I did what all good interns would do in the same situation. I rolled my eyes in the direction of the ER resident and waited for his response.
You have to be the sieve....the sieve.
We all did it. Stonewalled the ER in hopes that they would send our new admission packing. It rarely happened though. Somehow each admission always made it up to the floor. There was no turning back once the papers were filed and the bed was assigned.
Scottie was no different. His twenty year old body was fit and lean. His chest moved up and down in a rapid rhythm. I took my time examining him. As we talked his respiratory rate slowed. I placed my stethoscope on his chest. Maybe a few wheezing sounds but I had my suspicions that they came from his neck and not his lungs.
The paperwork classified him as an admission for asthma and bronchitis. My resident and I were doubtful. Scottie wanted, not needed, to be in the hospital. We just couldn't figure out why.
*
I spent the next three days trying to convince Scottie to go home. By day I would find him sleeping in bed with the covers pulled over his head. At night he awoke. His cell phone dangling from his tattooed arms. He teased the doctors and nurses. He convinced the dietary staff to bring him extra portions. He was king of the ward.
His charm was his greatest weapon. He smiled. He cajoled. He begged. But as another call day was approaching, my resident and I became more stern. We had to clear our census for the next onslaught of patients.
As I wrote the discharge prescriptions, Scottie tried again.
If I leave today I'll die out there. I just need more time!
By now I was immune to his pleas. His lungs sounded great and he was ready to be discharged. He pulled his hat over his eyes and his pants fell low on his waste. A few of the nurses gathered to wish him well. They whistled and catcalled as he disappeared through the hospital doors.
*
A few days later I was paged to the ER at three in the morning. As I yawned and rubbed the sleep from my eyes, A man dressed in sports coat approached from the door. He wore a cowboy hat and boots and I could see the outline of a gun tucked behind his coat.
He introduced himself as a detective from the St. Louis police department. He reached deep into one of his pockets and produced a tattered piece of paper. He held it up in front of my face. I squinted to read the writing. It was a set of discharge instructions with my signature at the bottom.
We found this in Scottie Pearson's back pocket. He was shot in the head and dumped in a field.
*
Scottie's story quickly spread among the physicians in our program. Everyone had a different idea of why he was hiding out in the hospital. Was it drugs? Gangs? Organized crime? A love triangle?
For many, Scottie became another memorable book mark in a series of odd and difficult experiences that marked our years in training. But as I get older, I think more about what he really had to teach me.
As so often happens in our lives, Scottie was trying to tell me exactly what he needed. Although I heard his words, I kept trying to interpret them based on my own point of view. Clearing my patient census for my next call rotation was more important to me then keeping him in the hospital. Sure I justified my actions by saying that he was healthy. But I never took the time to step outside of my own space to understand his.
Whether professionally or personally we all express our deepest needs to the people around us. Years ago, Scottie was trying to tell me his.
I just wasn't listening.
Saturday, October 1, 2011
Friday, September 30, 2011
The Ties That Bind
I saw a familiar face amongst the crowd of children dusting the snow off their boots and replacing them with soccer shoes. My wife and I stood in the corner and watched our daughter run into the middle of the gym and socialize with a group of little girls.
As the woman approached I realized she was a former patient. After a brief exchange of greetings her eyes opened wide and she developed a lump in her throat. She turned to my wife.
Your husband saved my life!
She then excused herself to fetch her parents who were helping her daughter get changed for practice. She wanted them to meet me.
*
I will never forget the early morning during residency when I struggled into the hospital with the stomach flu. Between each patient I had to run to the bathroom to vomit. It was one of the hardest days of my career.
Or the time when one of my fellow residents showed up for a weekend on call yellow. Literally yellow from jaundice. It took several hours to convince him to go to the emergency room. Fortunately it was just a bad case of Mononucleosis.
So when Sheri arrived for her ICU shift with a severe headache, she sucked it up like everybody else. As the night progressed, however, she knew something was wrong. Her vision became blurry. Her speech started to slur.
The nurses put her in a wheel chair and sped her through the maze of passages to the emergency room. Upon arriving she had her first of several seizures. Two weeks later she would leave the hospital for a rehab facility with a diagnosis of terminal brain cancer and a fresh scar on her head to prove it.
Sheri struggled over the next few months. She measured life's ups and downs with little triumphs. By the time she walked down the isle with her long time boyfriend, she used only a cane.
A year later she was rounding with the rheumatology consult service. She was no longer a resident but she didn't want to abandon her life's work. She missed every other day for chemotherapy, or radiation, or doctors appointments.
Her life had been extended but her clock was still ticking.
Each resident regarded Sheri in a different manner. Some ignored her. Others acted like nothing had happened. And some of us struggled to treat her as if she was anyone else going through something horrible. We walked the tightrope between caring and melodrama.
After leaving residency I would never hear of Sheri again. A decade later I assume she is dead.
*
As the soccer game began my wife stood by my side smirking. She knew how uncomfortable I was with public recognition.
After all, I didn't really do that much for the woman. She came to me with a mild case of post partum depression. We talked about medications and therapy. But mostly we just talked. I was also a new parent. Like her, I was exhausted and overwhelmed. I was tired all the time.
For brief moments, during our visits, we felt like fellow soldiers in a an arduous battle. Apparently, for her, the personal connection did more then medications or therapy could.
And I thought of my residency program. I thought of my years as an attending. As physicians we spurn our own personal illness as if it does not exist. We stand above it as if we are superhuman. Our patients may get sick but not us. We try to lift ourselves out of the fray.
But what if our own mortality serves a purpose?
What if our frailty is neither embarrassing nor an Achilles heal?
Maybe. Just maybe.
It is the tie that binds.
As the woman approached I realized she was a former patient. After a brief exchange of greetings her eyes opened wide and she developed a lump in her throat. She turned to my wife.
Your husband saved my life!
She then excused herself to fetch her parents who were helping her daughter get changed for practice. She wanted them to meet me.
*
I will never forget the early morning during residency when I struggled into the hospital with the stomach flu. Between each patient I had to run to the bathroom to vomit. It was one of the hardest days of my career.
Or the time when one of my fellow residents showed up for a weekend on call yellow. Literally yellow from jaundice. It took several hours to convince him to go to the emergency room. Fortunately it was just a bad case of Mononucleosis.
So when Sheri arrived for her ICU shift with a severe headache, she sucked it up like everybody else. As the night progressed, however, she knew something was wrong. Her vision became blurry. Her speech started to slur.
The nurses put her in a wheel chair and sped her through the maze of passages to the emergency room. Upon arriving she had her first of several seizures. Two weeks later she would leave the hospital for a rehab facility with a diagnosis of terminal brain cancer and a fresh scar on her head to prove it.
Sheri struggled over the next few months. She measured life's ups and downs with little triumphs. By the time she walked down the isle with her long time boyfriend, she used only a cane.
A year later she was rounding with the rheumatology consult service. She was no longer a resident but she didn't want to abandon her life's work. She missed every other day for chemotherapy, or radiation, or doctors appointments.
Her life had been extended but her clock was still ticking.
Each resident regarded Sheri in a different manner. Some ignored her. Others acted like nothing had happened. And some of us struggled to treat her as if she was anyone else going through something horrible. We walked the tightrope between caring and melodrama.
After leaving residency I would never hear of Sheri again. A decade later I assume she is dead.
*
As the soccer game began my wife stood by my side smirking. She knew how uncomfortable I was with public recognition.
After all, I didn't really do that much for the woman. She came to me with a mild case of post partum depression. We talked about medications and therapy. But mostly we just talked. I was also a new parent. Like her, I was exhausted and overwhelmed. I was tired all the time.
For brief moments, during our visits, we felt like fellow soldiers in a an arduous battle. Apparently, for her, the personal connection did more then medications or therapy could.
And I thought of my residency program. I thought of my years as an attending. As physicians we spurn our own personal illness as if it does not exist. We stand above it as if we are superhuman. Our patients may get sick but not us. We try to lift ourselves out of the fray.
But what if our own mortality serves a purpose?
What if our frailty is neither embarrassing nor an Achilles heal?
Maybe. Just maybe.
It is the tie that binds.
Thursday, September 29, 2011
The Place Between Grief and Guilt
When Donna spoke of the "old bag" it took a moment to realize that she was not being self referencing. Although her left arm laid limply at her side, her right hand clutched a small purse. It was old but sturdy. I imagined it was from the 1920's. One of the handles was slightly eschew and had recently been repaired. Her fingers moved across the fabric rhythmically, absentmindedly.
