Two Patients

 

 

This one patient of mine had rapidly become quite special to me. She was a sweet grandmotherly type with warm and often tear filled eyes. Her smile was pleasantly positioned halfway to a full smile as if the strain of more was too tiring.
She was in the hospital with severe heart disease. In her pink gown, brushed hair and mild scent from her array of soaps one would never think of her as a “patient”. She looked too comfortable and accustomed to hospitalization- this was her home.

I can’t remember the specifics of her stay…the lab tests, the rounds, the discussions. I do remember the conversations I had with her that were both disturbing and compelling.

I developed a routine of sitting at her bedside and pretending to take in medical information as she would relate her stories. I learned about her children, her grandchildren her youth and most importantly about her husband.
All her stories revolved around her husband.
They had reached their 50th wedding anniversary recently and shortly afterward he was diagnosed with cancer, then died six months later. This occurred about a year of this current hospitalization.
She gently cried every time she mentioned her husband. It was easy to understand why she felt that life was no longer important to her. She no longer shared her life with her constant companion, her children didn’t visit and it seemed that her friends had forgotten her. Perhaps she had become socially reclusive after the death of her husband. Perhaps she was viewed differently now that her husband was gone.

This lonely person had now become a lonely and sick hospital patient full of emotions, memories and stories.
I remember having difficulty identifying with the enormity of her loss. Fifty years of marriage and fifty years of the events of this relationship were now just a part of the past to be shared with strangers. I had only been married three years and I couldn’t fathom the loss of my wife. The memories and history I had in those three years seemed so full that in comparison fifty years seemed impossible to contain in your heart and soul.

I tried my best to listen, share and console her as I cared for her medically. She didn’t seem to notice though. She was lost in a world long past and cared little of the present. There was only one time that she grasped my hand and made strong eye contact. She didn’t say anything.

I was disturbed by her loneliness and sometimes wished that I hadn’t met her, yet I was quite fond of her. She died on one of those rare days that I wasn’t in the hospital and her death was not something that I had anticipated. I didn’t find out until preparing for rounds the next morning and while getting report from my fellow intern.
“By the way, your cardiac in room 305 died last night. She coded at 2AM….. Kept me up for an hour…you owe me”
I smiled as I was supposed to; being a strong hospital warrior was an important image to maintain.
I made rounds and passed her bed fighting away thoughts of her death. Did she abandon me or did we abandon her…I didn’t know. I didn’t even know if this was supposed to be a happy or sad event. I do know that the experience of knowing a little about her life and passion was an honor and a lesson. I learned about life, relationships and death because of patients like her. I also learned that bonding or identifying with your patient was painful and dangerous in the practice of medicine.

In contrast to this patient, our medical team had inherited another patient that was simply a body that didn’t seem to know she was dead. She was a thin, bony woman with deathly pallor, chapped lips and a blank dry eyed stare at the same spot on the ceiling. When we first started taking over her care from the last “team” we would make rounds at her bedside and do the usual thing.
The intern would report of clinical changes or events.
Recent laboratory findings were mechanically vocalized.
A problem list was presented with an associated plan.
The resident would then ceremoniously listen to the patient’s heart and lungs and perhaps feel her calf for pain.
She had end stage lung disease and her only therapy was oxygen and IV fluids. She was a “no code” which unfortunately meant “ignore me” in that era. We complied, and though her condition remained unchanged we eventually started bypassing the traditional rounds on her.

We stopped going into the room. The resident stopped listening to her lungs and we spent just moments discussing her at the door side.

“Patient with end stage pulmonary disease…no code…no change.” The intern would state.

The team would then peek in the room and we would start toward the next patient. I do remember that she never seemed to change position. She was always unkempt and had a bad odor. That smell was what I began to associate with impending death.

One day, while doing the doorway rounds with her, we noticed something surprisingly different about her. Something had changed and wordlessly we filed into the room with curiosity. Her appearance had changed; she was wearing a pink gown, not the hospital green. There was more though. She looked like she had a better skin color and…she was moving! We called the nurse in who was caring for her.
This young new nurse didn’t seem to be surprised by her changes but was worried she had done something wrong.

“Oh, I’ve just been washing her….her hair was a mess by the way…her lips were so dry that I started using Chap Stick on her” She looked concerned after this confession.

“That’s Ok isn’t it…I mean to use the Chap Stick and change her clothes on my own?”

Our resident said “of course” and he even smiled a little as we all left the room without further discussion. No one spoke of the event or revelation, but I’m sure that we all felt similar feelings of shame from our neglect.
The patient continued to improve because of this real human contact and the caring nature of this nurse. The patient started talking, eating a little and looking like a member of the living once again. Her odor of death turned out to be an odor of abandonment.

Hopefully we all learned something from that experience. She didn’t die under our care and as we passed the baton to the new team of interns taking over our ward we did emphasize that she did need attention and thrived with contact and care.

Two things I learned from these two patients were critical for my future years. Identifying with patients was dangerous but compassion, listening and caring for patients was part of the practice of medicine. The latter, in many ways, offers more cures than the tests and drugs we offer.