Gravity

Yesterday was my last day at UCI for the next month. Starting next week I'll be at the Long Beach VA, with a very different patient population.

This past week has been a week of serious patients who aren't going to make it. My team's workload of patients all of a sudden were rather young patients who were terminally ill. Other young patients we've had were chronically ill, but not on their deathbed. It's one thing to treat patients, make them better, then send them home. It's entirely another to know you can't help, no matter what you do.

One was a 36 year old woman with breast cancer that had metastasized everywhere despite a double mastectomy - her lungs, liver, spine, pelvis, and brain. There was so much cancer in her brain that she was throwing up constantly but still coherent and talking when we admitted her. By the next morning though, her brain had swollen so much that all she could do was groan and reflexively contract her arms inward, a very ominous sign called decorticate posturing. They call it "decorticate" because you can tell that the site of the brain injury was such that it essentially shut off her brain cortex functions. The neurologist happened to stop by while I was at the patient's side and he remarked that it was a sign she was about to stop breathing, and we'd better intubate her before she did. So much mayhem and excitement later, she was sent to the ICU, from which she will probably leave only in a casket. I met her children the first day; the boy looked around fifteen and the girl looked about eight. The girl didn't seem to understand that she was about to not have a mom.

Another was a 37 year old man who'd essentially drank himself to death's door. He was in the hospital with our team for over a week, a belly swollen with fluid backed up because it couldn't get through his too-damaged liver, looking like he was pregnant. He was so jaundiced that it looked like someone had taken a black-and-white photo of him and colored in his eyes and skin with a yellow crayon. Literally. I'm not even exaggerating. I was part of the team taking care of him, but he wasn't primarily my patient so I didn't talk to him much when we visited his bedside during rounds every morning. Still, we had a little ritual that kind of came about after seeing each other every day. He always had downcast eyes while we were there, but as the team left his room, I would wave and he would look up and smile. Yesterday he looked so sad, sadder than usual, but he did give me a smile at the end. It was dimmer than usual, but it was still our little ritual.

Another was a 41 year old man who found himself diagnosed with HIV a week ago. He had been mysteriously losing weight for a couple months, but had suddenly started going blind and had spots growing all over him, so he went to the doctor and that's how he found out. The tell-tale spots were surprising because those aren't seen anymore with HIV therapy that's available nowadays. He thought he got it from a tattoo he got in Viet Nam several years ago, because he said there they use the same needles for everyone. It was a very cool dragon, but to think it could have been the cause of his death diminished its luster. He started to cry as I was talking to him. Apparently he had been married a few years ago and he had always used condoms because the wife didn't want children, then she left him after a year. He was so sad and didn't want the burden of sadness in life anymore, so he started studying to become a monk. He completed his three years of studies and was set to go to Tibet to finish up, but ended up in the hospital. Can you imagine, studying to find eternal peace as a monk, and one day you find out you've got AIDS. He squeezed my hand when I asked him if he'd like me to try to find a Buddhist monk that he could talk to. I hope he gets reincarnated into something nice.

Even though these people are a few days away from death and no amount of medicine will cure them, I guess the one medicine they can benefit from is kindness.