I heard these words a lot from Mr. F. during the time I helped care for him at the Department of Veteran Affairs (VA). It was his usual greeting to me when I would wake him up at 7:15 a.m. every morning to pre-round on him. After nearly three weeks as my patient, several liters of normal saline, a handful of procedures and even a biopsy or two, he always gave me the same response to my inquiry on his status.
In a world where so much is in flux and on a ward where there were always admissions, transfers and discharges, it was nice to have some consistency. During a time in my life when nothing seemed settled, I felt increasingly nomadic as I roamed New England to further my medical education: I appreciated having a periodic reminder of one of the few things in both my life and Mr. F.’s that hadn’t changed a single iota.
Mr. F. had served twenty-six years in the United States Air Force as he eventually told me. He traveled all over Asia: Japan, Korea, Thailand and other far-flung locales. I learned he investigated wrongdoing, ranging from drug offenses and accidents to anything and everything that could go wrong in the military. He had a wife and children who he was thankful to have around during his hospital stay. “I’m very blessed,” he reminded me on a few occasions.
Mr. F. was, by his own description, an “ex-GI-type.” I didn’t exactly know what that meant at first. Early on, I assumed it meant saying very little and giving as pithy a response as possible to review of systems questions. However, over the course of taking care of Mr. F., I realized that being an “ex-GI” did not mean being terse or stoic: It meant something far simpler and more meaningful. It meant that, no matter what he was going through, he should always keep breathing.
Mr. F. told me a story about his time in the air force. He was in Thailand during the Vietnam War. One day, he arrived at his unit’s command post whistling a tune. His commanding officer did not take too kindly to the jovial way in which he was carrying himself.
“Mr. F.!” the commanding officer barked.
Mr. F. saluted and stood at attention.
“What do you mean with all this whistling?” the officer asked him. “We’re in the middle of a bombing campaign, and we’re losing pilots left and right. How can you possibly be whistling at a time like this?”
“Sir,” Mr. F. calmly responded, “I’m whistling because if I don’t, I might ball up in the corner and cry.”
Immediately, the commanding officer apologized.
Mr. F. had been admitted for weakness, hypotension and weight loss which are never good signs in a man well into his eighties with an extensive smoking history. Only a month prior, he’d thought he had pneumonia from his symptoms. He soon learned that he had lesions of the lungs, liver and bones that were likely cancerous. By the time Mr. F. was admitted, he had been so ill that his sons had to carry him out the door of his home to get him to the hospital. So, while the consults came and went, biopsying here and scoping there, the VA acted as Mr. F.’s medical home for twenty days. The medical team and I helped him by checking vitals, bolusing fluids and encouraging oral intake as tolerated.
Through it all, Mr. F. kept breathing.
He kept breathing as his roommates came and went until eventually, he had none because he had too few white blood cells to tolerate the potential infections associated with a roommate. He kept breathing as his appetite waxed and waned. He kept breathing as he came so incredibly close to discharge before suffering setback after painful setback.
During my four weeks at the VA, I watched one man come perilously close to death before a code blue was called, and he was, against all odds, revived and transferred to the medical intensive care unit (MICU) before eventually succumbing to his illness. I watched as another man went from talking to our team at 7:00 p.m. to developing flash pulmonary edema rapidly decompensating and gasping for air at 7:30 p.m. I watched as patients took some of their last breaths on earth as disease finally won out, and there was nothing with which to combat it.
Mr. F. kept breathing when others couldn’t.
For Mr. F., he kept breathing so he could get out of the hospital to get to rehabilitation so he could eventually get home. He had grandchildren, and even with dire diagnosis, he wanted to try chemotherapy so he could be around for them for as long as possible.
Mr. F. kept breathing even when I didn’t want to.
Four years of medical school, especially the third, take a toll on a person. For the first time, the hours are grueling. For the first time, I was entrusted with the health and well-being of real patients. For the first time, I have a role to play.
All of this had worn on me for the past seven months: being shuttled from site to site, constantly under the microscope of evaluations and feedback and never entirely sure of what I’m supposed to be doing. This cycle, and above all, being uncertain of my own abilities as a future physician, had taken a toll on my psyche. Combined with some personal turmoil, I felt as if I had reached at least a half-dozen proverbial “low points” with a handful of trips to the so-called “dark place.”
In other words, I didn’t want to keep breathing.
After almost one month, Mr. F., too, was taken to intensive care and stabilized long enough to say goodbye to his family members who had been by his side even as multiple myeloma robbed him of his life.
Though my heart ached for his family, I kept breathing.
To keep breathing does not mean to go at it alone or to put up a brave front even when it feels as if the world is collapsing. To keep breathing is to always push towards the goal even when it’s hard and even when it doesn’t feel worth because it will be in the end. To keep breathing is to persevere in the face of adversity, to get back up when knocked down and to keep the air moving in and out of the lungs even when each breath is painful.
For me, I want to keep breathing for everything I want in life: to be able to call myself a doctor, to achieve a career and a life that has meaning and fulfillment and most of all, to be happy and satisfied. Through each storm and stressor of third year and every time I want to give up when I lay my head down at night, I will wake up the next day with a profound sense of accomplishment because I managed to live by the words I came to know so very well: