Patient is a 75-year-old female with past medical history of incidental lung nodules presenting with three months of shortness of breath and unintentional weight loss, found to have bilateral pleural effusions of unknown etiology, admitted to medicine for further workup. She has a “distant” history of smoking, which is to say she once stole a cigarette from her older sister’s purse when she was seventeen, lit it with the kitchen lighter, and then coughed so hard she nearly threw up in the lake behind the house. She tells me this with joy and wonders aloud whether that could have anything to do with what’s growing inside her, the poppyseed nodules peppering her lung. I try to tell her that we’re unsure whether the nodules are malignant, but I stumble over the words—she tells me, “no need for that, I already know.”
•
Patient is a 75 year-old female who is post-op day one from pleural drain placement, and is quietly observing the tube sticking out of her chest. On physical exam, she follows the fluid with her eyes as it rises through the sterile straw, and up into a clear plastic container nailed to the wall. In a distant memory she recalls another world’s summer, where she mixes watermelon juice with honey in a worn glass pitcher, her lake-soaked fingertips handing glasses to each of her seven sisters, and that is what the fluid draining out of her looks like, she tells me, “it’s just like that, it’s just like that time on the lake behind the house,” and for a moment she lifts herself out of the hospital bed. I’m elated until the attending reminds me that “functional quadriplegia” is written in her problem list, and tells me her drainage is better described as “serosanguinous.”
•
Patient is a 75-year-old female who cannot breathe. A call on the intercom, and a gaggle of navy-blue scrubs have materialized to investigate why so many monitors are chirping alarms like frightened birds. Yesterday, a resident challenged me and asked me what compartment the fluid is in, and his question seemed incomprehensible to me, because the patient told me everything is where it should be. The water fills the lake behind the house. The water fills the worn glass pitcher. And today the water is filling her lungs.
•
Patient is a 75-year-old female who tells me her car, which has been sitting in the Long Island Jewish Medical Center parking garage for four weeks now, is mine for the taking should I want it. Her grandkids are just fine on that front and have sent her fresh flowers today, yellow and blue and white, along with some printed photographs of the new great-grandbaby. I ask her what the grandchildren are up to. “They’re teaching the little ones to swim,” she tells me. “In the lake, behind my house.”
•
Patient is a 75 year-old female who asks me what dying will feel like. I was midway through a muddled explanation of her medical status—stumbling over words like “endotracheal intubation” and “pleural effusion”—words that, as a third-year medical student, I was saying aloud for the first time, after having read about them in a textbook. It all seemed like a game, back then. With colorful pens, I would reproduce textbook diagrams in my notebook for hours, using blue highlighter to color in the gap between two layers of the lung membranes. But in the diagrams, I never drew in a face.
She looks at me, plaintively. Blue, placid eyes, like the midsummer sky. “You keep saying it’s water in my lung, water we have to drain out,” she says. “Does that mean it will feel like drowning?” I have no idea, I think to myself. I’ve never drowned before. “And how long does it take? Two days or two weeks or two months?” The pulmonary fellow to my right mentions a phrase I had never heard before—that she will experience air hunger. “I don’t feel hungry,” she mumbles, her eyes fixated on the flowers atop the windowsill. We’re wondering the same thing: how can she become hungry, for something so universal?
•
Patient is a 75-year-old female with medical history of malignant pleural effusion, pending palliative PleurX catheter removal today, who asks me what I mean when I say the word PleurX, and breaks out into laughter when I mispronounce it as Purex. “Like the laundry detergent? Come on, Sunny.” We laugh and laugh, fits of giggling so lively that the nurses turn their heads. I almost don’t notice that whenever she laughs, her oxygen desaturates to eighty-nine percent. I water the flowers and pour her another coffee. I reach into my coat for a packet of sugar, and my hand brushes against the form marked DNR/DNI folded neatly in my pocket.
•
Patient is a 75-year-old female who asks me for more sugar with her coffee, if I wouldn’t mind. Patient is a 75-year-old female who needs me to pick up her Chapstick after it fell on the ground, and apologizes for the trouble. Patient is a 75-year-old female who asks me what I’m so busy typing in her chart. Patient is a 75-year-old female who now needs two or three more pillows behind her head to feel comfortable, if there are any spare ones in the back. Patient is a 75-year-old female who doesn’t really care for the news, and wonders if I could change the channel to Wheel of Fortune, if it isn’t too much of a bother. Patient is a 75-year-old female who is no longer hungry. Patient is a 75-year-old female who’s never been this tired before. Patient is a 75-year-old female whose MRI spine lit up like a Christmas tree. Patient is a 75-year-old female who I didn’t wake up on morning rounds this time.
•
Patient is a 76-year-old female who can no longer turn her head to see the flowers on her windowsill.
•
Patient is a 76-year-old female whose final request before discharge is to move the vase to her bedside table, so she can see something pretty today.
•
Patient is a 76-year-old female who asks: “Please, call me Jane.”
| previous | return | next |
|---|