Visiting The Gates Of Hell

March 15, 2014

Health, Intensive Care, Medicine

The Gates of Hell

I am writing this post on my phone, in a waiting room, just outside the gates of hell, and I’m delighted not to have been invited in. This particular hell is an English intensive care unit (ICU) and all the patients inside are in constant pain or extreme discomfort, and have either been or are very close to touching the shadow of death.

Drips, tubes, masks, respirators and all the paraphernalia of modern science are employed in the task of playing God and performing the essential functions of life. The smell of urine, sweat and feces blends imperceptibly with the scent of fear and disinfectant to produce the distinctive odor of ICU’s world-wide.

The lowest orderly has total power over each patient, jabbing, squeezing, inserting, manipulating and otherwise controlling body parts. Degradation and humiliation are always the friends of powerlessness and nobody has less power than an ICU patient. God periodically  passes through the ward in a green coat surrounded by a huddling,  chattering mass of respectful gofers. The devil is a regular visitor too, claiming his pound of flesh. You know he is there because you see the rush of curtains pulled around the bed, the frenetic activity to reverse what cannot be reversed, the sudden quietness…

Each bed is a world in microcosm brimming with the dashed hopes of a life crushed by sudden misfortune. The colorful panel of flashing numbers and graphs reel off life’s vital statistics, not in coffee spoons, but in the raw physicality of breaths and heartbeats. Humanity is represented, not by the patient, who has all but been reduced to the periodic table, but by family members struggling to convey love, hope, humor and compassion to the memory on the bed.

The memory I have been visiting is just that, a shadow of his former self. A 64  year old man reduced to a child  and locked in the decrepit body of a 90 year old. He is only alive because of the ICU but he is also only alive by its definition, rooted as it is in the crudest physicality. Rest in peace David.


“The public blames the medical profession for giving too many tranquilizers and antidepressants. But what would you do? Doctors like to see healing as the result of their work. Yet today we often must be content with far less. There are so many things wrong with people’s lives that even our best is only a stopgap.”
   Richard A. Swenson, MD
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About Malcolm Greenhill

Malcolm Greenhill is President of Sterling Futures, a fee-based financial advisory firm, based in San Francisco. I write about wealth related issues in the broadest sense of the word. When I am not writing, reading, working and spending time with family, I try to spend as much time as possible backpacking in the wilderness.

View all posts by Malcolm Greenhill


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40 Comments on “Visiting The Gates Of Hell”

  1. chr1 Says:


    Nice to hear from you, and hope you’re doing well.


  2. sally1137 Says:

    I’ll say a rosary for David.


  3. Jon Sharp Says:

    Sorry about your friend Malcolm. I suppose sometimes there just aren’t any satisfactory solutions to the situations we encounter. I wish you all the best,


  4. Anne Says:

    I’m sorry you have lost someone you care about. Your reflections on the ICU, its people and activities are very poignantly expressed. They evoked many memories. Thank you.


  5. Inion N. Mathair Says:

    I hit the like button though I’m not sure why! And I don’t mean that in a bad way Malcolm. This post was heartbreaking but utterly truthful & as all your posts are…Brilliant! First, our sympathy to you! We lost three family members in a very short time (matter of a few months.) Mesothelioma. I don’t know how my mother & Nana survived after that. All 3 men we’re “old-school” & chose to die at home, making my mother & Nana their caregivers to the grave & making it a Nightmarish ring-side event for me & my brother. It’s a part of life I know, but it sucks! And contrary to what every soothe sayer, tries to say…there is no fu****g closure! Not if you really loved someone. Hang in there dear friend! ❤


    • Malcolm Greenhill Says:

      I am very touched both by your warmth and the personal ordeal you were kind enough to share in this comment. How to die with dignity is not an easily answered question and clearly there are as many downsides to dying at home as there are to dying in hospital. We have to have more debate on this subject because I second Tahira’s comment that there is nothing worse than a bad death.


