O Bane, I call thee Medicine!

So today was my last day of internal medicine. And it's been a really hard month--not all bad, but very long.

I had to personally tell 3 different patients and their families that they have cancer, and not the kind of cancer that we're good at fighting, the bad kind of cancer that will most likely kill them sometime in the next 5 years. The other day I was driving home exhausted after one of these conversations, listening to the radio and a very fitting song came on. It was a country song, not sure of the title, but the refrain is "someday soon I hope you'll get the chance, to live like you were dy-iiinnng." Do you like how I sang the last bit for you? But it tells a story of a man who found out he had cancer and was going to die soon and his response to it; he went out and did all the things he wished he'd done earlier. I've heard sentimental stories like that before and all of it can be a bit cheesy I suppose, but it really makes you stop and think when you're telling this person that their life is nearing its' end. I guess I just don't really think about that very often, but to really think what it would mean to me to find out that my time is so limited. What would I do? Well, come on, we all know what I would do, I'd find myself a dang husband already! But besides that. Just made me think.

I watched an 83-year-old little frail old black woman get better from an illness that very easily could have killed her and I got to send her back home as healthy as when she came. She probably weighed all of 75 pounds, had no top teeth, but had big bottom teeth that jutted out in front of her toothless top lip; the first time I met her I told my attending that she was the cutest little old lady--she looked just like a piranha. My attending didn't know me very well at that time...I'm not sure he thought it was very funny. But it was. When I first met her she was so sick she could hardly nod yes or no but the last 10 days of her hospital stay after she'd made the first big improvement, whenever I'd walk in the room, she'd tilt her chin forward, raise her eyebrows, as if to say mmm-hmmmm...not just a regular mmm-hmmm, but a mmm-hmm with attitude, that "I got three grown babies and 8 grand babies, I live in the South and I eat chicken-liva" sort of attitude, and she'd use her bony little pointer finger with a come-here motion. I'd go to her bedside and she'd reach out and just stroke my hand. I'd talk to her for a bit, but when I told her I had to go she'd get all feisty, drop my hand and say "well now, when you comin' back?" Once when my very well-educated tall, thin, very proper and somewhat socially awkward attending went to her bedside, she reached out, all 75 pounds of her, grabbed his hand and said "Well who are you? Are you John the Baptist?" The poor guy was so shaken by her reference to something religious (heaven forbid) that he just "Well, uh, I , uh, I'm not sure, uh.." his way through it until the medical student gave her a little giggle and she said "See? She knows what I'm talkin' about!"

Next I move to one of the funniest moments. You must read it in the right context: first imagine that you are stressed to the max, mildly irritated by little teeny things, and exhausted. (It makes it a little funnier). So we're leaning over this poor old woman who is extremely altered--she doesn't know where she is, she's not really responding to very much, she's not even breathing very well. Our whole team of 6 doctors gathers closer around her bed, leaning over slightly because she's so hunched down into her bed. We look for even the slightest indication that something really bad is starting. Her breathing starts to slow and my attending, a little short woman with a little brown bob, and I lean closer to her face to try to get her attention. "Marge?" we practically shout right into her face, "can you open your eyes for us?" Her breathing slows more and she starts gasping a little, almost choking. I move my head further away from her face to allow my attending to move in a little closer, "Marge!" she shouts again. At this point they are face in front of face, probably no more than 18inches or so apart. Suddenly, this poor frail old woman takes one last deep breath and before any of us had time to predict this could have happened....she let out an explosive sneeze! And not just the clean kind of sneeze, the huge cloud of spit sneeze that comes out of the nose and mouth at the same time. My attending moved real quick!

