another beautiful day! the good weather is following us and i'm loving it. the boys are outside examining worms and dead beetles and butterflies. i need to clean the house, i need to go to the market, but i need to stop for a few minutes because yesterday three guys reminded me again, of why i do what i do.
it was friday. it was work and my fellow who usually sees most of the patients first, was on vacation, so i knew i would be busy. and it was busy. not because so many people showed up, but because so many people needed things urgently- blood work and CT scans and urgent referrals and admission. it was one of those days when the system needs to work and people need to answer their phones, and the person who needs stuff done, always shows up late on a friday or during lunch when people don't answer the phone. but despite all the logistical challenges- it was a day with great opportunity to care for others.
mr c. i've written about before. he's a very smart guy but he's spent many years homeless because of alcohol. last year he got it together, went into treatment and eventually, and recently, got back with his wife and son. two weeks ago, i saw him in clinic and i knew something was up- he was acting shifty and agitated and so i called him out on it. he told me he'd been drinking some and knew he needed to stop, knew he was headed down a bad road. so we made a plan- he would go back to his counselor and come see me again in two weeks. yesterday he came in, he'd seen the counselor, he'd tried to cut back, but he also had gained 12 pounds of fluid. this was a concern. we started the work up- labs first. they were off, but not that off, not revealing a clear cause, leaving a gray picture. it could be his heart, it could be his kidneys, more likely for him, his liver, his cancer, lymph nodes infiltrated or cancer or blood clot blocking his venous return. i don't want this for him. we did a quick scan to make sure he didn't have a leg clot, he didn't. i set him up for a scan this morning- to look inside- to see where the trouble is. all that took most of the day- most of his day, some of my day. for him it was a day of waiting. a night of waiting. and now another day of waiting- for the results- for a possible change of fate.
as i was walking him to the elevator yesterday afternoon-
he said, "i am so thankful for you- really."
i'd spent the in between times yesterday feeling badly that i couldn't figure out exactly and immediately what was wrong with him. i'd felt that i hadn't really done anything.
i said, " i really didn't do anything- you spent all day here and i still haven't figured out what is causing your edema- or treated it."
"no- you care. you really care, and you're going to figure it out, and not everyone here does that. so i thank you."
"well, you are welcome. i do care about you- and you're right, we will figure it out- let me know when your done with the scan in the morning."
i think it comes down to non abandonment, to transparency, to relationship.
mr r. has also spent many years on the street, also been addicted to many things and probably still is. he is also very smart- but because of his skin color- wasn't given certain opportunities, things were withheld - doors were shut- and this has haunted him for the past 50 years. these wrongs have stuck onto him and formed him- misshapen him. now as he sits in his life, with his cancer growing, he's been reviewing it all, and yesterday was filled with regret and anger.
we talked about his life, then and now. we talked about control and lack of control. we talked about choosing to let go of certain things, of moving into peace, and i'm not sure we named it, but, forgiveness. he has a beautiful voice. a voice that is deep and clear and confident- if i closed my eyes i could swear it was morgan freeman. and with that penetrating clarity, he recited a poem he'd written:
'my mind is like a tidal wave,
with a mass image to show
But in spite of the way i try to behave,
the trouble lies deep below.
Even when the surface appears to be calm,
an under current will always move.
but just like the quiet before the storm,
you must seek what you wish to prove.
how can i free myself from me,
what technique can i employ.
to reawaken the man i am supposed to be,
and stop acting like a young boy.'
wise and clear. it was such a gift. i asked him to write it down. then we talked about him going back to his group for PTSD (post traumatic stress disorder) and i increased his pain medicine. i told him i knew he had a lot going on, a lot in that mind, a lot to say. i asked if he'd write another poem before his next visit - that he had a lot to give- and that his voice was powerful. you'd have thought i'd given him the Pulitzer, he was so proud. to be heard. to be acknowledged.
he said, " doc, i'm going to write about today- about this talk- thank you"
no, thank you mr. r.
finally, my dear mr. w. he called me from the 9th floor. he was being admitted from the oncology clinic because they said, he was dying. this was confusing, because i thought we all knew he was dying. so i went up to the 9th floor to see it about it. he was lying in his bed, hair all a-poof with his giant tumored abdomen sticking out above the rest of him. i'd seen his blood work, it didn't look any worse, examined him, i got his story, and i gave him a hug. he'd gone home to visit his family in another state, he'd stayed longer than he thought, he'd been discharged from hospice in all that and had run out of pain meds 2 days ago.
i spent 30 minutes getting him his pain medicine. i told him we would make sure he was not in pain, that if he wanted to, he could go home and be with his son and grandkids, that there were options for him. then i knew we needed to have 'the talk'. the conversation about his 'code status'. a conversation we'd had probably 10 times, but had never been concluded. a conversation that perhaps needed more prescription than i'd been willing to give. and when i saw him yesterday, with his ribs sticking out in the back and his disease sticking out in the front- i knew he needed me to tell him what i would do, not ask him. i told him if he worsened, if his spirit was trying to go, when he is actually dying, that i would make sure he was comfortable, but that i wasn't going to put him on any machines, that i wasn't going to pound his chest, that we would let him pass peacefully and honor who he is.
