Giving back the helm

I

I am what we call around here a “medical student”: I ask a lot of questions, I am thrilled by obscure diagnosis and I never, ever, complain.

October 23rd.

My first day on the 12th floor started with a challenge: Laura. She was a 62-year-old lady with a new onset of anasarca, progressive parasthesiae of the lower extremities and extreme leukopenia. Briefly, a real medical mess. Despite my stubbornness and my passion for the literature, Laura remained, throughout her admission, an “unclear diagnosis.”

II

The morning rounds on November 11 went smoothly. The patients on the floor were surprisingly stable and by 4 pm, I was quietly reading about the mysteries of finger clubbing in the residents' room.

7:20 pm. My pager went off. “Room 1243D.”

Laura, again. Her breathing was laboured, she was mottled, she was about to leave us. I frantically phoned my senior and from there, everything escalated: an acute abdomen, a difficult central line insertion, a call to the intensive care unit. Laura left the 12th floor like a traveller without a train ticket and I naively wondered why the world had to end so often.

III

She was back on the floor 3 days later.

7:15 am. I entered Laura's room. She smiled serenely. I pulled the rail of the bed down to examine her. Her eyes were gleaming, her breathing was unsteady, her lips were crackled, worn away by a life that must once have been good to embrace.

Something was about to go sorrowfully wrong.

She stared at me and stated: “I took an important decision.” My stethoscope wavered. Without leaving any space for maybes, she notified me that she wanted to stop everything: the drugs, the specialists' visits, the central line, the food. My heart skipped a few beats. What? For a moment, I lost my identity, my purpose. She wanted to die. All my differentials crashed in a long and loud silence. She wanted to die. MY patient wanted to die. I sat down on her bed.

She closed her eyes, a tear rolled down her cheek: “I can't take it anymore, sweetheart.” She took my hand in hers because I was turning very pale and whispered: “It's going to be just fine, don't worry.” Her words left me speechless. I wanted to cry, to scream, I wanted to die too. As I recalled in a blink the last weeks I spent with her, looking for something I could have said or done differently, she murmured: “Thank you for everything. You were my favourite doctor.” For the first time since we met, I didn't point out the mistake. At this point, who cared if I was a medical student or a doctor, really?

IV

The weirdest thing about Laura's decision was that it smoothly reconciled her with what was leftover from her life. She gained back the tiller of her boat in order to deal with the last wave. She never quivered in the storm, never even slightly changed her mind. Her husband and her daughter shed tears, but remained silent. My senior residents were astonished. The ward staff were dazed. I was inconsolable. The day she chose to “withdraw medical care,” a part of my soul was somehow left limping.

On November 19, she was declared competent by 3 different physicians. My eyes were dry as I removed her central line.

V

Some days are cold, some are hungry, each and every one of them holds grief. On a rainy night in November, she expired. Painlessly. Peacefully. 11:15 pm. Her family was at the bedside. Another death without ceremony on the 12th floor. No questions were asked; everything was answered in a mutual emotion.

11:32 pm. I walked out of her room, swallowed my soul and whispered some last goodbyes. Why is it that I can never hold back my tears?

I finished my late admission in a lungful of air and finally hit the bed at 1:15 am, exhausted.

3:00 am. My pager squealed and for the first time since the beginning of my clinical rotations, I uttered a sigh.

VI

Today, my clinical rotation in internal medicine is over. The encounter with Laura was unsettling and emotionally draining; but isn't it always worthwhile? Laura's memory will surely allow me to make it through a few dark Novembers to come as I recall how on that unusual day, by withholding her lines and her drugs, by holding her hand and risking to show a tear, I moved closer to being a doctor.