She explained that the purse belonged to her mother. It was stowed away until Jessica, her granddaughter, came upon it while foraging through the closet. Since that time the two were inseparable.
Jessica would race around the house with the bag tucked under her arm. She refused to carry it properly because the handle was dangling by a thread and she didn't want it to break.
The bag followed her everywhere. When Jessica and her brother would sleep in the guest room, Donna would see the bag standing proudly on the side table basking in the glow of the moonlight.
*
As I examined Donna, I thought about how similar she was to the adornment that sat next to her on the examining table. She was well into her seventies. Fine stitching and excellent craftsmanship. A repair here and there, but generally in good shape.
I took a look at her left arm. The surgical site was clean. Her strength and range of motion were perfect. Her stitches had long been removed but her scars remained. Although functionally proper, the arm fell back lifeless by her side. Donna looked the other way as if it didn't exist.
Memories from the accident were starting to return.
*
Donna remembered waking up confused. She was grasping the small purse that was last in Jessica's hand. The strap was broken and it was speckled with blood. Her grandson was screaming in the back seat.
She remembers the orthopaedist leaving the room after placing her cast. The emergency room doctor returning with eyes shining with empathy. He held her hand and told her that Jessica was gone.
Donna remmebered how the room suddenly became still. How instead of screaming or crying out in anger, she felt she had to concentrate very carefully. She heard the words but she couldn't understand the meaning.
But her brother sitting next to her...not a scratch.
The doctor's eyes became cold and distant. He turned his head away as he continued.
When the back of the car was crushed.....
Donna was no longer on my examining table. Her eyes were blank and looked up towards the ceiling.
She was lost in the place between grief and guilt.
Her words were monotone and spoken into the air as if to no one in particular.
Unlike that old purse and I, Jessica's sins were shockingly innocent.
As most girls of a certain age, she was just a little bit
too tall.
She explained that the purse belonged to her mother. It was stowed away until Jessica, her granddaughter, came upon it while foraging through the closet. Since that time the two were inseparable.
Jessica would race around the house with the bag tucked under her arm. She refused to carry it properly because the handle was dangling by a thread and she didn't want it to break.
The bag followed her everywhere. When Jessica and her brother would sleep in the guest room, Donna would see the bag standing proudly on the side table basking in the glow of the moonlight.
*
As I examined Donna, I thought about how similar she was to the adornment that sat next to her on the examining table. She was well into her seventies. Fine stitching and excellent craftsmanship. A repair here and there, but generally in good shape.
I took a look at her left arm. The surgical site was clean. Her strength and range of motion were perfect. Her stitches had long been removed but her scars remained. Although functionally proper, the arm fell back lifeless by her side. Donna looked the other way as if it didn't exist.
Memories from the accident were starting to return.
*
Donna remembered waking up confused. She was grasping the small purse that was last in Jessica's hand. The strap was broken and it was speckled with blood. Her grandson was screaming in the back seat.
She remembers the orthopaedist leaving the room after placing her cast. The emergency room doctor returning with eyes shining with empathy. He held her hand and told her that Jessica was gone.
Donna remmebered how the room suddenly became still. How instead of screaming or crying out in anger, she felt she had to concentrate very carefully. She heard the words but she couldn't understand the meaning.
But her brother sitting next to her...not a scratch.
The doctor's eyes became cold and distant. He turned his head away as he continued.
When the back of the car was crushed.....
Donna was no longer on my examining table. Her eyes were blank and looked up towards the ceiling.
She was lost in the place between grief and guilt.
Her words were monotone and spoken into the air as if to no one in particular.
Unlike that old purse and I, Jessica's sins were shockingly innocent.
As most girls of a certain age, she was just a little bit
too tall.
Tuesday, September 27, 2011
Mastery
My son is standing in a crooked line of students with violins dangling from their chins awkwardly. As all beginners, they don't yet know what to do. They fidget uncomfortably and wait for the teacher to approach. She appraises each separately. Lifting the chin of one. Lowering the arm of another. The parents sit in desks in the back corner. We search our children for hidden signs of excellence. I wonder who will be the next virtuoso?
I contemplate mastery.
*
The white coat is finely pressed and stiff. It slides over my shoulders but refuses to conform to the shape of my torso. I take the stethoscope out of the pocket. It gleams in the sunlight. It is perfect. Free of blemishes or scuffs. It has not been used yet.