  6. Tahira Says:

    Malcolm, I am an ICU nurse. I have witnessed families imagining that there could be nothing worse than their loved one dying. But in fact, there are things worse – Having someone you love die badly. The culture in ICU’s is to “sustain life” at whatever cost.
    There is hardly anything more gratifying than having a patient recover and walk out of an ICU. But on the flipside there is nothing more soul crushing than seeing the “dying badly”.

    Where do we draw the line between sustaining life and dying with dignity is a great question that I wish more people would ask.


    • Malcolm Greenhill Says:

      Tahira, I appreciate your input. I have seen too many people die in ICU’s without dignity because no distinction was made between, say, a heart attack at age 65 where every effort should be made to sustain life, and one at age 90 where the body is simply saying ‘enough is enough’. In societies where there are strict laws governing the behavior of doctors and nurses in these situations it is often left to informal ‘negotiations’ between medical staff and relatives to inject some humanity into the situation, for example, acceding to the request of relatives that no ‘heroics’ be taken to prolong life. I wonder whether this is the same in Saudi Arabia?


  7. jan Says:

    Dear Malcolm, I am so very sorry to hear this sad news, could you email or text us. Big love always J n S, H, J XX


  8. NicoLite Великий Says:

    Like for the thoughts. And condolences for David. I spent two nights in the ICU as a patient ca. 10 years ago, and having been so close to death at that time, I could swear I felt another patient giving his due to Charon


  9. Martin Button Says:

    I assume it’s your brother in there. So sorry to hear he is worse. Take care and be strong. M

    Martin E Button. Cosdel International Transportation. iPhone


  10. Bill Hayes Says:

    Sorry for your loss Malcolm. I always find hospitals quite dehumanising. I look forward to you being back to your chirpy self in due course.


  11. Dalo 2013 Says:

    Very powerful post Malcolm, and it must be such a draining experience…your writing brings it right to our door. Wish you the best.


  12. Holistic Wayfarer Says:

    M, you leave me hardly with any words. This is one of the most compelling, touching, best written pieces here. And I know literary panache was not on your mind.

    “God periodically passes through the ward in a green coat surrounded by a huddling, chattering mass of respectful gofers. The devil is a regular visitor too, claiming his pound of flesh. You know he is there because you see the rush of curtains pulled around the bed, the frenetic activity to reverse what cannot be reversed, the sudden quietness…”

    I deplore hospitals – which had a little to do with my having my son at home. I can go on but could not add to the disturbing beauty and ugliness in this post. Hope you don’t worry about resuming blogging right now. And I hope you can feel my heartfelt support. Sorry it’s so difficult.



  13. Gregoryno6 Says:

    Sad news about your friend.


  14. Daniela Says:

    Dear Malcolm,

    I cam over to yours so say ‘hi’ … only reading this post brought me to tears for it is touching and compelling on many levels. It is also raw, haunting and disturbing. As I am sorry for the sadness you are experiencing, I am also grateful to you for writing it.

    Death is part of life … we should be allowed to die with the same dignity we have lived. With ever expending advancement of modern medicine it seems harder and harder to distinguish when to fight to save life and when to stop … to ensure peaceful, dignified end.

    Take Care,


    • Malcolm Greenhill Says:

      Daniela, you put your finger on the essence of the problem. The Greeks and Romans wrote tomes about the ‘good death’ but we seem to have forgotten the concept. Instead we insist on fighting death until the last moment in every single case, ensuring that most of us will die in an ICU or at least a hospital, surrounded by strangers rather than family and often without time to do the ‘business’ of dying i.e. wrapping up one’s affairs and/or saying the things that need to be said.


  15. Michele Seminara Says:

    Powerful writing, Malcolm. You say what needs to be said, and I appreciate that.


  16. The Savvy Senorita Says:

    Such a powerful post Malcolm. My heart goes out to you and those you hold dear. Take care, Bex


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