NPO and be merry

It is the holiday season, and all through the hospital, patients are being made “NPO.”  This is the medical term for “no eating or drinking allowed.”

Mr. T, silver-haired and newly unemployed, is NPO on account of his pancreatitis.  “We don’t want to upset your pancreas,” the team tells him when we pass through on morning rounds.  It is nearly breakfast time.  We hover around his bed in a half circle like an uncertain a cappella group.

He is sitting on the bed, legs swung over the side and hands on his knees as if he is about to push up and take off.  Okay, he says.

“Okay?” says the team.

“Okay,” he says again slowly, and nods.

We keep going.  Two rooms down is Mr. M, a large man in his seventies, here because he vomited blood the day before.  He has a history of stomach ulcers, which concerns us, and eyes like a blind person’s — only he isn’t blind, because after the whole team has crowded into the room, he looks at me and bellows, “And who are you?”

A medical student, the doctors reassure him.  Anyways, any blood?

“No blood!”  He thinks we are fools.  “I had some raw bacon yesterday, and that’s why I threw up.”

We check the basin next to his breakfast tray.  Inside, bits of food float in a merlot-colored broth.

You shouldn’t be eating, says the attending.

“Says who?”

Says me, says the attending.

“Are you a doctor?” the patient demands.

Yes, says the attending, we’re all doctors.

“She’s not!” says the patient, shooting a finger in my direction.  We have to give him credit: raw bacon aside, the man is quick.


We go back around the next day.

“Mr. T,” we ask our patient with pancreatitis, “how are you feeling? How is the pain?”

“I ate cake,” he tells us.

Alright. We ask that he not do that anymore, and he nods: it is not an unreasonable request.

Mr. M, meanwhile, has been advanced from NPO to a liquid diet, so we expect him to be in a better mood.  Instead, we find the opposite.  “This is not food!” says Mr. M from an armchair, jabbing his tray.  On it are two ginger ales, something resembling gruel, and several cartons of Jell-O.

“Have you tried this?”  He lifts a spoonful of gruel.  “You all should have to try this stuff before you make other people eat it.”

Sympathy liquids, I think to myself — either a reasonable or highly unreasonable request.

“This is killing me,” he says.

I am learning the distinction between what is important to doctors and what matters to people.  I once met a pregnant woman with Marfan syndrome — a tissue disorder that can damage the heart — who had a massively dilated aorta.  She could easily die from the pregnancy, her doctor warned.  The patient dismissed this to ask: was it possible, when she accidentally rolled onto her stomach in her sleep a few nights ago, that she might have crushed the baby a little?

Another woman with cancer growing in her neck flagged me down half an hour before a surgery to remove the cancerous mass.  The surgeon who would be operating on her was famous, and she was a fan of his writing.  She was thinking about making a joke before the operation, she told me, but wasn’t sure how he would take it.  She practiced the joke and waited for my reaction.  The line across her neck, marking where the surgeon would make an incision with his scalpel, was curved like a smile.


The day goes on, and Mr. M is taken for an endoscopy.  It turns out he has bleeding ulcers after all.

Mr. T is spotted lurking by the service elevators, IV pole in tow, waiting to catch a ride down to the cafeteria.


In the emergency department, an old man with stomach cancer and dementia has pulled out his feeding tube.  The tube goes straight into his gut, because he can’t eat the normal way anymore.  The patient is restless.  “I need an ambulance,” he says over and over again in Spanish.

You’re already in the hospital, we tell him.  What do you need an ambulance for?

“To go home,” he says.

This holiday season, patients all through the hospital are far from home, far from the comforts of food and drink, far in many cases from good health.

We think of doctors as doers, slicing out problems with their scalpels or melting them away with their medicines.  They give the orders that are supposed to set betterment in motion — NPO, they peck out on a keyboard, and suddenly the world changes.

But maybe the world lives by slightly different rules, rules that account for not only getting better but also getting there in a certain way.

“Guess what Mr. T ate today?” my teammate reports.  “A cheeseburger.”

In a perfect world, patients would do exactly what their doctors said, and doctors would prescribe cheeseburgers.  Short of that, the best thing for patient and doctor alike may be to have a cup of gruel and get to know each other — not as one person trying to save another one’s life, but just as two people living.

Rena Xu is a medical student.  Her writing has appeared in The Atlantic and The New England Journal of Medicine.  She can be reached on Twitter @xrayunicorn.

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