I feel like an untrained actor in a play for which I don't know the lines. I neither understand the posture nor the rhythm. Doctoring, at this point, is an elaborate game. The work of children.
I stand with my fellow students and recite an oath. We are being inculcated into a culture although we are still foreigners in a foreign land.
*
Bows have now been tightened and rosin applied. Ten sets of horse hairs meet ten strings. Each moves back and forth across the body of the violin. Squeaks and squeals emanate as parents look as if they want to plug their ears.
This is practice. The place where beginners start on the rode to mastery. The violin produces music but it is immature, tentative. Movement is neither novel nor comfortable.
Practice is an evolution. In can last lifetimes. Some will never leave this forsaken phase. Some will reach mastery for moments. They will perfect one composition or set. But they will continue to struggle.
*
My short white coat has been replaced with a longer one. My stethoscope dangles around my neck. The ear pieces no longer sting when placed correctly. My blue scrubs are warn and have black pen scrawled in various places for later use.
The hospital has become a second home. I walk with confidence because I know my surroundings. But I am still maturing. History and physical, labs and x-rays, assessments and plans. They are separate sections which need to be assembled and rejiggered. There is a lack of fluidity. A loss of buoyancy.
*
The teacher picks up her violin. The room becomes silent as she begins to play. Her posture lacks the tension of the beginners. Instead of playing separate notes she performs the composition as a whole. There are no pieces...just raw sound.
*
After years of practicing I feel closer to mastery. The tools of my trade are no longer foreign or separate; it is as if my stethoscope has become another extremity.
Doctoring has evolved from a process of parts. There is only the whole. The dance between care giver and patient.
I think in terms of composition. Less history and physical and more rise and fall. My mind spurns process. It is free to expand and contract.
Science has transformed into art. Each encounter its own small performance littered with both structure and free style riffs.
*
We run a risk when we interfere with mastery. When we replace the intuitive with the laborious.
The process experts will tell you that it is OK to add extra steps. An electronic medical record here, a check list there. Adding and subtracting tick marks.
We must remember that these experts understand composition no better then my young son understands how to play violin. They have an inkling. Their knowledge allows them to see the parts.
But their lack of mastery is blinding
and they can't see past them.
I contemplate mastery.
*
The white coat is finely pressed and stiff. It slides over my shoulders but refuses to conform to the shape of my torso. I take the stethoscope out of the pocket. It gleams in the sunlight. It is perfect. Free of blemishes or scuffs. It has not been used yet.
I feel like an untrained actor in a play for which I don't know the lines. I neither understand the posture nor the rhythm. Doctoring, at this point, is an elaborate game. The work of children.
I stand with my fellow students and recite an oath. We are being inculcated into a culture although we are still foreigners in a foreign land.
*
Bows have now been tightened and rosin applied. Ten sets of horse hairs meet ten strings. Each moves back and forth across the body of the violin. Squeaks and squeals emanate as parents look as if they want to plug their ears.
This is practice. The place where beginners start on the rode to mastery. The violin produces music but it is immature, tentative. Movement is neither novel nor comfortable.
Practice is an evolution. In can last lifetimes. Some will never leave this forsaken phase. Some will reach mastery for moments. They will perfect one composition or set. But they will continue to struggle.
*
My short white coat has been replaced with a longer one. My stethoscope dangles around my neck. The ear pieces no longer sting when placed correctly. My blue scrubs are warn and have black pen scrawled in various places for later use.
The hospital has become a second home. I walk with confidence because I know my surroundings. But I am still maturing. History and physical, labs and x-rays, assessments and plans. They are separate sections which need to be assembled and rejiggered. There is a lack of fluidity. A loss of buoyancy.
*
The teacher picks up her violin. The room becomes silent as she begins to play. Her posture lacks the tension of the beginners. Instead of playing separate notes she performs the composition as a whole. There are no pieces...just raw sound.
*
After years of practicing I feel closer to mastery. The tools of my trade are no longer foreign or separate; it is as if my stethoscope has become another extremity.
Doctoring has evolved from a process of parts. There is only the whole. The dance between care giver and patient.
I think in terms of composition. Less history and physical and more rise and fall. My mind spurns process. It is free to expand and contract.
Science has transformed into art. Each encounter its own small performance littered with both structure and free style riffs.
