I didn’t even want to argue that point. How could I? There are some things you just know you’re going to get through, even though they may seem like a big deal to someone else. For example, you’re running with your boyfriend, and the cramps just get too horrible, and your head is exploding even after two extra-strength Tylenol, and you’ve been bleeding for thirty hours by then, so you just have to stop running. But you know you’re going to be OK, and you’ll be OK a month later too, when it happens all over again. So you laugh at him as he promises to desist from calling 911 and shakes his head with that worried, apologetic, guilty look in his eyes, as if his being a male had been a choice.
“Please, don’t ask me again, dear,” Mr. U. rasped through the oxygen mask. I felt like Luke Skywalker talking to the dying Darth Vader. Only I wasn’t related to Mr. U. at all; we’d only met days ago, and even then, he was introduced to me as COPD.
CHAPTER THREE: TRAPPED AIR
That week, Mr. U. had become for me the personification of flow-volume loops. I’d only seen pictures of them in textbooks and on PowerPoint slides and, if our teacher was old fashioned, in real-time chalk. Flow-volume loops are complex graphs that describe a patient’s breathing pattern. I remembered thinking how ironic and unfortunate it was that patients viewed their chronic obstructive pulmonary disease as one that makes them unable to get enough air in, and that doctors viewed it as a disease that makes lungs unable to get enough air out. So how do we treat the trapped air? Mr. U. had little tubes up each nostril giving him even more air—five times as much oxygen, in fact, as the rest of us breathe. I couldn’t figure out if air was his enemy or his friend.
CHAPTER FOUR: FREE AIR
A couple of days later, the answer was obvious. His x-ray revealed one of the few things I could recognize: a thin black moon of air lifting up a stretch of white diaphragm. Free air in his belly, while worrisome, was also exciting because it meant we were going straight where I wanted to be: the operating room.
The question was, did Mr. U. want to be there? His choices weren’t presented with the gravity and melodrama that I had grown to expect from movies. There was no dimming of lights, no music in the background. It wasn’t even raining outside. Wasn’t it always supposed to rain? Thomas Hardy would have arranged for a downpour. I wondered if this was only the dress rehearsal for the real moment when we’d tell him.
Surgery: they weren’t sure he would survive it, but they were sure he would die without it. To me the choice seemed to be, did he want to die tonight or in a couple of weeks? Now or later? But that’s not what he was asked. He was asked if he would approve the preparing of the operating room. He was asked if they had his permission to call the anesthesiologist in case her services became necessary. He was asked if he was ready for the transport team to come up. Mr. U. was not stupid. He could see all these events were corollaries to the real decision. Selfish questions doctors ask when we’re trying to decide what we have to do next: did he need a CT scan? Should we call for the anesthesia consult? Was his consent signed? From Mr. U.’s point of view, though, the big question was still, surgery, and risk dying tonight, or no surgery, and risk dying next week or month? Die tonight or later? His answer was always the same: “I don’t know yet. I’m waiting for my brother to come before I decide.”
CHAPTER FIVE: AIRHEAD
The guy who came looked like a punk high school kid.
“I’m here from transport to take you to the OR,” he declared in that couldn’t-care-less voice all teenage boys master.
The doctors had all left the room by then, and for once, so had the nurses. The only one remaining was Mr. U. He looked so small and helpless to me—a tiny turtle with big blue eyes, a tuft of white hair slicked back like Pat Riley’s, and an oxygen mask. I sat down in the only chair, with all my youth and health and all the fierce protectiveness I usually reserve for my little sister. Only now I was going to protect Mr. U. from the boogeyman, currently disguised as the punk high school kid with the stretcher.
“He isn’t going anywhere yet,” I told Mr. Gum-Chewing, Tattooed Stretcher Pusher. “He’s waiting for his brother to come.”
The kid puffed, annoyed with us both, and snapped his gloves off noisily before turning around. Mr. U.’s eyes were livid.
“I already told them that,” he reminded me. “What’s wrong with these people?”
What could I say? I knew the feeling. It was that Alice-in-Wonderland terror that comes over you when you can’t recognize the social rules of the game and you think that either everyone around you is insane or you are, and it’s much easier to believe and harder to swallow that it’s only you. I’ve felt that way throughout much of medical school.
With the stretcher gone, Mr. U. calmed down a little, and we resumed waiting for his brother. My job became that of a scout: every few minutes he would ask whether I saw his brother in the hallway.
“Not yet,” I’d answer, “but he’s on his way.”
Of course, I had no idea what his brother looked like, but I figured I’d see him eventually, unless, as I was beginning to suspect, his name turned out to be Godot.
So I started talking to Mr. U. At first, it was about stupid things like the fact that his name was Irish and whether he thought Ireland was really as green as in the Irish Spring commercials. He laughed at that and said he’d never been there, but that he’d been to the South Pacific during the war. This only served to remind us that there was something else we were both thinking about and yet neither of us was saying.
“I think it’s crazy for you to have to make a decision like this,” I ventured.
“Yeah,” he replied.
“Are they good?” he then asked without warning.
