The Old Man

November 19, 2006

men in St. Vincent truck

He refused the joint. They were heading back from Prospect on Colin’s truck. He always sat on the edge of the bed, back curled forward so his hands could hold the frame and with his legs splayed for balance. It had rained earlier, and his plastic sandals weren’t much use to him against the metal. He kicked them off.

This was his third month with work. Yesterday he bought a wallet to hold his money since selling the last one some time ago. He felt worth something again to have so much. Colin and his brothers had started giving him lifts home since the second week. They were his new friends and this ride home was the highlight of his day. He knew its every inch.

He knew just where to lean. Past Git’s Supermarket there was a hard bend to the right with a pot hole. He would normally lean into the turn, but Colin had two beers tonight and would probably forget the dip. At the turn he leaned opposite as the wheel fell, dropping the weight of the car, and he kept his balance. Andrew didn’t know his brother as well and tumbled from his seat into the bed of the truck. He kept silent while the three others laughed. They teased him, “What matter wit you, boy? An’t you learn from d’old man? You don see him fall!” He had mastered these roads.

He knew the importance of details. Details mattered. He saw men with soiled clothes and recognized them. The lines of dirt on a man’s shirt shifted between begging and honest work, and he knew this. He saw it in his own sleeve slapping around his arm and he leaned his sholder forward against the wind, proud of the difference. Details mattered. His callouses were his proof.

He took the beer from Andrew. Colin was driving faster tonight and the smooth level spaces between bends and holes were shortening. He timed it to take a sip without knocking his teeth. He leaned to hand the beer back when Colin jerked the wheel. He had taken the last turn too quickly, too close to the center of the road, and swerved to avoid a car he should have seen.

He fell backwards. His bare feet lifted from the truck bed as he reached down for the lip. The beer still in his hand he didn’t think to drop it even as he balanced off the edge, half in and out of safety. Colin swerved back on course but into another hole. The dip and bounce of the bed sent him straight into the air. The truck kept moving forward while he hung there, still. He landed on the pavement flat on his back.

****************************

“Did you hear about the accident?”

“No, what happened?” Read the rest of this entry »

Advertisements

Psych 0-5

September 14, 2006

Another psychiatry experience today. This man hallucinates fisherman turning into giant frogs. He describes smells coming to attack him. He was jealous of his brother’s success so set fire to his mother’s house. He tells us all of this while smiling. He says that his sister, who died years ago from GI cancer, visits him in recurring dreams. She keeps trying to have sex with him, he says. He’s missing a leg. Really ‘missing’ it, as in, can’t remember where it went. His file says that after setting fire to his mother’s house, he attacked his guards in prison and they shot him in the knee. No heroic measures were taken to save the limb.

All of that sounds interesting except I can’t focus on any of it. There’s a patient in the courtyard outside the window whose been playing the guitar for the last two hours. He’s a very good player and singer. I wish I were outside and far away from this guy’s problems.

I told my roommates today that I was very close to ruling out psych altogether. They all laughed at that: “Like you could ever be a psychiatrist.” I’m not offended by this at all because it’s just so completely true.


The Bell Curve

September 12, 2006

MD teaching bell curve Those outside of medicine, I want you to know this: doctors are doctors because they know medicine. They are not doctors because they are great teachers. And who teaches future doctors? Doctors do. For students looking to learn, it’s the lottery of the bell curve. Will today’s doctor also be a great teacher, an ok one, or confusing? Most of us will end up drawing in the middle. This week it feels like I’m on the losing tail.

To the clinical tutors I have had this past week, this is my open letter to you: Read the rest of this entry »


Wasted Mind

September 8, 2006

The Psychiatrist I have no idea if this is normal. Going to school in the Caribbean is great, but it isn’t the US, and for that reason I always catch myself wondering if my experience is a “normal” experience comparable to my US studentdoctor peers. Here goes:

I’m still in M2 and the school is interested in giving us a lot of clinical exposure before the clinical years. It’s the logic of pre-kindergarten. Twice a week I’m off to the hospital with my roommates to sample Peds, Med, OBGYN, etc. In addition, we have Clinical Skills, a class where we take non-sick volunteers and try to work them up for the Congestive Heart Failure that they don’t have. So once a week I’m reporting a 3rd heart sound that I don’t hear or a nodular liver in another healthy person at the urging of the tutor and feeling very silly. I am fine with all of this.

I am not fine today. Read the rest of this entry »


Cracked lips

August 12, 2006

Lip Balm If someone were to ask me, “What’s the stupidest thing you’ve ever done?”, I’d answer with this: trying to be in control.

Working on the terminal onc ward is pretty stressful if you’re emotive. People came to our floor because they were going to die. A lot of them were there for a week to receive the next chemo cycle before heading back home. Some of them stayed for longer, months even. But no one ever got so healthy that they left for good. Thankfully, I’m not as emotive as most.

You start to get a feel (or think that you do) for how people are doing. Some are feeling so well that they start thinking their cancer may be going away. Others are holding steady with their treatments, walking up the down-escalator. Some are doing horribly but are stably horrible. Those are the ones that are just agonizing to serve. I remember starting on the floor and taking care of the same women for three months. Every two hours, adjust position in bed. Clean as necessary. It was always necessary.