*
We run a risk when we interfere with mastery. When we replace the intuitive with the laborious.
The process experts will tell you that it is OK to add extra steps. An electronic medical record here, a check list there. Adding and subtracting tick marks.
We must remember that these experts understand composition no better then my young son understands how to play violin. They have an inkling. Their knowledge allows them to see the parts.
But their lack of mastery is blinding
and they can't see past them.
Monday, September 26, 2011
The Stories Of Our Lives
Lisa clutched at the tissue dangling from her hand as we settled into an awkward silence. The only sound in the room came from her seven year old son obliviously sitting in the corner. He violently smashed two toys together and then made laughable siren noises while reaching behind to grab a miniature police car.
We stared in his direction content to have a distraction from the intensity of our conversation. In the lull that followed my thoughts wandered back to childhood. I remembered the day my father died.
*
My mother is lying in bed. Her head is barely visible hidden under floppy curls of disheveled hair. She is thirty seven years old. My childish body struggles to climb over the ledge as I flop onto her comforter. My older brothers are busy entertaining the crowd of people who wander in and out of the house at random intervals.
I watch as her body heaves up and down slowly. She is weeping. I place my hand on the part of the blanket that is covering her shoulder. I know that there is something wrong but at seven years old I don't have the intellectual capacity to understand.
I feel the faint excitement of missing school but I am distressed by my mother's grief. I coax her gently.
Mommy. Lets go out and play.
She lifts her head and looks over in my direction. She smiles faintly.
Maybe in a few minutes honey.
The adult in me wishes I could reach back and comfort her. Tell her that although happiness had left us, it would return eventually. Assure her that her boys would grow up to be successful men. Touched by their father's death but not destroyed by it.
Remind her that our greatest gifts are bestowed upon us not only by our triumphs but also by our sufferings.
*
The police car has now pulled up to the fake crash seen. Lisa gasps as she realizes that her son is using toys to reenact her husbands fatal accident. Her eyes fill with tears as she turns her head towards me. She is drowning.
I have already accepted my fate. But him...
She gently motions her head toward the shy boy playing in the corner. She can't finish the sentence.
I open my mouth to speak but have trouble conveying a lifetime of experience in a coherent manner. I want her to know that I am her son. That my father died and yet despite this tragedy my life has beauty and meaning. That I am a doctor, a husband, and a father.
I want her to know that her beloveds death will become part of the vast fabric of her son's experience. But his life will forever guide her son's future. She doesn't yet know that she will have the strength and fortitude to provide for his well being.
Eventually the words come to me.
We tell ourselves the stories about our lives that make it bearable. Or better yet magical, mystical. At forty years old part of your own story is already written. But your son. Your son sits in front of you an open book.
The pen is in your hands.
Write from your heart.
We stared in his direction content to have a distraction from the intensity of our conversation. In the lull that followed my thoughts wandered back to childhood. I remembered the day my father died.
*
My mother is lying in bed. Her head is barely visible hidden under floppy curls of disheveled hair. She is thirty seven years old. My childish body struggles to climb over the ledge as I flop onto her comforter. My older brothers are busy entertaining the crowd of people who wander in and out of the house at random intervals.
I watch as her body heaves up and down slowly. She is weeping. I place my hand on the part of the blanket that is covering her shoulder. I know that there is something wrong but at seven years old I don't have the intellectual capacity to understand.
I feel the faint excitement of missing school but I am distressed by my mother's grief. I coax her gently.
Mommy. Lets go out and play.
She lifts her head and looks over in my direction. She smiles faintly.
Maybe in a few minutes honey.
The adult in me wishes I could reach back and comfort her. Tell her that although happiness had left us, it would return eventually. Assure her that her boys would grow up to be successful men. Touched by their father's death but not destroyed by it.
Remind her that our greatest gifts are bestowed upon us not only by our triumphs but also by our sufferings.
*
The police car has now pulled up to the fake crash seen. Lisa gasps as she realizes that her son is using toys to reenact her husbands fatal accident. Her eyes fill with tears as she turns her head towards me. She is drowning.
I have already accepted my fate. But him...
She gently motions her head toward the shy boy playing in the corner. She can't finish the sentence.
I open my mouth to speak but have trouble conveying a lifetime of experience in a coherent manner. I want her to know that I am her son. That my father died and yet despite this tragedy my life has beauty and meaning. That I am a doctor, a husband, and a father.
I want her to know that her beloveds death will become part of the vast fabric of her son's experience. But his life will forever guide her son's future. She doesn't yet know that she will have the strength and fortitude to provide for his well being.
Eventually the words come to me.
We tell ourselves the stories about our lives that make it bearable. Or better yet magical, mystical. At forty years old part of your own story is already written. But your son. Your son sits in front of you an open book.
The pen is in your hands.
Write from your heart.
Sunday, September 25, 2011
Some Thoughts On Quality
Sonia struggled to express herself through broken English. Her lively facial expressions and exuberance betrayed by her inability to string the words together fluently. One hand gesticulated widely while the other rested gently on the elderly woman's hair.
She somehow managed to coo quietly in her companions ear, calming her, as she continued the conversation with me. Sonia's eyes opened and closed in an exaggerated blinking manner as she questioned me further. Although she understood my words, she doubted their meaning.
*
Sonia moved to the United states five years ago to build a life with her fiancee. She took a job as a caregiver for an elderly woman with Alzheimer's. Over the years her love affair with her beau dissipated but her relationship with her employer flourished.
She quickly became the primary care taker. She ran the house and finances. She spent every waking moment feeding, cleaning, and nurturing. Her patient...her employer had become her friend.
*
There was absolutely no doubt her friend was dying. She walked a slow and relentless march to the grave. She no longer spoke. She couldn't feed herself. Such simple tasks as bathing or dressing had become as complicated as quantum physics.
Sonia choked on each word.
But I can't just let her die!
I explained that for her friend, death was no longer the feared outcome; no longer the emergency. It was suffering that was anathema. We would work together to make her comfortable. We would steer her away from the hospital and manage complications from home. Eventually she would slip away quietly and without fuss or fight.
I could see the transformation in Sonia's posture. She understood. Her head bowed as she whispered up towards me. The tone of her statement rose at completion as if she was asking a question.
So we will no longer try to save her.
I could see the internal struggle as she paused. Her arms stopped moving and fell to her side. Nothing in her former life prepared her for this moment. It was as if I erased a large part of her essence with a sweeping motion of my hand.
*
Sonia and I would talk multiple times over the next few months. Eventually her friend would die quietly in her own bed. Sonia's hand on her forehead with a wet cloth clutched by her side. Her lasts breaths peaceful. Her lasts moments enveloped in selfless love.
She visited me one more time before she drove to the airport and got on a plane back to Poland. She thanked me profusely and handed me a box of chocolates.
As I watched her walk out of my office I thought about the state of our country.
We talk about healthcare and quality as if they are quantities that can be hung in IV bags in high tech hospitals garnished with radiology suites and cancer centers. We cherish magazines that outline the best hospitals and the best doctors as we read through the best advertisements effacing each of their pages.
But if you really want to search for the highest quality you have to look further. You have to wend your way through the living rooms and parlors of our people. To the quiet places where the ill and beleaguered are being tended to moment by moment with careful hands and open hearts.
You have to look to our caregivers... to our families.
When are we going to start learning from them?
She somehow managed to coo quietly in her companions ear, calming her, as she continued the conversation with me. Sonia's eyes opened and closed in an exaggerated blinking manner as she questioned me further. Although she understood my words, she doubted their meaning.
*
Sonia moved to the United states five years ago to build a life with her fiancee. She took a job as a caregiver for an elderly woman with Alzheimer's. Over the years her love affair with her beau dissipated but her relationship with her employer flourished.
She quickly became the primary care taker. She ran the house and finances. She spent every waking moment feeding, cleaning, and nurturing. Her patient...her employer had become her friend.
*
There was absolutely no doubt her friend was dying. She walked a slow and relentless march to the grave. She no longer spoke. She couldn't feed herself. Such simple tasks as bathing or dressing had become as complicated as quantum physics.
Sonia choked on each word.
But I can't just let her die!
I explained that for her friend, death was no longer the feared outcome; no longer the emergency. It was suffering that was anathema. We would work together to make her comfortable. We would steer her away from the hospital and manage complications from home. Eventually she would slip away quietly and without fuss or fight.
I could see the transformation in Sonia's posture. She understood. Her head bowed as she whispered up towards me. The tone of her statement rose at completion as if she was asking a question.
So we will no longer try to save her.
