Balls and Walnuts
more than you ever wanted to know
A death
Suisan’s story reminded me of one of my first (and last) patients, a woman who came to the University Hospital for a tuneup and left . . . well, she left on her own terms.
Flashback to med school. On my first night of call on my first Internal Medicine rotation, the chief resident assigned me to Mrs. Johnson. No, I can’t remember her real name. Anyway, she was in her late 60s, a black woman with chronic renal failure, diabetes, no family to speak of, and a cool determination to exit this world without dialysis. She’d soldiered on for months, allowing the fleas (internal medicine docs) to tweak her electrolytes as needed, but not giving an inch on the dialysis question. Her Do Not Resuscitate order plastered the chart in several places.
My job: I had to do a complete history and physical on Mrs. Johnson and present her to our attending on morning rounds. My chief resident’s parting words were, “Take good care of her,” accompanied by her always-bright smile, the smile of an eternal optimist.
In case you didn’t know, a “complete history and physical” for a medical student is an arduous job. Forty-five minutes later, I hadn’t yet completed the history, yet Mrs. Johnson’s answers were becoming quieter, less coherent. And then her answers stopped altogether.
I couldn’t rouse her, so I called the intern, who called the junior resident. By then, Mrs. Johnson’s breathing had become loud and coarse, noisy on inspiration and exhalation. Our silly junior resident didn’t understand what he heard, so he called for an ENT consult to rule out airway obstruction. A husband-and-wife team showed up with a flexible fiberoptic laryngoscope. They scoped her, decided her airway was clear (despite her stridor), and told us this was it, the last scene. Mrs. Johnson’s respirations were agonal.
She died within the hour.
***
Details are the blood of any story, right? And yet I haven’t said word one about Mrs. Johnson’s life. Truth is, I remember nothing but her resolve in how she wanted to exit, that and the fact she had no family with her when she died.
I remember how her death affected me. As I mentioned yesterday, many things surprised me in med school — the fact that autopsies could gross me out, that vaginal childbirth is not a joyous experience for the guy splashed with the dirty dishwater, that the sewn up uterus after C-section looks uncannily like Alien*. And it surely took me off guard that the death of a woman whom I had just met could rattle me to the core.
This woman’s death soon became a story about ME. The attending met with me privately for at least two or three sessions “to help me deal with it.” My chief resident took me aside and apologized for telling me, “Take good care of her.” The other med students handled me with kid gloves. None had been present at a death. I was marked.
I got into it, being the center of attention, if only for a few days. Other patient responsibilities soon distracted me. Life moved on. There would be other close bonding experiences, other deaths — thankfully few. Nurses get that honor.
But I can’t decide which is sadder: that she died without her family, or that the one person who might have remembered her — who took her history, for heaven’s sake — was too caught up in his own tender feelings to mark her passing. I could have tried to remember something, anything about her.
Yet I can’t even remember her name.
D.
*I’m scraping my jaw off the ground . . . meanwhile, the new mom, wide awake in Epiduralville, asks her husband, “So, honey! How’s it look down there?”
New dad replies, “You’re just as beautiful on the inside as you are on the outside.”
True story.
And that is why I have stayed as far away from the heathcare professions as possible when making my own career choices. That and a tendency to puke when I see blood.
Maybe it is not so important whether or not you remember Ms. Johnson’s real name or not. You remember her spirit and she has never really left you. It is sad that her family was not there, but it sounds as if she died peacefully and with a great deal of dignity. We should all be so lucky.
If you think a c-section LOOKS wierd it is too bad you can’t know how wierd it feels to BE the person who is wide awake during that kind particular surgery. I am not wishing pain on you. It is not as bad as you might think, but it is by far the most surreal thing I have ever experienced. My hubby didn’t have anything clever to say at the time, but when I delivered our second child via VBAC 16 months later he remarked that he liked the c-section better because it was much more “impressive.” All I could say was, “With WHOM were you more impressed? Because I am a HELL of a lot more impressed with myself THIS time.”
Karen delivered Jake vaginally, and I was pretty damned impressed. I remember thinking things like, “God-DAMN,” and “Hurry up, get him out of there, he’s TEARING HER APART!” But she did very well. She’s had her share of health problems, but difficult childbirth was not one of ’em.
That husband (in the delivery room) deserves a medal. (Or else he was serious, he thought his wife looked like an alien.)
My husband was in a hospital ward in England one evening when the little old lady next to him passed away. A few hours earlier he’d been chatting with her. Shook him up badly. He released himself the next morning and took the flight home to Paris although he’d just been operated on the previous day (smashed nose) He said he wasn’t staying a minute longer in a hospital ward, lol.
forgot to add – come play!
http://samanthawinston.blogspot.com/
I bet you’re a great doctor. I know you are such a good writer.
Doug, thank you for your story.
I think death brings along tremendous guilt. Guilt that you shold have remembered her name, or guilt that it “all became about you” or some other thing we can think of to feel guilty about. Grief doesn’t seem appropriate for the death of someone you’ve only just barely met, so I think guilt comes to play checkers for a while.
And she didn’t die with her family, but she didn’t die alone.
Thanks for writing about her.
Huh. . . OT: Did michelle whelp again?
Thanks for your input, folks. Kate, that link doesn’t work for me!
http://risinghegemonxxx.blogspot.com/2006/03/ask-michelle.html
trying again
I don’t think she popped recently, Kate. If she had, the media would have been all over her . . . like usual. I think her last one popped out in November.
You were there with “Mrs. Johnson” when she needed someone. For those moments, you became “her family” and she did not have to die alone. People aren’t about names. That is just our tag in this world. You remembered her soul and that is so much more important.
I agree that Mrs Johnson,did not die alone, you were with her.She was probaly grateful that you were.
The effect she had on you proves that you are obviously a very caring person.