In another part of the hospital I had a special moment. There is a floor called the palliative care unit which is where the patients go who are very close to dying and just need to be made comfortable. The lights are softer, there's carpet and calming pictures on the walls. The rooms are more homey and less sterile and that's where they placed my patient Walter. (By the way, I do change all the names in my stories. Don't be alarmed). Now, Walter was not actually a palliative care patient. He was very old, almost completely deaf (especially to the upper part of the sound spectrum), mostly blind and having lots of belly pain. He was sent to the palliative care unit because it was the only empty bed just then. I went to see him the next morning to see how he was doing and examine him. He was in the bed closest to the window. I entered the room and sitting in the bed closest to the door was a wiry very old frail man and he was just hollering! "Hey! I'm dyin! I'm dyin!" I tried to find out what was bothering him, he said he was in pain and that he was dyin'. Once it became clear that this dear old man was not completely...with it, I went to get his nurse to help him so I could continue with my plan to see dear deaf Walter. I come back into the room and as I pass the holler-er he starts up a-hollerin' again. "I'm dyin! I'm dyin!"--Are you in pain? "YES! I'm dyin!" Just for the record, I'm pretty sure he wasn't dying just then. So I pass his bed to dear deaf Walter. I try to wake him with a nice hushed tone that seems appropriate for the palliative care unit, "Walter....Walter" a little louder the second time with a little shoulder shake. Nothing. "Walter! Good morning! I'm sorry to wake you!" I say in my sweetest, but a little louder, doctor voice. Now dear reader, what you must recognize about me is that I have somewhat of an upper range voice, especially when trying to speak loudly; and, if you'll remember back you'll note that dear deaf Walter was particularly deaf to the upper register. Still, I persisted: "Walter!" in my lovely sing-songy voice. Nothing. A little louder, this time with a little more shoulder shaking, "Waaaalter! Wake up!" ... Nothing. Next I tried...the sternal. rub. That's right. The Sternal Rub. To perform the sternal rub, you hold your hand, preferably your dominant hand in a soft fist. You then proceed to rub this fist firmly up and down the patient's sternum. It is usually reserved for alcoholics who are so drunk they may stop breathing if they are not stimulated. But anyway, I used a gentle sternal rub along of course with the "Walter!" and STILL, ...nothing. He just kept snoring away. Finally, I raised my voice to it's loudest pitch (mind you, I'm still on the palliative care floor at 6:30am) and, just to be sure, I lower my voice to it's manly pitch and shout "WALTER!!!!" (For those of you who are familiar with the movie "A Knight's Tale", picture here the scene at the end of the movie...you know the one. He's just become a true knight-Sir William, and he's riding to beat the mean guy in black and has he does the film goes into slow motion as he shouts in resonant echoing tones "Wiiiiillllliiiaaaaaammmmmmmmm--mm--mmm--mmm"), again I demonstrate for you--say it in your head, if you will, with my manly voice, "WAAAALLLLTTTTEEEERRRRR!" Now, you think this is going to be the best part of the story, that Walter awakes--and indeed he does with a snort and a "Eh? What?" but then, the scene unfolds. The characters include, me (M), Walter (W), and the holler-er on the other side of the curtain (H) and the nurse taking care of the holler-er (n). Ahem.
M: WAAALLLLTTTTEEERRRR (manly voice please)
W: eh? What??
M: HOW ARE YOU FEEELLING TODAY?
H: I'm dyin!
W: eh? what?
M: HOW ARE YOU FEEELLLINGGGGG TODAY??
H: I'm dyin!
n: Holler-er, are you ok (she says gently and softly)
M/H: WAAALLLTTTTERRRRR! Wake up!/NO! I'm dyin!
M: WALTER! ARE YOU IN ANY PAIN?
W: eh? what?
H: Yes I'm in pain! I'm dyin!
n: sweetie I don't think she's talking to you.
M: WALTER! Are you IN any PAIN?
W: what? NO!
H: yah I'm in pain! I'm dyin! I told you that!
M: WALTER, have you had a Bowel Movement?
H: NO I Haven't!
W: What??
M: A BOWEL MOVEMENT (don't forget I'm still using my manly voice here at the top of my lungs in the quietest part of the hospital)
H: I just told you I haven't!
W: NO!
M: Are you having trouble urinating?
W: WHAT?
M: (louder) URINATING!!
H: NO, I told you I'm dyin!
W: NO!
n: sir, I don't think she's talking to you.
*the doctor then leans onto the edge of the bed railing exasperated and laughing hysterically. Dim the lights. End Scene.




And this, ladies and gentlemen, is my life.