I didn’t even blink. I assured him they were the best surgeons I’d ever seen. Of course, they were the only surgeons I’d ever seen. I hoped he wouldn’t misinterpret my smile. It’s just that my ex-boyfriend had rubbed off on me after all. It was one of his favorite jokes. “Did you like the ballet, sweetie?” “It was the best ballet I’ve ever seen.” Of course, it was the only ballet he’d ever seen. My fingers reached, habitually, for the dangling turtle around my neck and traveled halfway up each side of the chain before realizing that what they were looking for wasn’t going to be found anymore.
Mr. U. was still searching for answers.
“What do you think I should do?”
He tossed the grenade into my lap as freely as if it were a red rubber ball and we were playing foursquare. I felt about as qualified to give him advice on this matter as I was to perform the surgery itself. So at first I said what I always say when I’m asked something in the hospital: “I don’t know.”
Then I smiled at him: “But I’ll tell you what I do know. I do know that they’re very worried about you. And I also know that when this has happened to other people, they always take them down to the OR. It’s not something we think gets better by itself. But you still have a choice, you know.”
“I know.” He sighed.
Then I asked him what I’d wanted to ask all along: I asked him if he was scared. I’d be scared. He didn’t answer. And then he nodded.
“What are you most scared of?”
“Of not being able to breathe.”
That surprised me. It wasn’t what I was expecting him to say.
“Not getting enough air during the surgery?”
“Yeah.”
That’s when he became the first patient I made a promise to, just as I was taught not to do. I couldn’t have guaranteed anything else about that surgery—not what they’d find when they opened him up, not what they would do to repair the problem, not what the outcome would be—but I swore up and down that I’d make sure the anesthesiologists hooked him up to a machine that would absolutely give him enough air. In fact, the machine would literally push the air right into his lungs, I promised.
He nodded again.
CHAPTER SIX: FORCED AIR
Mr. U. is intubated in the surgical intensive care u
nit, so he can’t talk to me in his raspy whisper, and come to think of it, I’ve never seen him smile. But there is a certain change that takes place in his eyes when I come to see him. Even after having taken anatomy, I can’t tell you what part of the eye changes exactly. It’s not a blink. His pupils don’t dilate, but it’s not more subtle than that. It’s as obvious and physical as a change of color or a wink, and yet it’s neither of those. But I know it means he’s seen me.
Bruce, his nurse, always thanks me for stopping by and assures me it means a lot to Mr. U. Maybe it does, and maybe it does not. I don’t go every day, or even every other day—not since I switched teams. Sometimes it’s because I’m too busy—for whatever that pathetic, overused excuse is worth. More often it’s because I’m scared that I won’t know what to say. I’ve never been good at small talk. I’ll take a four-in-the-morning, college-dorm-room, does-God-exist conversation any day, but put me in a room with cocktails and hors d’oeuvres and I’m suddenly quite fascinated by tiles on bathroom floors around the corner, or whatever’s up on the walls that I can read.
I once asked Mr. U. if he wanted me to read him something. He shook his head no. Then I felt stupid for asking. I might’ve wanted someone to read to me the way my mom always did when I was a kid and sick in bed. Who knows how long Mr. U. will be here? It might be like that summer when it took me two months to get through Uncle Tom’s Cabin in Cyrillic. His chart is getting impressively thick, though not as impressive as his neighbor’s. The first time I saw that chart, I thought it was somehow mine. Clearly printed on the front cover were the letters VI with Roman-numeral lines drawn horizontally across the top and bottom, exactly the way I sign my name. I stared at them, feeling like Scrooge, until I realized they weren’t my initials at all. It was a volume number—volume six of his chart! Not so long, if you consider that half of what’s written in charts is the same information, repeated over and over again. Of course, the other half is completely illegible, so I guess it all cancels out.
Sometimes when I visit Mr. U., we play charades. He motions me over to the bed, and I try to guess what it is he wants me to do. “The thumbs-up sign … up … you want something up … the heat? Are you cold? Do you want a blanket? No, OK. The lights? The volume on the TV? The head of the bed? Yes? OK, good. Now, how the heck do I do that?” I was glad no one else was in the room when I took five minutes to find the correct button.
I’m not the only one who visits Mr. U. He sometimes gets visits from his brothers. I’ve run into them elsewhere in the hospital, and they have always recognized me as a member of the surgical team taking care of Mr. U. At first, that made me feel good—almost like a real doctor—but then one of them stopped me in the cafeteria a few days ago to ask how his brother was doing. I’d already rotated to another service by then. I had the same question for him. Not knowing what was going on with Mr. U., medically, put me back in my place—as a spectator. I was no longer following that race, and even now, I don’t know who’ll end up winning. Does the tortoise finish first, or does the air?
