Well, the theme for this issue seems to be
Fan History Through the Years. Given that, you might think we've got our work cut out
for us in attempting to even tenuously connect the latest installment of Sharon
Farber's 'Medical Life' series with that theme, but never fear -- we're up to it!
Actually, the connection is a pretty easy one -- the history of fandom is literally
filled with many, many stories of and by fan humorists. There are a lot of
currently-active fan humorists whose exploits will someday fill pages of fanhistories
yet to be written. The writer of the following is one of those fan humorists who we
think will be remembered.
Well, because I just don't have any stories like that -- when one of my patients dies, it's either fast and unexpected, with no chance for reconciliation or meaningful dialogue. Or else it is very very slow, first stripping away the patient's dignity bit by bit, while the family watches the deterioration and suffers its consequences.
And as for heart-warming -- well, the warmest my patients' hearts get is after cardiac bypass, when the surgeon brings them back up to body temperature.
But if I were to try for one of those vignettes, here are my tales that come closest to their requirements -- only, I think they all fall a little short. Like maybe a mile.
I. THE GRATEFUL PATIENT
Some doctors have patients who bring them produce or home-baked goods; not me. (Of course, I'm not in primary care; my mom had a large population of folks from Chinatown whom she had cured of tuberculosis. They never failed to bring tasty treats on their yearly check-ups. I miss the pork buns, but I can do without the seaweed cookies, thank you.)
During my residency I saved a guy's life -- well, okay, I only diagnosed his heart attack, then hustled him off to the cardiac care unit for the cardiologists to save his life. The man was a raspberry farmer, and despite it being harvest season, and despite the none-too-subtle way I kept saying how much I love raspberries, I didn't even get a thank you when he left the hospital. Patients tended to thank the attendings who came by once a day and signed the chart, not the residents who sat up all night sweating blood over them.
When I was a fourth-year medical student on my medicine subinternship, I did have a grateful patient. She had been admitted with myxedema -- severe hypothyroidism, with her body just about shut down. Her past history suggested she had a problem with depression, but we didn't know she was actually a manic depressive until we brought her metabolism back into the normal range, precipitating a manic episode.
I made the unfortunate discovery one morning when I came into her room. "I'm so glad to see you," she said, "you've been so good to me. Here is a chocolate bar for you."
She handed me a Snickers, and then held out a piece of lined paper covered with childish handwriting.
"..and here's a letter for you from God."
God said lots of nice things about me. But I was surprised by how rotten he spelled.
II. THE HAPPY DEMISE
I guess I've had one patient die happily. It was during my internship. I'd just finished my rotation in the intensive care unit and two of my patients there, who had been hanging on for no apparent reason for weeks, died a couple days after I transferred to the wards. Then when this old man died too, so that I had, in a way, lost three in one day, people started calling me the Angel of Death.
That's the sort of nickname that can really make your day.
Anyway, we admitted an ancient man with pneumonia and bacteremia -- bacteria in the blood. That carried an 85% mortality in his age group, and as I was leaving the next evening, having been up the usual 36 hours or so, I heard the operator announce a code (cardiac arrest/resuscitation). "I bet that's my guy," I thought, and scurried back to his room. Big mistake.
The resident running the code had just taken the Advanced Life Support course, and was anxious to try out his new accreditation. He ran through the asystole (no heartbeat, as opposed to V-fig -- bad heartbeat) protocol several times, until they ran out of calcium and epinephrine on the crash cart. So he told them to go get another crash cart. (Which reminds me of the unfortunate time, a year later at City Hospital, that I was running my second code in as many days. "Epi," I said. "There is none," said the nurse accusatorially. "You used it up yesterday!" I had seen her going through the crash cart after the previous day's code and, silly me, had thought she might have been restocking it.)
Because the resident was having such fun, the code went on for at least an hour, although it was apparent to the rest of us that it was pretty useless. I felt I ought to stick around, so someone who the family knew could give them the news. At long last, while there was still some calcium left somewhere in the hospital, the resident gave up and declared the code over. I went to the waiting room to tell the relatives how sorry I was.
"Oh, don't worry about it," they said, and told me how the code had begun. It seemed that the old man had been sleeping quietly, when suddenly he sat bolt upright in bed and stared off into space.
"I'm satisfied," he said. "I'm satisfied. I'M SAT-IS-FIED!" And promptly dropped dead.
And if he was satisfied, well, so were they.
III. LOVE WINS OUT
This happened to one of my roommates during her third-year rotation as the medical student on cardiothoracic surgery. She was caring for a woman with rheumatic heart disease, in for a valve job. The husband was in the room constantly, and a more concerned, loving spouse one seldom saw. The couple had six children -- surprisingly, she had got through the pregnancies and deliveries without the complications one would have expected from her severe heart disease. Thus my friend was a bit surprised when she discovered they the couple were not actually married.
"Wait a minute," said my friend. "You two have lived together for fifteen years, you have kids, you clearly love each other. Why don't you get married?"
They both looked sad. "Well, you see," answered the patient, "when I got the rheumatic fever as a little girl, my doctor took me aside and said, 'Honey, you can never get married.'"
When my friend explained that the doctor had really just meant that she should not have children, and that there was absolutely no reason they could not marry, there was joy all around.
IV. THE FAMILY REUNION
During my stint as chief resident at Regional Hospital (the successor to City Hospital, which was shut down), an elderly alcoholic was admitted to my service, after being found semiconscious on the sidewalk outside a bar. He had alcoholic dementia, old strokes, and new pneumonia. He could tell us his name -- let's call him John Jones -- but no other information. There are an awful lot of Joneses in the St. Louis phone book.
In desperation, I finally called the only address we had on the chart: the bar he'd been found outside. To my surprise, they knew him well -- in fact, he lived in their back room, but they didn't want him back.
He recovered from the pneumonia quickly, but he had no family, no money, and the city nursing home had got in some kind of government trouble, and was no longer accepting patients. It looked like we would be stuck with him indefinitely. This depressed us, as the whole ward was filling up with similar unplaceable patients.
(In fact, if an intern managed to place a patient in a nursing home or otherwise discharge someone, he was awarded my official Superman pen, to use until the next intern or student earned it. After a prodigious feat of servicedom, the entire team would start chanting "The pen! The pen!" until I took it from the pocket of the last hero, and presented it formally to the new one. But then, I also used to round wearing a button reading 'Doom Patrol'. We were a bit loose there.)
Anyway, it looked as if Mr. Jones would be another permanent fixture in the neuro ward. Then, one night, my resident admitted another man named Jones, with alcohol withdrawal seizures. The only empty bed was in the elderly Jones' room, and despite the sensible policy against two patients with the same name occupying the same room, my resident had no choice.
As the stretcher entered the room, the young drunk looked over at the old drunk.
"Daddy!" he cried.
He refused to take him home too.
All illustrations by Jeanne Gomoll