A difficult patient helps a doctor see the light. Literally.


In November of my intern year, I had trouble finding the sun. It was dark when I woke up for work, and it was dark when I headed back home. I’d picked up the service on the cancer ward from an intern named Bob, and he left me six handwritten pages on the subject of Jim Franklin.

This was the deal: Jim Franklin, thirty-seven years old, was in the cancer ward for the last three months. He had a two-foot-high stack of records, and the pity and admiration of nearly every nurse, tech and doctor in the hospital. He’d been diagnosed with Hodgkin’s lymphoma four years earlier, treated with chemotherapy and thought it was cured. A year ago, his cancer had recurred, and therapy was failing.

By November, I had been a doctor for six months. I thought that I’d seen just about everything there was to see, but I had never seen this. Jim weighed ninety pounds, his hair and teeth were falling out and his legs were covered with oozing sores that were never going to heal. He grew antibiotic-resistant bacteria and esoteric fungi out of his blood every time we cultured it. I spent most of my day fielding calls from the lab about Jim’s consistently out-of-range test results. My chief resident looked over my shoulder at Jim’s chart one day and had this to say about the status of Jim’s protoplasm: “Incompatible with life.”

But Jim Franklin did live, and this was most evident to me in the way he got pissed off every morning when we interrupted his breakfast with more bad news about his body, and he would let the oncologists have it.

“You morons tell me every day I have to gain weight! Why don’t you tell me how the goddamn hell you expect me to do that when you interrupt my damn breakfast every time I pick up my damn fork? I thought you retards were supposed to be fucking geniuses and shit. Hell, I’ve met dogs smarter than you pack of vultures. Go ahead, stand around and stare at me like the idiots you are.”

Privately, I enjoyed hearing these morning tirades.

It was no secret that the specialists hated Jim. They couldn’t take that he was going to die. Watching these guys have to stand there and politely take it from a man who couldn’t even lift his head off the pillow delighted me. I worked all day every day on Jim, and I got a lot of sympathy from the other doctors for having to do so, but the secret was this: I was glad to.

I never told him, but Jim and I had more in common than he suspected. He was from a small town, as was I. He was far from his family, and his hospital room had become the entirety of his existence. I was new to town, and the hospital felt more familiar to me than my apartment, which I used only for sleep. Neither of us had any friends nearby. We were two lonely planets, set on intersecting orbits.

When I was alone with him in his room, drawing his blood or trying to find a vein for another IV, he would make his apologies to me for his morning tirades. He was old-fashioned enough to believe that you shouldn’t swear in front of a woman.

“Now, you know those are just words. I don’t mean anything by them.”

“No apology necessary.”

“Only thing left that I can do is swear. Look at me.” He showed me his arms, his elbows thicker around than his biceps. “I used to be a big guy. Hard to believe!”

“You should get your family to bring in some pictures, so people could see how you were.”

“Nah, my family ain’t coming all the way up here to bring me pictures. The day they brought me up here they knew I wasn’t coming home except in a coffin.” He looked at me out of the corner of his eye and pointed to himself.

“Piss and vinegar,” he said. “You’re stuck with me, and I’m stuck with you.”

The radiologist felt that Jim Franklin was a waste of X-ray film. One day, he threw Jim’s latest chest film on the light box and gestured vaguely at it: “There’s nothing normal about this X-ray.” He meant the eaten-away bone, the big, weak heart, the fluid on the lungs, the huge tumors.

I knew the radiologist meant that the dirty thumbprints of Jim’s cancer were everywhere. But the way in which he said it made me mad. Jim’s X-ray suggested nothing but hopelessness, but every day I walked into his room and saw someone who was still alive. The radiologist didn’t have to deal with that, but I did.

So I pointed to the bones of Jim’s left shoulder.

“It’s normal right there,” I told him.

He snickered in earnest. And in fact, the radiologists never found anything wrong with his left shoulder, even though I was to order many more X-rays, tempting fate each time. And the intern who took over his case when I left the ward at the end of the month took up where I’d left off and ordered some more, right up until the day after Christmas.

That’s when Jim’s family showed up, packed his things and took him home. He didn’t leave in a coffin as he predicted, but we all knew he was never coming back.

A folder of Jim’s X-rays labeled “Volume 17” lay around on a desk on the oncology ward, collecting dust. Late at night, having been called up to the ward to attend to a fever or a headache, residents would page through his films, deep in some sad, sentimental fog. We missed him. I missed him.

So one evening, when no one was looking, I took one of his chest X-rays and cut out the left shoulder. It was a piece of film the size of an index card, and I carried it around in my pocket.

In may of that year, there was a solar eclipse. I was surrounded by charts and deep in thought about a note when a nurse shook my arm, telling me that it was happening, and I was going to miss it. I ran down the stairwell and out onto the pavement outside the ambulance bay.

The sun was bright, and half the residents in the hospital were out there, waiting and fingering their chirping beepers. The internists all had little three-by-five-inch cards in which they’d poked pinholes. They were ready to safely project the eclipse onto the asphalt in front of them.

To me, that seemed like a lousy way to watch such an exciting thing happen — the wrong time to be so prudent. I considered just squinting straight up at it, the way the surgeons were, chancing blindness. Then I saw the radiologists across the way. They all had X-rays in their hands, and they were holding them up to the summer sky and looking through them. They saw the sun through a film of sickness and shadow.

In November of my intern year, I had trouble finding the sun. In May, I found myself looking right at it. I took Jim Franklin’s normal shoulder out of my pocket, and I looked up and through.

For a few moments, the eclipse was perfect, earth-silencing, a ring of white in the dark sky.

In those seconds, our little crowd paused in mid-breath, just a little scared. We stood expectant, waiting to feel the warmth of the sun once again and be reassured. And then I heard a bird chirp, and I listened to the traffic roar. The sun slipped from behind shadow, and I felt the world resume.

I returned to work, putting Jim’s X-ray back in my pocket, but knowing I’d see the world through his shadow for a long while yet.

Pulse logo 180 x 150Christine Todd is an internal medicine physician. This piece was originally published in Pulse — voices from the heart of medicine

Image credit: Shutterstock.com


View 1 Comments >

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories