Mirrors & mirages

November 28, 2018
Kaba Berhanu, MD
Volume 95, Issue 23

2018 Physician Writing Contest runner-up.

I could tell he is loved by many. I could tell he is a good man. His smile is kind and it has a quality that I cannot identify. He is thin with a full head of salt-and-pepper hair. He has a gentle and serene aura about him as he lays in his bed. As I talk to him, I realize that the serenity about him also comes from his stillness.  It is subtle, his lack of motion-and also deceiving. Looking at him, he does not look “toxic” as we tend to call the really sick ones.

It is a random day, much like many before it, busy and demanding. By the time I get to Mr. T, it is evening and his family members have made their way to his hospital room, the young the old, the millennials and the baby boomers. I introduce myself as the hospitalist who will be the main doctor on his team. There is a hum of worry, dimly present behind the jovial hellos and the small talk.

It is the usual, community-acquired pneumonia that has failed outpatient treatment. His primary care doctor had tried a few antibiotics but nothing seemed to have worked; that was a clue to which I turn a blind eye. I simply do not see it.

So, I give them hope. He should be out of here in the next few days I say. We are giving him stronger antibiotics I explain, “the big guns,” and they nod their heads. As I leave the room, I make a joke, and they all laugh. I am pleased because my jokes are usually off and rarely do I get a perfect setup where the joke is funny and there is a room full of people who get it and laugh. My biggest worry as I leave the room is that on the subsequent days when I see him during my daily rounds, they will realize that my jokes are really awkward and poorly timed and not that funny at all.

The days come and they go. Mr. T, who has been getting out of bed to his chair, now prefers to stay in his bed mostly. He tells me some days that he feels good, maybe even better, but lately he says he has been having rough nights. He is so short of breath, the only thing he seems to be able to do without losing his breath is think. His daughter, who happens to be a nurse, often tells me that until the time he started having the cough he was fit and that he played volleyball with his grandchildren on summer vacations.

The infectious disease specialist, Dr. P, a petite woman with probing eyes and one who does not sugarcoat things is the first to voice her concerns that the patient might have cancer. It takes my breath away. When I go into the room, I see Mr. T with yet another one of his many children. I cannot say the word and where I cannot give hope there is no replacement. I leave the room quickly.

Having mainly done the admission part of patient care for many years, I rarely have had the chance to make a claim on a patient the way I claimed this patient on the third floor of our small hospital. I had made a prediction that he would be well and I had worked every day towards that goal which had initially seemed attainable.

It has been over a week since I first met Mr. T and his family.  I approach his wife as she stands outside his room with a nurse and the infectious disease consultant. All of a sudden, Mrs. T wails and puts her hand over her mouth.  I assume that the biopsy result is back and that Dr. P has just given her the news before breaking it to Mr. T. The nurse hugs Mrs. T.

I hover, trying to give my support or answer questions. Nobody notices. The nurse is wrapped up in the moment, wrapping her arms around the wife’s shoulders and Dr. P is looking at them with those eyes, bracing herself for the consequences of her words.
Instead of hanging around them I step into Mr. T’s room. He is lying in the same position. He is weaker today than he was yesterday and weaker at this moment because he has just heard his wife’s anguish and he knows. His son who also now knows is holding his hand. Tears well up in my eyes and I have to leave right away.

Later I sit on the couch in our office and I tell our office manager, who also at times doubles as my unofficial therapist, about it all and my tears seem to surprise her. In the past my tears have come from telling her how my ten-month-old fell down the entire flight of stairs at my house. There was also the time when I announced my third pregnancy that had occurred a little too soon after my second pregnancy and I fretted about how I could be the breadwinner of my family and leave two babies  at home while I work full time.

However, this time I cry not just because despite my armamentarium of medications and knowledge, death will win more times than I would care for it to but also because I had unintentionally crossed an invisible line.  Over the years, I had put myself at a distance, given patients labels like “toxic” and did my best to make them feel better.  When I walked into Mr. T’s world however, I had allowed myself to hope with the rest of his family, then after that, I had allowed myself to feel, to be caught up in the sadness and later on in the acceptance of the end. Caring for Mr. T has made me realize I still have room to feel for strangers what I feel for my family, that I was still fighting the good fight with more passion than I knew I had.

Editor’s note: The names of patients have been changed to preserve privacy.

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