. It pains me sometimes to see how far we go just to prolong the quantity of time left in a person’s life instead of the quality. But for me, I have come to terms with the inevitability of death and therefore appreciate each day with a thankful and peaceful frame of mind.

  2. Mark&Mary June 1, 2013 at 10:22 am

    We like your intelligent compassion, your writing and your wild red hair

  3. Paul Schmidt May 30, 2013 at 10:18 pm

    Powerful stuff here, and a great illustration of the life or death dilemmas facing healthcare professionals and patients on a daily basis. Most people can’t imagine being in that situation, and you did an eloquent job of shedding some light on this extremely delicate issue.

Comments are moderated before approval, but always welcome.

%d bloggers like this: