Mr Lee, the father of a twenty-year
old quadriplegic, spoke to me in short rapid sentences
adapted to a doctor's rushed morning rounds. "He's starting
to move his left arm a little bit. And he keeps saying
he wants fries. He never used to speak before."
It had been three months since
his son suddenly became drowsy and confused after a
party. He had deteriorated ever since, his body becoming
spastic, his mind lost somewhere in a moaning incoherent
nightmare. Was it some kind of brain infection? Was
it due to drugs? The team didn't have much of a working
diagnosis but they called it Acute Disseminated Encephalomyelitis.
Every morning, Mr Lee would be
there at his son's bedside. The attendings had essentially
dubbed him a static invalid. I felt like I had to be
Mr Lee's voice, reporting on his son's progress, comparing
him now to how he was three weeks ago when I started
the rotation.
But at the bedside, my optimism
was guarded. After filling me in on the latest developments,
Mr Lee would look to me hopefully for some news. Would
we try another course of cyclophosphamide? Would this
week's attending offer to attempt one of the experimental
treatments that Mr Lee so meticulously researched?
No. All I could do was acknowledge
what Mr Lee said and change the subject.
A
SENSE OF PERSPECTIVE
As a medical student, I never felt it appropriate to
be the first one to break bad news. As a resident, it
sometimes seems like that's all I ever do.
"Mrs Bradd, you've had a stroke,"
I told the newly left-sided hemiplegic woman. There
was fear in her eyes as I tried my best to explain.
On neurology I diagnosed a stroke every day — it
was easy to lose sight of the fact that Mrs Bradd had
just acquired a life-altering disability.
Mr Lake came in for a workup of
an incidental mass found on chest x-ray. "Mr Lake, has
anyone told you what we found on the bronchoscopy you
had yesterday?" He shook his head. "There's no easy
way to say this, but you have lung cancer." I let the
words settle, searching his expression for comprehension.
"Do you know what I mean when I say this?"
"That's bad, isn't it?" he replied.
I nodded. I answered his questions, deferring any prognostic
speculation to the oncologists, thankful that he didn't
ask me outright. I ran away to a different rotation
yet again.
I notice now, how patients look
out their windows in quiet contemplation, or in the
cafeteria where families eat together in silence. As
much as they need me for guidance, there's a limit to
how much support and hope I can offer. And that's where
I'm struggling knowing how long to linger in my patients'
lives.
On my last day on neurology, I
said goodbye to Mr Lee and explained that another resident
would be taking over. He told me his son was moving
more and sweating less. "Make sure you emphasize your
son's progress to the attendings and residents every
time they come to see him," I said.
But I also told him: "As much as
your son is improving, it's unlikely he'll ever be completely
independent again." It broke my heart. Mr Lee paused
and blinked. Exhausted, he acknowledged what he already
knew deep down inside. We shook hands and I never saw
him again.
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