yesterday at work, i got to see one of my favorite guys- (kevin it was mr. w). he has spent most of his life living in the fringe- on the edges- homeless for years- a drinker- a smoker and other things too. he's a guy who wasn't surprised when he got lung cancer- well, until he actually got it and found out it was incurable. the lung cancer wasn't the shock- the incurable was. there is something about endings. he had lived hard- and this diagnosis was a turning point- a chance for reconciliation- for redemption- and that part he has embraced wholeheartedly. i've watched him go through this process - i've seen his regrets and his acceptance and his outreach to family - his making lemonade with his lemons. he has a beautiful soul- and i'm reminded that most people do, underneath it all.
he was really late for his appointment - which always makes me nervous- but i found him downstairs finishing his oncology appointment. i was getting directed to his exam room by one of the oncologists- who said to me,
"oh mr. w is doing great!".
"really?" i said, knowing he is losing weight, that he has a growing mass in his abdomen that terrifies him, and that he is on a third line chemotherapy and his disease is continuing to progress,
"what do you mean?"
"oh mr. w is doing great!".
"really?" i said, knowing he is losing weight, that he has a growing mass in his abdomen that terrifies him, and that he is on a third line chemotherapy and his disease is continuing to progress,
"what do you mean?"
"well, his pain is controlled and he is able to a lot of things for himself."
this is true. but he is also dying. he has a few months left to live.
this is true. but he is also dying. he has a few months left to live.
what do our words mean? and what is the relationship between the words themselves and who is speaking them? because if mr. w's friend said that to him, it would mean something different than if his cancer doctor says that to him. we assume that context is relevant. and it should be.
i've spent many hours with mr. w- i've been to his home. he has really struggled with wrapping his mind around facing the end of his life. he's only 53.
we need to be careful with our words- in both directions. we need to tread lightly. to listen before we speak. to know the heaviness and not just pour syrup on it. to know the heaviness and help make it lighter with honesty and hope. to face the music.
the man right before mr. w- is another tough one. diagnosed only a few months ago with bad disease- no time to process. he came into clinic sick- kidneys failing- in pain- not functioning- and looking bad- bad like i wouldn't be surprised if he died during this hospitalization. we had only seen him in clinic once before and we hadn't had 'the talk'. we hadn't talked about what he would want in the end- how he sees the last chapter. and it was clear that he didn't believe his book had an end. i sat with him and held his hand and said i needed to know who he would want to make decisions for him, if he couldn't make decisions for himself. he told me he wasn't going anywhere- he told me he wasn't going to die. i told him that we were going to do everything we could to help him feel better and get better. but i told him we are all going to die.
i've seen what happens when you don't talk about it. the default. one of the first times i really knew that i was going to struggle with certain aspects of medicine was during my ER rotation as a senior resident. i was in "zone one" the high acuity area and we'd just received a call that an old man was coming in in v-fib arrest. this is bad. the ER attending physician was all pumped up.
"this is great! you'll get to run the code."
did he just say 'this is great?' all i could thing was how awful it was. that his poor old man was dying- and that he was going to die on a cold table in an overly bright emergency room, surrounded by strangers who will descend upon him in full protocol mentality, without knowing what he wants or who he is. and that if he survived- he will not have much left upstairs- and he'd be stuck in some new reality- the in between zone- not really dead, but not really alive. i felt sick. he rolled in- and we heard the report from the EMTs. man found down- resuscitated in the field- had a pulse-but lost it- some electrical readings on the monitor of his heartbeat. he was in trauma room 2 - his "name" was trauma elk. that means that no one knew his name and he'd been letter E on the shift (the 5th pt) with no name. i began the algorithm for a PEA arrest - pulseless electrical activity. it wasn't cool, it wasn't exciting, it wasn't good practice. it was someones dad. since i was running it- i asked how long it had been since he'd been down- at least 20 minutes. enough. i said. i'm calling it. time of death- 2:15 pm. i still didn't know his name. i found his wallet in his pocket and it had a number in it. i went out to the nurses station to call it. it was an answering machine, " hi you've reached earl, i'm sorry i can't take your call- please leave a message after the tone." it was weird to hear a healthy sounding voice coming from a dead man. i felt like i'd done him a disservice. i saved his 'trauma elk' sticker, and when i came home, i put it on a small canvas and painted it orange (above). i wanted to do something to honor him. and to remind me of the life behind each person- of respecting each individual in both life and in death. and to remember the that the words we speak matter- to remember this when i'm the attending physician- when i'm the teacher.
our words reach out to each other everyday. what we say matters- not just as doctors- but as people. friends, parents, spouses. neighbors. we can hang on to words forever- they live with us- bring us joy and sadness- and who speaks them matters. the word is linked to the mouth, mind and heart who spoke it. powerful.
so i'm reminded to be careful- to tread lightly- to be gentle- and to pay attention to which hat i'm wearing-and to who is listening. that words can be magical or harmful and they stay with us-playing over and over- shaping our days.
i've seen what happens when you don't talk about it. the default. one of the first times i really knew that i was going to struggle with certain aspects of medicine was during my ER rotation as a senior resident. i was in "zone one" the high acuity area and we'd just received a call that an old man was coming in in v-fib arrest. this is bad. the ER attending physician was all pumped up.
"this is great! you'll get to run the code."
did he just say 'this is great?' all i could thing was how awful it was. that his poor old man was dying- and that he was going to die on a cold table in an overly bright emergency room, surrounded by strangers who will descend upon him in full protocol mentality, without knowing what he wants or who he is. and that if he survived- he will not have much left upstairs- and he'd be stuck in some new reality- the in between zone- not really dead, but not really alive. i felt sick. he rolled in- and we heard the report from the EMTs. man found down- resuscitated in the field- had a pulse-but lost it- some electrical readings on the monitor of his heartbeat. he was in trauma room 2 - his "name" was trauma elk. that means that no one knew his name and he'd been letter E on the shift (the 5th pt) with no name. i began the algorithm for a PEA arrest - pulseless electrical activity. it wasn't cool, it wasn't exciting, it wasn't good practice. it was someones dad. since i was running it- i asked how long it had been since he'd been down- at least 20 minutes. enough. i said. i'm calling it. time of death- 2:15 pm. i still didn't know his name. i found his wallet in his pocket and it had a number in it. i went out to the nurses station to call it. it was an answering machine, " hi you've reached earl, i'm sorry i can't take your call- please leave a message after the tone." it was weird to hear a healthy sounding voice coming from a dead man. i felt like i'd done him a disservice. i saved his 'trauma elk' sticker, and when i came home, i put it on a small canvas and painted it orange (above). i wanted to do something to honor him. and to remind me of the life behind each person- of respecting each individual in both life and in death. and to remember the that the words we speak matter- to remember this when i'm the attending physician- when i'm the teacher.
our words reach out to each other everyday. what we say matters- not just as doctors- but as people. friends, parents, spouses. neighbors. we can hang on to words forever- they live with us- bring us joy and sadness- and who speaks them matters. the word is linked to the mouth, mind and heart who spoke it. powerful.
so i'm reminded to be careful- to tread lightly- to be gentle- and to pay attention to which hat i'm wearing-and to who is listening. that words can be magical or harmful and they stay with us-playing over and over- shaping our days.
2 comments:
I so needed this today. You have no idea. . . . .
lets talk- i'll call you tomorrow!
xo
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