Two weeks ago, he was working at a very high-tech job. Yes, he had metastatic cancer, but he had hope; he was on a powerful anti-cancer drug. Now he lay in front of me, wife and college-age son in attendance; and he was dying…
He complained of stomach pain; he was in shock. In time, my nurses and I were able to reverse his immediate threat, and set about to figure out what was going on. The labs and x-rays began to dribble in. His kidneys were not working, evidently the result of his anti-cancer drugs. These drugs are toxins, poisons, and don’t discriminate between malignant cells and cells necessary for life. The CT scan resulted: small bowel obstruction, a blockage of the bowel by a new tumor in his abdomen; his cancer far more wide-spread than it had been.
I went into his room, he had finally stopped vomiting and was in peaceful sleep. All my frantic attempts to arrest his downward course had been successful, but I hadn’t saved his life; I’d only bought him some time.
I walked into the room, and told his wife the cause of his abdominal pain. “But, what caused the obstruction?” I couldn’t bring myself to tell her that her husband’s malignancy was running rampant.
She whispered, “Cancer…?”
I simply nodded.
I called his oncologist who admitted him, but asked me if it was the patient’s wish that we do
something for him or simply ‘put him on a drip.’ ‘To be put on a drip’ means to simply control his symptoms, be they nausea, pain, fear, whatever. It struck me as so ironic: I had pulled every therapeutic trick out of my hat to reverse this dear man’s downward course, and now, having succeeded in that hopeless undertaking, now, we do nothing?! But that’s the human side of me; the practitioner side of me knows there’s little more that can be done. Surgery – in his present state, he’d never get off the table, ie: the surgery would kill him. Still, there’s no fairness in it.
His wife had promised to love him ‘til death do them part; as young as they both were, she could lay valid claim to twenty more years of togetherness, then they, in due course, in the more natural order of things, could face the death which remove one of them from their relationship. But there’s a shadow across their door now; and it is dark, and baleful, and intransigent; immune to grief or tears, and they will have to deal with this dissolution far sooner than either of them could have ever anticipated.
When I come home, and all is quiet, I recall the cases of the day, and realize with some sense of short-coming how I could have done better. While in the ER, there are so many interruptions: ‘Read this cardiogram!” “Dr. Garvin, we need you in Room four, stat!” Cross-talking around other people gathered in the room, EMT’s, nurses, receptionists, makes it sometimes hard to think, hard to be human. Sometimes I forget; I omit the human touch; this becomes the more poignant when, as in this case, there is no other touch to give…
I could have hand-locked the patient, hugged the wife, knuckled-bumped the son by way of sympathy – but it gets so busy, so many interruptions, sometimes, it seems, there’s no time to be a human being…
I’ve won awards for Best Bedside Manner, but there would be no such awards for me this day. I could have done better. I should have tried harder.
Look for Lucky’s books locally and on-line: The Oath of Hippocrates; The Cotillian; A Journey Long Delayed.