"thank you. that is right. thank you."
knowing his faith background, i asked him if he wanted me to pray with him. "yes, please." so i held his hand and together we asked for peace, for freedom from pain and suffering, for comfort.
three guys. three gifts. three reminders of why i love my job. three reminders of the importance of being real, of being present, of the value inside each of us.
it was friday. it was work and my fellow who usually sees most of the patients first, was on vacation, so i knew i would be busy. and it was busy. not because so many people showed up, but because so many people needed things urgently- blood work and CT scans and urgent referrals and admission. it was one of those days when the system needs to work and people need to answer their phones, and the person who needs stuff done, always shows up late on a friday or during lunch when people don't answer the phone. but despite all the logistical challenges- it was a day with great opportunity to care for others.
mr c. i've written about before. he's a very smart guy but he's spent many years homeless because of alcohol. last year he got it together, went into treatment and eventually, and recently, got back with his wife and son. two weeks ago, i saw him in clinic and i knew something was up- he was acting shifty and agitated and so i called him out on it. he told me he'd been drinking some and knew he needed to stop, knew he was headed down a bad road. so we made a plan- he would go back to his counselor and come see me again in two weeks. yesterday he came in, he'd seen the counselor, he'd tried to cut back, but he also had gained 12 pounds of fluid. this was a concern. we started the work up- labs first. they were off, but not that off, not revealing a clear cause, leaving a gray picture. it could be his heart, it could be his kidneys, more likely for him, his liver, his cancer, lymph nodes infiltrated or cancer or blood clot blocking his venous return. i don't want this for him. we did a quick scan to make sure he didn't have a leg clot, he didn't. i set him up for a scan this morning- to look inside- to see where the trouble is. all that took most of the day- most of his day, some of my day. for him it was a day of waiting. a night of waiting. and now another day of waiting- for the results- for a possible change of fate.
as i was walking him to the elevator yesterday afternoon-
he said, "i am so thankful for you- really."
i'd spent the in between times yesterday feeling badly that i couldn't figure out exactly and immediately what was wrong with him. i'd felt that i hadn't really done anything.
i said, " i really didn't do anything- you spent all day here and i still haven't figured out what is causing your edema- or treated it."
"no- you care. you really care, and you're going to figure it out, and not everyone here does that. so i thank you."
"well, you are welcome. i do care about you- and you're right, we will figure it out- let me know when your done with the scan in the morning."
i think it comes down to non abandonment, to transparency, to relationship.
mr r. has also spent many years on the street, also been addicted to many things and probably still is. he is also very smart- but because of his skin color- wasn't given certain opportunities, things were withheld - doors were shut- and this has haunted him for the past 50 years. these wrongs have stuck onto him and formed him- misshapen him. now as he sits in his life, with his cancer growing, he's been reviewing it all, and yesterday was filled with regret and anger.
we talked about his life, then and now. we talked about control and lack of control. we talked about choosing to let go of certain things, of moving into peace, and i'm not sure we named it, but, forgiveness. he has a beautiful voice. a voice that is deep and clear and confident- if i closed my eyes i could swear it was morgan freeman. and with that penetrating clarity, he recited a poem he'd written:
'my mind is like a tidal wave,
with a mass image to show
But in spite of the way i try to behave,
the trouble lies deep below.
Even when the surface appears to be calm,
an under current will always move.
but just like the quiet before the storm,
you must seek what you wish to prove.
how can i free myself from me,
what technique can i employ.
to reawaken the man i am supposed to be,
and stop acting like a young boy.'
wise and clear. it was such a gift. i asked him to write it down. then we talked about him going back to his group for PTSD (post traumatic stress disorder) and i increased his pain medicine. i told him i knew he had a lot going on, a lot in that mind, a lot to say. i asked if he'd write another poem before his next visit - that he had a lot to give- and that his voice was powerful. you'd have thought i'd given him the Pulitzer, he was so proud. to be heard. to be acknowledged.
he said, " doc, i'm going to write about today- about this talk- thank you"
no, thank you mr. r.
finally, my dear mr. w. he called me from the 9th floor. he was being admitted from the oncology clinic because they said, he was dying. this was confusing, because i thought we all knew he was dying. so i went up to the 9th floor to see it about it. he was lying in his bed, hair all a-poof with his giant tumored abdomen sticking out above the rest of him. i'd seen his blood work, it didn't look any worse, examined him, i got his story, and i gave him a hug. he'd gone home to visit his family in another state, he'd stayed longer than he thought, he'd been discharged from hospice in all that and had run out of pain meds 2 days ago.
i spent 30 minutes getting him his pain medicine. i told him we would make sure he was not in pain, that if he wanted to, he could go home and be with his son and grandkids, that there were options for him. then i knew we needed to have 'the talk'. the conversation about his 'code status'. a conversation we'd had probably 10 times, but had never been concluded. a conversation that perhaps needed more prescription than i'd been willing to give. and when i saw him yesterday, with his ribs sticking out in the back and his disease sticking out in the front- i knew he needed me to tell him what i would do, not ask him. i told him if he worsened, if his spirit was trying to go, when he is actually dying, that i would make sure he was comfortable, but that i wasn't going to put him on any machines, that i wasn't going to pound his chest, that we would let him pass peacefully and honor who he is.
"thank you. that is right. thank you."
knowing his faith background, i asked him if he wanted me to pray with him. "yes, please." so i held his hand and together we asked for peace, for freedom from pain and suffering, for comfort.
three guys. three gifts. three reminders of why i love my job. three reminders of the importance of being real, of being present, of the value inside each of us.
2 comments:
Amen.
you get it, you know it.
oxox
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