November 25, 2013

old wounds

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

Help, lofty genius! Muses, manifest
  Goodwill to me! Recording what befell,
  Do thou, O mind, now show thee at thy best
- Canto II from Dante's Inferno

     Without even looking at the chart, this poor young woman was college age at the oldest.  And there by her side was her younger brother.  We were consulted for essentially existential anxiety.  The patient had exhausted every option at their own hospital and were now at MD Anderson to see if they could pull a miracle.  As I sat talking, but mostly listening to her story, she began to have pain spikes.  I knew what those were all too well.  Already on a dilaudid drip and clicker on demand, she was on the best pain control possible short of putting her into a medically induced coma.  But still the pain spikes hit and during the spike her whole body would grimace and contort.  She or her brother would click the button to administer the extra medicine and wait for it to subside.  There was little medically I could do as she was receiving the best care possible.  So I held her hand and told her to squeeze it until the pain passed.  Sometimes the best thing a doctor can do is just be present and witness and honor their story and suffering. 
     The pain would pass and then she would continue telling her story with tears beginning to well up in her eyes.  She was also concerned about her mother which would cause her mother to cry.  And behind it all stood her brother unwavering.  It was all I could do to not start crying myself.  The only thing that kept me from crying was I didn't not want to intrude on their pain.  This was not about me, despite all the similarities.  It was about them and their experience.  She eventually finished her story and I reassured them that we were available to them for any help we could provide.  I walked out and waited for my resident to present to.  While waiting, the brother came out of the room to look for a coke machine.  While it was not about me, I felt that I did have something to offer the brother.  I interrupted his search and spoke to him briefly.  I told him to make sure he takes care of himself and especially his mother as they were both going through hell.  And I also gave the well used line, "and besides, how can you care for your sister if you're too broken and worn down?"
     My resident showed up shortly after and I presented to her without breaking down into tears, though my eyes did get a bit watery.  It was ok, my resident already knew my experiences with cancer (she had asked me why I seemed so comfortable around the dying patients).  There was very little we could do medically for this patient except listen.  The mother was religious so we put in a request for a chaplain.  Of course the chaplain was a familiar face from my experiences with my own brother.  Doing rounds the next day, I bumped into the chaplain and asked for his thoughts on the case.  I then bared my own experiences with him and his face went ashen.  He pulled out his card and gave it to me insisting that I contact him at some point.  I never did.  I was too busy.  Too much to do.  I wish I had taken my own advice and taken care of myself first.


Abe said...

And how quickly the moment and the opportunity do pass......

Isaac van Sligtenhorst said...

Life can change in the span of a heartbeat.