My ex-boyfriend has moved five times since I’ve known him. Each time, some of the items with which he chooses to decorate his walls get put up in the same places, whereas others are retired. I’m not sure how he makes those decisions. I suppose the retired items are just the stuff he’s grown tired of. Why do we choose the things we put up on walls, anyway? My room was always covered. For years it was pictures torn out of National Geographics—the kids’ version, of course, not the adult ones my parents still have neatly ordered on a shelf. Later on, it was quotations from books—not books by dead white Englishmen or Bartlett’s Familiar Quotations or anything stuck up like that. I had my favorite ones from Zora Neale Hurston and Barbara Kingsolver and Primo Levi, and some Tolstoy because he’s just so familiarly Slavic. I had them up in my room because when I read them, they reminded me of what I’ve chosen to value most in life, or of a way that I wanted to be, or they just made me feel good about people and the world and how lucky I was to be in it.
This ex-boyfriend I’ve mentioned never fails to put up his old firefighting helmet, the American flag, and the poster that now makes me think of Mr. U. It is a poster of a long, winding road that goes down a hill and then back up again. The scenery is not particularly beautiful, not like the Irish Spring commercials. But if you look really closely, you can see a little person running up the hill. At the top of the poster it says in plain white print, “The race goes not to the swiftest but to those who keep on running.” I don’t know why I never thought about what that meant before I met Mr. U., and I don’t know if Mr. U. is going to win this race. But last I heard, he’s still running.
“Looking at the World from Far Away”
Amy Antman
Dear Dr. Vedanthan,
This month I am on my medicine subinternship, and I’m finding the experience intense to the point of being almost overwhelming. Every night on call I have met a patient whose story is completely heartbreaking. Last time it was the gentleman with pancreatic cancer worrying about his dying wife. This time it wasn’t even my patient—I was just standing in the ED when one of the interns on my team came up and said, “Amy, you have to see this!”
I knew she’d just been examining a gentleman with hemophilia who’d bled into his shoulder joint. I’d never seen hemarthrosis, so I eagerly went with her to see the patient. Mr. Jamison was sitting on the gurney with his shirt off, his right arm angled awkwardly and draped over a pillow for support. Rising up from the back of his right shoulder was a mound roughly the size of his head. I was stunned that someone could bleed that much into a joint, and when I felt it I wondered where his scapula had disappeared to, because although the mound was firm, there seemed to be no bone in it.
The resident and intern finished examining him and left. They instructed me to stay behind and try to hear his extra heart sound. Once we were alone, Mr. Jamison told me that he’d bled into that shoulder so many times that his right scapula had been entirely eroded away by blood, and the only thing now supporting his shoulder joint was a “pseudotumor,” a growth of tissue, which had filled in the space once occupied by bone. It was causing him significant pain, and he was planning to have surgery to remove it. I had no idea what a pseudotumor was, so I decided to just keep listening and let him teach me. “They might have to take the arm,” he said, “because the brachial plexus [the nerves to the arm] and the blood supply might get injured during the surgery.” His eyes searched right and left as he spoke, so that he only intermittently made eye contact. The way he had phrased it had sounded so calm and collected, but I couldn’t help but notice he had said “the arm,” not “my arm”—it pained him.
My mind flashed to imagining him with just a stump, or some sort of metallic prosthesis. I felt at a loss for what to say to a person who had just told me he was possibly about to lose one of his arms. I noticed that although I had finished examining his heart, I had not yet stepped back out to the usual interpersonal distance, and I felt as if neither of us wanted me to just yet.
He saved me from my search for words by speaking again. “So it’s a lot to think about in the next few weeks,” he said. I made some sort of sympathetic gesture with my hands, urging him to go on. He continued, telling me about how he was on a lot of pain medications right now, and he didn’t like how they made him feel. I asked him what he meant. Did they make him groggy? Did he feel out of it?
This time his eyes met mine dead on, and he said, without rushing, “It’s like looking at the world from far away. Sunsets don’t seem quite as nice. And you don’t laugh quite as much.” It was such a stunning description of a stolen life, medication induced or otherwise. A dulling of sunsets and loss of laughter, medications designed to relieve pain denying and dampening life.
As I was readying to go, I told him I would see him again up on the floor. “Thanks for listening for a minute,” he said, which made me feel wonderful and awful at the same time—why was I giving him only a minute?
; “No, thank you for sharing,” I said, and patted the elbow of his wounded arm before leaving.
They break my heart, these patients; they really do. There’s something unbelievably kind about them, even as they are losing something that seems so unbearable to lose—a wife, an arm. I almost wonder if it is the terrible loss that makes them so kind, though the implications of that scare me. Or is their kindness so robust that even their suffering, their pain, does not overshadow it? This is why it bothers me when I hear classmates saying that medicine is “just a job.” Because the patients are scared, and often alone, and I can count on less than one hand (mine not cut off) the number of jobs where people will let down their guard and permit you to shield them from that fear and loneliness, if even for just one minute.
With thanks for your support and guidance,
Amy
Early-Morning ED Blues
Kim-Son Nguyen
SHE LOOKED UP, her eyes weary, her mouth sour with acidic vomit. The dangling nose ring again caught my attention.
“How are you feeling now?” I asked, almost whispering, futilely trying to respect her privacy as she lay on a stretcher in the hallway to the trauma area.
The Soul of a Doctor Page 8
