[This is an advance post in a series from the ESN blog. You can find the first part here or here.]
In the first post of this series, I was ruminating about a patient who had a rapid decline in health and social circumstances, culminating in a recent scan that showed the possibility of cancer even while he was struggling with homelessness. It was a bleak situation that caught me off guard because I was not expecting it and was grieved to think of what it would be like for him to die alone.
It was stunning news. I listened with disbelief as my colleague described how a patient of ours, in whom we had uncovered a host of serious diseases over a few years, was now newly diagnosed with cancer after an incidental scan. In addition, his social supports had been eroded and I thought about what it would be like for him to die from a vicious terminal disease while alone and homeless. He would not be the first patient for me to watch die in such a way.
Last Saturday I tried to go to work early and catch up on some paperwork. The building was not yet unlocked, so I went to the diner across the street for some breakfast.
I ordered the $3.25 breakfast, consisting of a carb (2 slices of white toast), a vegetable (fried potatoes), and a protein (2 fried eggs). The man at the counter a couple seats down ordered the $5, which added sausage and subbed in french toast for regular toast. Apparently he was too hungry to wait, and decided to order a muffin while his food was on the grill. I believe it was a blueberry muffin. And I believe the muffin contained as much, if not more sugar as flour.
I stopped and put my fork down on the plate. There was still food on it, but an emotional force had interrupted my appetite. My wife and I had been sitting at the dining table, chatting idly about preparations for our child, now nearly 34 weeks old and still in the womb.
34 weeks. In the mere act of thinking those numbers, my mind suddenly brought out memories of many other children I had seen with those same numbers attached. 34 weeks but still with an unexpected high-grade intraventricular hemorrhage. 34 weeks but with panhypopituitarism. 34 weeks but with neurologic devastation. 34 weeks but…
I haven’t exercised in several years. Really, the only time I run these days is when someone is literally dying. I run to Code Blues in the hospital. I run to stat messages on my 1980’s style pager. And that’s about it.
It’s shameful. I’m a physician who routinely counsels children and adults about the benefits of exercise and the importance of maintaining a “healthy lifestyle”. Consequently, I often feel like a hypocrite because I grouse and mutter and make excuses when my wife encourages me to do something active. It’s ironic because most people who see and know me shake their heads and say that I should gain several pounds.
The drug dealers around the corner work long hours, rain, snow or shine. Sometimes they purposely look away when I walk by. Sometimes they say hello/hi/good morning or “Do you have a light, ma’am?”, to which I respond, “No! I don’t smoke. And you shouldn’t either!”. Sometimes they look like hardened criminals with their lower orbital tattoos. Sometimes they look pitifully vulnerable sipping on a Capri Sun. If you’re sipping on a Capri Sun, I’m gonna have a hard time taking you seriously. Victor is one of the local dealers. I met him a year and a half ago.
Every year, over the span of a couple short weeks, I celebrate my birthday, Christmas, and the New Year. I reminisce over the past year and resolve new goals for the next. This year has been filled with what I call alone-in-the-middle-of-the-night moments. Do you ever get those? One of the moments came for me as I was lying awake one night listening to my grandmother’s shallow breaths over a baby monitor and calculating her doses of Ativan and morphine in my head. Another time came when I walked into the basement to submit an electric meter reading, that was due at midnight two days earlier, only to see inches of dark murky water all around. And there was the time I was curled up in pain on the bathroom floor, wrapped up in an old afghan, knowing I had to be at work in a few short hours. And yet another moment came as I was anxiously pacing in the emergency room waiting to hear news of a sick friend. It’s those moments when crisis hits after dark and no one is humanly available to share in my pain. Perhaps the knowledge that I was alone was worse than the actual event. My normal practice would be to call up a friend, but calling is just not a nice thing to do at two, three, or four in the morning. In the silence, my mind tends to run wild with all the things that could go wrong. I flounder to find a sense of peace or organized plan of action or method of processing. My mind tries grasping at something, just one little sliver of brightness to cling onto. Continue reading “In the Middle of the Night”→