He wasn’t particularly likable upon first encounter. He wasn’t apt to answer questions asked. He had a long pause and a long drawl and a tangential, winded story — and backstory — all of which he was bound and determined to tell to its detailed completion. With an irregular heart rate in the 170s and a respiratory rate in the 30s, I tried to steer him in the direction of concise answers so I could obtain as much information as possible and do my job. This is an emergency. He is an emergency. An emergency which had waited until the last possible millisecond; we did not have the luxury of time.
But he was not to be rushed. My mind raced through his long pauses. My hands flitted around. Feeling his pulse, feeling his distended abdomen. Feeling the smoldering, red, hot cancer that took over his right thigh. I had never seen anything like it. It took my breath away and chilled me with impending fear of the extent of disease yet to be uncovered.
I tried to redirect him, but each interruption was met with a pause and an indignant return to where he had left off in his storytelling.
It had been three years since he found out. Then, it was just a small bump. They told him it was cancer. It was easily covered up with clothing and easy to deny. He muffled it’s pervading presence with his stubbornness. He was indignant. This wasn’t happening. But it continued to happen. With or without his permission. It grew and grew and grew. And now, it was an undeniable monster. Growing on his thigh, in his liver, in his lungs. Filling up all his space, causing him to take staccato, labored breaths. Fighting to steal some room for oxygen every moment of his days.
His heart medications had gotten mixed up, confused, or refused. It was hard to completely tease out what had happened, as he wasn’t ready to be completely forthcoming. His stories took us farther away with every follow-up question asked.
Now his heart worked in an overloaded chaotic state.
Infection had found its window of opportunity and seeped its way in to make sickness sicker — his organs on the cusp of failing.
His last name ended in an “-er,” like “Tyler” or “Kramer.” I brought the consent form for the procedure. He turned his head sharply towards me; we were practically nose to nose, as I had leaned in close so he could hear me in his good ear. “That’s not me. My name has no ‘S.’” he said. I looked at the name I had written on the consent form. I had mistakenly added an “S” to the end of the “-er,” like “Tylers” or “Kramers.” “You’re right,” I said. He gave me a gruff, indignant grunt.
We did what we could to stabilize him. I prepared for a procedure. “Have you done this before, doc?” He looked suspicious. “No,” I said resolutely. “But I just looked it up on YouTube, and it looked really easy.” He was startled and appalled. I winked and smiled. “Oh, you got me. You got me good. That was good.” He let out a bellowing laugh like a man with all of his breath and strength. It filled the room. We both needed to share that.
I spent my time in room 7 with him. Fluids, antibiotics, labs, imaging, procedures, talking. I softened. I grew to see his heart. His light. And I grew to like him very much.
I ultimately admitted him to the hospital. He may not have too much more time.
The next day was a day off clinical work, but I was at the hospital for meetings. My mind settled time and time again on Mr. “-er” with no “s.” I wandered between meetings up to his hospital room.
It took him a second to register who I was. My hair was down, and I wore normal clothes, not scrubs. “Oh hi, doc. Well, what are you doing here?” He asked breathlessly.
“I was just thinking I wanted to see how you were doing.”
“You want an update? Well, I can’t say it’s looking good, doc.”
He recounted his last 24 hours.
“I think I waited too long, doc. And now my wife, you know. She’s home. She needs someone to take care of her. So, you know. We have to figure out how to tell her. My son was here, you know. He slept here last night. You just missed him.”
We sat for a long time. I watched his monitor. An irregular, fast heart rate still in the 140s. I listened to the rapid jagged, sharp breaths he sucked in and out.
“This must be tough. You have to remove yourself. You can’t let yourself feel. You see terrible things. All the time. But you have to do, not feel. It must wear on you.” In a moment about him, he made it about me.
“Well,” I said. “I just want you to know you have touched my heart.”
We cried. That awful stifling cry where so much needs to come out of what feels like a pinhole. I gripped his forearm with its weathered, dry skin. My finger scraped the edge of the medical tape that held his IV in place. He patted my hand with his other hand until the blood pressure cycled and forced him to straighten it out.
“Oh, doc. Thank you. For your therapeutic tears. They are warming. You worked last night, and now here you are. Right next to me. What a doc you are. What a doc you are.”
He lay with his eyes closed. Tired. Silent. Just his labored breathing.
Mr. “-er,” no “-s,” you are on my mind. Know that I’ll be here. Right next to you.
Cindy Winebrenner is an emergency physician who blogs at Mom-Wife-Doctor Thoughts.
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