I could see the internal struggle as she paused. Her arms stopped moving and fell to her side. Nothing in her former life prepared her for this moment. It was as if I erased a large part of her essence with a sweeping motion of my hand.
*
Sonia and I would talk multiple times over the next few months. Eventually her friend would die quietly in her own bed. Sonia's hand on her forehead with a wet cloth clutched by her side. Her lasts breaths peaceful. Her lasts moments enveloped in selfless love.
She visited me one more time before she drove to the airport and got on a plane back to Poland. She thanked me profusely and handed me a box of chocolates.
As I watched her walk out of my office I thought about the state of our country.
We talk about healthcare and quality as if they are quantities that can be hung in IV bags in high tech hospitals garnished with radiology suites and cancer centers. We cherish magazines that outline the best hospitals and the best doctors as we read through the best advertisements effacing each of their pages.
But if you really want to search for the highest quality you have to look further. You have to wend your way through the living rooms and parlors of our people. To the quiet places where the ill and beleaguered are being tended to moment by moment with careful hands and open hearts.
You have to look to our caregivers... to our families.
When are we going to start learning from them?
Saturday, September 24, 2011
The Prodigal Son
I walked into Sarah's room like the prodigal son. Her husband stood above her holding a glass of thick liquids in one hand and a spoon full of pureed food in the other. She lay defiantly on the bed in front of us. Her left arm dangling over the sheets would occasionally move in a semi purposeful manner. Her right side was painfully still.
She looked nothing like the other fifty year olds in my practice. The ravages of cerebrovascular disease had devastated her body. Her mind was clear but her lips struggled through garbled musculature.
I greeted her husband with a firm handshake. A brief flash of relief quickly gave way to a sheepish hesitancy. We hadn't seen each other in a year since he requested his wife's medical records and disappeared without an explanation. I fained ignorance as I stepped passed him and placed my hand on her shoulder. Her lips curved upward in a crooked half smile.
Long time no see, stranger.
I pulled a chair forward in order to keep both husband and wife in view. As I flipped through the hospital chart we caught up on what I missed in the last year.
Her husband's brow had furrowed with new wrinkles since our previous encounter. His hairline had receded slightly farther. His tone was quiet but belayed the struggle and torture of the last few months. There had been a number of hospitalizations. Medicines came and went with many side effects but few benefits.
As I got up to leave I couldn't help but ask what was on my mind since I got the call from the emergency room.
So why did you come back.
He swayed uncomfortably in his chair and then stood up and strode forward. I could see him mentally rehearsing his answer as he cleared his throat to speak.
You see Doc. I don't really believe in what you do. What any of you do. It's all the same to me. God has a plan for my wife and there isn't a thing you or I can do about it.
But you...you're different. You answer my questions. You return my phone calls. And all those other doctors got angry every time they walked into our room.
You are like a breath of fresh air. You don't blame us at all for what has happened.
You seem to actually like Sarah.
She looked nothing like the other fifty year olds in my practice. The ravages of cerebrovascular disease had devastated her body. Her mind was clear but her lips struggled through garbled musculature.
I greeted her husband with a firm handshake. A brief flash of relief quickly gave way to a sheepish hesitancy. We hadn't seen each other in a year since he requested his wife's medical records and disappeared without an explanation. I fained ignorance as I stepped passed him and placed my hand on her shoulder. Her lips curved upward in a crooked half smile.
Long time no see, stranger.
I pulled a chair forward in order to keep both husband and wife in view. As I flipped through the hospital chart we caught up on what I missed in the last year.
Her husband's brow had furrowed with new wrinkles since our previous encounter. His hairline had receded slightly farther. His tone was quiet but belayed the struggle and torture of the last few months. There had been a number of hospitalizations. Medicines came and went with many side effects but few benefits.
As I got up to leave I couldn't help but ask what was on my mind since I got the call from the emergency room.
So why did you come back.
He swayed uncomfortably in his chair and then stood up and strode forward. I could see him mentally rehearsing his answer as he cleared his throat to speak.
You see Doc. I don't really believe in what you do. What any of you do. It's all the same to me. God has a plan for my wife and there isn't a thing you or I can do about it.
But you...you're different. You answer my questions. You return my phone calls. And all those other doctors got angry every time they walked into our room.
You are like a breath of fresh air. You don't blame us at all for what has happened.
You seem to actually like Sarah.
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