I remember a frail patient of mine that was in her seventies. Her family knew that things were worsening and that this weekend would be her last. Everyone from out of town was coming in and spending the full day with her. As a tech, it was always a strange experience entering the room to take vitals or perform a blood sugar test. The family members would watch me so intently and then each advance their chins to me, awaiting the result. “Her blood sugar is 136.” When there is no control, there must be control. Keeping track of BP, HR, and sugar are all our best attempts at control of some kind.

The family left for the night. I had ten patients for my census and checked in on her as much as possible. She was heading downhill and her breathing was becoming more and more labored until she started using her accessory muscles to pull in the air. They call this “agonal breathing” which just about hits it on the nose. I stood by her side and waited for the nurse to respond to my page. I didn’t see her do it, but the woman reached out and grabbed my wrist. It was unexpected and cold and it gave me a start. I reflexively pulled away and then felt a heavy embarrassment and sadness for her. I think I reached out to hold her hand. The nurse came in and the two made eye contact. She had such fear and the nurse looked at her and said that it was okay. You’re dying. It wasn’t cruel or improper, but somehow perfect for that moment. She relaxed.

There was nothing I could do for her. She was dying in front of me and I would be there for her final new and final final experience. I saw that her lips were cracked. I got some lip balm, held it out, and between gasping breaths she pursed her lips so that I could apply it. That was my stupid attempt at control. I can’t remember if I held her shoulder, or hand, or just stood there doing none of those things. She was staring straight ahead, bracing. And then she stopped.

We called the family. They came up the elevators crying at 4 in the morning. They stayed with her until 6 and, before my shift ended at 7:30, I walked into the room. After taking off her gown, I tied her feet together. I tied her wrists together. And just as I had turned her side to side so many times before, I managed her into the big white plastic bag. I wrote her name on a tag and looped it into the zipper. Security came and wheeled her away.

Alive, I could do something for this woman. Dead, I could do something for this woman. But dying? They didn’t cover that in training and it seems like something impossible to get entirely right. Even so, when the best you can do is stand in the room and treat cracked lips, it seems especially futile. A new patient with a new cancer and a new family was in the room within the hour.

Two years later and I still feel the pang of failing her that day with my stupid attempt at control. Worse, I know that it was one of her last memories.


Anne

April 30, 2006

Hospital Corridor I worked in a hospital for over a year on the Hem/Onc floor. We were the highest Onc floor, which meant we had the most terminal patients save for the ICU just above us. The night shift was a long shift, and we would pass it at the nurses’ station talking about nothing. The nurses would tell me about each patient or go through the charts with me (which might be against JCAHO, might not be) and I’d try to absorp what I could. When a patient needed to go for a CT scan, I would take him in his bed or wheelchair and sit behind the consoles watching the slices of their body on the screen.

 

After a year, even without any training in Anatomy, you get an idea of which cancers are the worst and what they look like on the CT. You know where each organ sits in the body and what it’s supposed to look like. And more than all of that, you can tell when the CT tech is holding her breath and the physician brings his hand to his mouth that this person is in some trouble.

 

So it was with Anne. She was a little younger than me, a year maybe. She went to a college that I knew well. We might have known some of the same people. She came to our floor with her parents and sister. I admitted her, went through my “this is everything” speech after I took her vitals, and let her family know that I was only a call-button away. She was beautiful and healthy and trying to make the best of it.

 

The admitting physician called me over with a wheelchair and I took her down to CT. She asked me where I went to school, if I was a nursing student or a med student (neither at the time, but hopeful), and my age. We had a lot in common. I helped her onto the table and then went in the back with the monitors. The Tech held her breath, the doctor covered his mouth. I saw what they saw: hundreds of tumors in her liver. “Poor girl. She’s so young.”

 

Everyone was speaking less as I took her upstairs and she knew. When we were alone in the elevator, she asked me, “So. What do I have?”

 

I didn’t say. “I’m just a tech; I can’t read a CT.” Again, she knew. I brought her back to her room and she said, “thank you.” My shift ended a few hours later, but not before every nurse on the floor knew about this girl.

 

I came back the next night and I could tell that the doctors hadn’t told the family. I came back the next night and off the elevator I could hear the papers moving at the secretary’s desk above the sounds of the nurses’ conversation. They had told her. I looked at the assignments and she was my patient that day. I rounded, got all my vitals and emptied urine and talked to families. Her room was the last. I came in ignorant and smiling because I’m not supposed to know what everyone knows. Her mother met me, told me it had been a hard day for the family, and that the nurse already got the vitals. “If you need anything, please…”

 

“We know. Thank you.”

 

She became sicker, friends started to visit, and then she left for a different hospital. I never found out what happened to her.

 

——-

 

Working in the hospital, that first week, you’re obsessed with knowing everything about the patients. You write their first and last names on your record sheet, you know what they did for a living, and you look at your insensitive coworkers that don’t know their patient’s names until they read their wristband. They have patients 3, 4, 5, 7, 9, 10, 14, and 15 instead of Mrs. Hayes, Mrs. Bopp, etc. You tell yourself that you’re going to remember the names of every person. You’re an idiot.

 

I’m no different. I tried it and slowly they slipped away. Then I started forgetting the names of people that had been on the floor for weeks at a time. Then I couldn’t remember the names of the people that had died on the floor, or the ones I had watched die. Then I couldn’t remember even 10 of them.

 

But I’ve always remembered Anne. Everytime I feel the year I spent in Hem/Onc slipping away and I can’t remember the nurses’ and the doctors’ and the patients’ names, so long as I remember Anne I feel like I haven’t lost it all. And I wonder how she’s doing. And I worry about her often.