“They just told me I have cancer. It’s everywhere in my body. And you say you’re a kidney doctor? What the hell are you doing here?”
His voice is gruff, and as he looks at me, I feel the weight of his gaze.
For a moment I hesitate, then ask.
“Mind if I sit down?” 1/
His voice is gruff, and as he looks at me, I feel the weight of his gaze.
For a moment I hesitate, then ask.
“Mind if I sit down?” 1/
“What do I care, you’re gonna be gone in ten seconds anyways. Nobody sticks around, tell that chickenshit doctor who hasn’t seen me in three days that I know he’s gonna bill me anyways.”
I don’t speak. Not now.
He continues, “Sit down, tell me how bad my kidneys are.” 2/
I don’t speak. Not now.
He continues, “Sit down, tell me how bad my kidneys are.” 2/
The harsh truth is that my day would be easier if I didn’t sit down.
If I just stood at his bedside and spoke fast, did a perfunctory physical exam, and moved on.
The system incentivizes me to see more people, faster. And the faster I’m done, the faster I can go home. 3/
If I just stood at his bedside and spoke fast, did a perfunctory physical exam, and moved on.
The system incentivizes me to see more people, faster. And the faster I’m done, the faster I can go home. 3/
Some days, yeah, all I want to do is go home early.
Some days.
I sit down and make eye contact. His gaze is angry, accusing, and beneath it all, afraid.
He is twice my age, and for a moment, I see myself through his eyes.
Young. Detached.
An agent of the system. 4/
Some days.
I sit down and make eye contact. His gaze is angry, accusing, and beneath it all, afraid.
He is twice my age, and for a moment, I see myself through his eyes.
Young. Detached.
An agent of the system. 4/
I start talking, and almost immediately I’m interrupted. I knew he was angry, but I underestimated his rage.
This isn’t just about the cancer. I understand.
There’s grief here too. An undercurrent of grief, far more than I can know.
My instinct is to deflect. 5/
This isn’t just about the cancer. I understand.
There’s grief here too. An undercurrent of grief, far more than I can know.
My instinct is to deflect. 5/
I want to tell him this isn’t my fault, and to quickly launch into one of my pre-canned speeches about kidney function and lab values.
To face emotion like his, head on, can be terrifying.
Instead, a distant memory calms me.
My father’s voice, “What did it take?” 6/
To face emotion like his, head on, can be terrifying.
Instead, a distant memory calms me.
My father’s voice, “What did it take?” 6/
When I was a child, I was at a party at a friend’s house. There was a toy my mom had bought for me before the party. A ninja turtle, the purple one, Donatello.
At the party we watched “Teenage Mutant Ninja Turtles.”
And my friend said his favorite turtle was Donatello. 7/
At the party we watched “Teenage Mutant Ninja Turtles.”
And my friend said his favorite turtle was Donatello. 7/
As we were leaving the party, my friend saw the toy in my car and asked if he could borrow it.
His parents were pretty strict when it came to expenditures on toys. I knew he didn’t have any ninja turtles.
Impulsively, I gave him Donatello.
On the drive home my dad smiled. 8/
His parents were pretty strict when it came to expenditures on toys. I knew he didn’t have any ninja turtles.
Impulsively, I gave him Donatello.
On the drive home my dad smiled. 8/
“Did you see how happy you made that kid? You make someone happy like that, and it’s special. And what did it take? Just a toy.”
I nod.
“What did it take?” becomes a mantra for me.
How simple kindness can be, how easy, if you’re mindful.
How positivity can ripple. 9/
I nod.
“What did it take?” becomes a mantra for me.
How simple kindness can be, how easy, if you’re mindful.
How positivity can ripple. 9/
My patient’s gaze is no longer angry, or scared, but defiant, “So… what do you have to say about my kidneys?”
I tell him I’m sorry. That I hear him. And that actually his kidneys are doing pretty well.
He laughs sardonically, “Well at least I got that going for me…” 10/
I tell him I’m sorry. That I hear him. And that actually his kidneys are doing pretty well.
He laughs sardonically, “Well at least I got that going for me…” 10/
As the days pass, I go in and see my gruff patient in the hospital every day.
I know visits with him will take longer than any other patient on my list, primarily because I am one of the only docs he gets to see.
His other docs tend to round when he’s asleep, or sedated. 11/
I know visits with him will take longer than any other patient on my list, primarily because I am one of the only docs he gets to see.
His other docs tend to round when he’s asleep, or sedated. 11/
We start having conversations that extend beyond the scope of his illness.
Conversations about life, and our experiences.
We have unexpected things in common, and discovering them is a unique joy.
The day finally comes where I take a seat in his room for the last time. 12/
Conversations about life, and our experiences.
We have unexpected things in common, and discovering them is a unique joy.
The day finally comes where I take a seat in his room for the last time. 12/
He has chosen to pursue hospice care, and will be going home to his family.
I am grateful that he will be at peace, surrounded by people who love him.
He thanks me for spending time with him, and “facing the music” as he gruffly puts it.
I thank him for his kindness. 13/
I am grateful that he will be at peace, surrounded by people who love him.
He thanks me for spending time with him, and “facing the music” as he gruffly puts it.
I thank him for his kindness. 13/
All I did was sit down in his room every day. Sit down and listen, and eventually talk.
There was no great medicine I prescribed, no cure.
And yet I faced the music with him, and it was my privilege.
As I get up to leave, we say our goodbyes. I feel a wave of grief. 14/
There was no great medicine I prescribed, no cure.
And yet I faced the music with him, and it was my privilege.
As I get up to leave, we say our goodbyes. I feel a wave of grief. 14/
Days later, as I round in the hospital, I find myself glancing at his room number when I walk past it.
Remembering.
The longer you practice medicine, the more faces never leave you. The more memories linger.
“What did it take?”
Nothing at all.
Time.
Every last thing.
Remembering.
The longer you practice medicine, the more faces never leave you. The more memories linger.
“What did it take?”
Nothing at all.
Time.
Every last thing.
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