I have this image and these words right at the tip of my tongue, I remember her, thin, tall, sun kissed skin and the lines on her face telling stories of a dense life, a hard life perhaps, but a fine one at that. Her silvery blond curls cut short close to her scalp. Her gaze, her blue eyes full of respect and kindness. Her voice as calm and simple as her demeanor. She was radiant in her simplicity.
Oh how I wish I remembered her words. For the longest time I held on to them, safely I thought; but now … they are gone. As I delivered the news of the brain tumor and that the neurosurgeon was reviewing her scan results and would be by to talk to her. As I told her she wasn’t allowed to eat since she might need surgery right a way. As I took her history and told her what her seizure was caused by, she calmly listened and smiled. She told me she had had a good life and was content and that God will take care of her. There was such conviction and resolve in her words. I don’t remember the exact words, but there was such conviction and resolve in them. They were quite beautiful. But I don’t remember.
“Likely a gleoblastoma” … I knew what that meant. Sadness filled my heart.
I am sure she is gone. Of course I don’t exactly know when or how since I finished my 7 day shift and was off duty. Great way we practice medicine these days. But years later and I still remember her, I hope she had peace and didn’t suffer near the end. She was beautiful.
Moaning and writhing in pain he was gracious and kind. My clumsy hands examining him, his abdomen exquisitely tender. My questions ignorant and irrelevant as I look back, and my inexperience comical and tragic. “I have to examine your rectum sir”. Poor man agreed. He was in so much pain but he told me it was his honor to contribute to my education and that he understood it was necessary. Was it my second month or third as a practicing doctor? I don’t know. I knew nothing but I felt fear as he nearly jumped off the bed at my slightest touch. I called the surgical resident.
“he is in bad shape, you need to examine him now”.
“are the CAT scan results back yet?”
“no, but …”
“Is it an acute abdomen?”
“I don’t know … maybe, I think maybe …”
“ what year are you again?”
“intern … but you really should see him now”
I recorded in my notes (59 year old veteran presents with acute onset abdominal pain” …. “surgical consultation placed, spoke with surgery resident, awaiting CT results”.
They took him to the operating room hours later. By then I was off duty.
The next morning I opened the electronic chart and there it was, “death note”. He died on the operating table. Cause of death: perforated appendicitis.
All the while I was pushing on his abdomen and checking his rectum for blood or stool, his bowels were bursting open, oozing angry bacteria into his insides. All the while he was thanking me and telling me it was his honor to contribute to my education. All the while he was putting up with my endless questions “where did you serve”, or when did you start smoking, how many drinks do you have, where do your kids live, … all these stupid questions. Perhaps the appendix hadn’t burst yet. Perhaps it burst while I was taking my full history and checking of my check list. While I timidly tried to get the surgical resident to see him. While I was learning to be a doctor, perhaps there was a few minutes there, between my incompetence and his angry appendix. Perhaps had he been seen by a real doctor, or a surgeon, perhaps … But now, he is dead.
At first glace he was disheveled. His mismatched ragged clothes several sizes too big hung on his thin frame as if he were a scarecrow. I crunched up my nose as I was entering the room, expecting the stench that was all too familiar in those wards.
He didn’t stink. In fact he smelled of clean soap and laundry detergent. He was slurring his speech. The emergency room note read he might have been drunk. But one look at his asymmetric face with a large swollen right cheek and jaw suggested there may be more to this story.
Sadly there was … significant weight loss, difficulty eating, and progressively swollen face. For the longest time I remembered his diagnosis. I was by his side as the pathologist took a fine needle and pierced and poked his face to get a sample. But now, it too is gone. As is he, I am sure. This was the year 2006 and he had advanced neck cancer. The last day I saw him his friend had brought in a portable CD player and he was listening to classical music. For such a rough looking man, he had such a gentle soul. I had wanted to bring him some of my CDs, but I never did. I still remember that, and him … That nice veteran, the scent of clean soap and soft classical music …