Abstract
His nurse was standing in the doorway, talking to the nephrology resident in his long white coat. Next year my coat will grow 12 inches and in those 12 inches I will be qualified to do all kinds of things I only play at this year. Those 12 inches will give me license to sign the orders I write, to make my notes in the legal patient record, and they will qualify me to make the telephone call the resident was about to make.
The nurse blurted, “He died just a few minutes ago. I just called the resident in here,” like it was one long word. She seemed desperate to relieve herself of its contents. “When I walked in he looked grey. As I bent over to check his pulse he stopped breathing.”
“Was Sandy here?” I asked, wondering if she would have wanted to be.
He looked so quiet in his hospital bed. His amputated foot was untucked from the covers, revealing the dark hole that the wound vac had been attempting to heal until 2 days ago when we switched him to “comfort care.” I held his hand for a moment. He felt warm. His eyes appeared freshly crusted from sleep. I wanted to cry, but I felt cold.
I knew that medical school would change me. I learned that the moment I slipped on my stiff white coat. It made me stand up straighter. I knew it when my mom handed me the Littmann box that contained my shiny, navy-blue stethoscope. I put the ear buds in my ears, backwards, and listened to my own heart pounding. Mine was the first of thousands of heartbeats. I hoped that some day those foreign sounds would tell me a story.
Yesterday morning, he was tachycardic. His heart sounded almost desperate as it thudded along, racing to get somewhere. This morning, my stethoscope remained looped around my neck.
I was standing at a computer station when the nurse told me Sandy had arrived. I was reading about a new patient: “end-stage breast cancer, respiratory distress, please consult for goals.” I wondered what goals we could possibly set other than “to die gracefully,” but maybe she wanted aggressive antibiotics like our other dying patients. It felt so strange to have to move on to the next case, the next dying person.
I knocked softly. The door creaked as I gently pushed it open. The room was so quiet compared with the bustle and beeping of the hallway. The nurse had covered him with a blue quilt and a teddy bear was placed carefully next to his head. No one should die alone. It seemed so ridiculous to send his family home with a stuffed animal when they came to the hospital with him. The smell of fresh lilies permeated the room. I have lilies on my kitchen table. My fiancé surprised me with them last week, with the same gesture of love that Sandy had shown her husband yesterday.
She turned toward me and said, “Thank you.”
People told me this could happen, but somehow it was the opposite of what I had expected. It was so hard to understand what she could possibly be thanking me for. Her husband died this morning.
She hugged me. A real hug, and neither of us seemed to want to let go. In medical school they teach us how to treat disease, but science does not prepare you for this. Lecturers do not have slides about how becoming a doctor isolates you, how crushing the privilege of people opening their lives to you can feel. Sometimes I wonder if it would be healthier for me to build walls, to use my coat as armor. For now it is my security blanket, the place I shrink into to feel safe.
She smelled strongly of cigarette smoke. She told me how he used to smoke at home even though he wasn't allowed. He would go home and smoke, and get sick and get stuck back in the hospital. “I told him if he didn't stop I would tell the doctors,” she confessed. I hope she quits after this is all over. But for now I hope she keeps smoking—one small thing she can still control.
As we let go, she started talking. We were coated in yellow paper isolation gowns, planted on the plastic cushions of hospital chairs. They met when she was 17. She laughed when she told me about how she learned he had diabetes. “I saw the needles. I planned an intervention. I had pamphlets and promised I'd help him get into rehab.” In reality, she helped him with his daily injections and faithfully attended each hospital admission.
As I turned to leave, I noticed a can of Mountain Dew sitting behind his head with a perky plastic straw perched out of it. She must have brought it in this morning, but I wondered why the straw was there. In his last days of life, all he had asked for was Mountain Dew.
I saw other patients that day. There was a woman in acute respiratory distress who had been refusing morphine through gasped breaths, a transplant patient who deliriously participated in his family meeting, and an elderly demented woman who was hallucinating.
But I thought about the patient who had died and his wife all day. Somehow, they were with me. I heard his unsteady, rasping breaths in other patients' rooms and saw her resolve on other spouses' faces. My first patient death, I kept thinking, but it really wasn't my patient's death. It was Sandy's husband who had died. He had lived apart from the disordered cadence of the hospital wards.
At the end of the day, my shoe squeaked down the hallway of my apartment building. I left my white coat in the car, but my kitchen still smelled like lilies.