From the Wards
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A Portrait of the Patient as an Old Man

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I looked up from my computer to motion the next patient in line and saw before me an elderly gentleman who resembled many of the other patients attending our health fair in Key West. Casually dressed: a white V-neck T-shirt and track pants. Hair: gray and wispy. Skin: tan and leathery from the sun. He was over six feet tall, with an athletic build for a man his age. It was approaching lunch hour and the line for my MED-IT station was dwindling.

“Sir, I can take you right over here,” I gestured towards the seat across from my computer. He approached with what I interpreted as confusion, declining to sit.

“Are you getting your cholesterol checked today, sir?”

He seemed preoccupied and glanced around the room impatiently.

“I guess so — guess that’s why I’m here, right?” He smiled tenuously and handed me his file.

But before I could ask whether he had been fasting, he broke in with, “A bear walks into a bar and says to the bartender, ‘Gimme a beer.’ The bartender replies, ‘I don’t give beer to bears in this bar.’”

Once he realized he had captured my attention, he dove into — essentially in one breath, as if diving into water — a long series of riddles, jokes and factoids, and once I had laughed at enough of his lines, he finally felt comfortable enough to sit down and introduce himself.

“My name is Patrick Goldenberg,” he said, and tossed his driver’s license nonchalantly across the table. He was slightly breathless from the aforementioned monologue, but when I spoke, he hung on to my every word, leaping at any chance to segue into a new story. He divulged, among other things, that his two siblings had been members of MENSA, and that both had committed suicide years ago. It became clear that he was rather brilliant — with a repertoire of endless dates and names at his fingertips — but he also possibly suffered from a mental illness. More or less modestly, he claimed to be ‘no genius,’ having taught sailing at Harvard and currently working as a professional card player. After several minutes I was able to gather that, according to him, this man had lived a very far-fetched life. But it wasn’t so much his actual dialogue — fragmented stories, tangential recollections from childhood, movie recommendations — that resonated with me, it was the fervor with which he sought my attention. His tone conveyed, on the surface, a sense of entitled joie de vivre over which any elderly man could claim ownership. But closer inspection revealed a vague sense of gallows humor, and behind that, a jaded sense of reality. I was left with the impression that his tall tales, albeit eccentric, had not impinged upon his conception of the world. While I didn’t perceive him as delusional, he was so focused on exuding this pseudo-savant persona that I began to feel like a tool for his own validation.

“Did you know that S-H-I-T is an acronym?” He sat facing my left, but as he asked, he turned towards me and put his hands on the table. I noticed his fingernails were quite dirty.

“In colonial times we would get our manure from England. How would they transport the manure, well, they would bring it over in boats. They would store the manure in the bottom of the boat, and what would happen? The manure would get wet, and the methane would cause explosions in the boat. That’s no good. They decided that they needed to store the manure higher in the boat. Higher in the boat. So it wouldn’t get wet. They put the manure in boxes high up in the boat. And what was printed on the cargo boxes? Ship. High. In. Transit. Ship high in transit.” He nodded smugly and I expressed polite amazement, but in the back of my mind, wheels started turning: was he homeless? Were any of his stories true?

I now couldn’t keep my eyes away from his dirty hands and fingernails, and I started questioning the last 30 minutes I had spent with Mr. Goldenberg. I was no longer so sure that he was in touch with reality — a reluctant dénouement on my end. Our interactions lasted a few minutes more and ended with Mr. Goldenberg adamantly suggesting I take his phone number, email address, and home address in case I ever needed a place to stay in Boston. He claimed that he would have asked me out to dinner that night, but he very strictly only dated women at least half his age. I had missed the mark by ten years. I printed the stickers for his cholesterol test and took my lunch break.

Weeks later, I still reflect on our meeting and wonder about the nature of reality when it comes to Mr. Goldenberg. I googled his address in Boston and found that it is the address of a sandwich shop. I searched his name in conjunction with “Harvard sailing professor” and found no results. But in a grand sense, does it really matter if he is real? Years from now I will most likely remember him just as he intended, a sharp old man replete with acronyms. And so I send him weekly emails and receive long messages in return, wrought with misspellings, often in all-caps, and always brimming with random didacticisms. I store these pieces of advice like small gems. My most recent favorite is, “If a boy you like says lovingly or cutely ‘what am I gonna do with you’ it ain’t a positive. He’s saying you ain’t got a good brain and he must make decisions for you.”

A part of me knows that these emails are somewhat incoherent and logically should be taken with a grain of salt, but a small part of me wants to believe that there is profound meaning behind them. A moderate part of me wants to make an exegesis of Mr. Goldenberg’s emails; perhaps he is the mortal embodiment of Zeus, veiled in semi-homeless garb to impart hidden truths. But a huge part of me knows that I tend to glean grand meanings from interactions that are only serendipitous at best, and I am wholly aware that life is not based on Homer’s “The Odyssey.”

Nonetheless, I will go to the ER to practice history-taking and leave raving about a homeless man who promised me he would quit drinking. I will carry his maxims with me to the grave, and I will be more touched by his affirmations than by any I could receive from my community preceptor. Why is that? Is it wise to assume more candor lies in members of subaltern groups? Regardless, there is a definite give-and-take in this unique relationship between doctors and patients. On the one hand, patients like Mr. Goldenberg want to be heard and, moreover, want to be seen in a certain way. But in regards to our own validation, is that not what we as medical students, as residents, as doctors, desire as well, from patients? All relationships lay claim to an extent of mothering, whether we see it or not. For the patient and the doctor, the reality is that both must believe in each other. And although I now assume that the majority of Mr. Goldenberg’s emails are fabricated, I indulge him in the hopes that he finds solace in my faith in him. If for nothing but my own level of catharsis, my portrait of Mr. Goldenberg is all that matters. And in reality, I remain his pen-pal as an underwhelming attempt to repay him for what he said to me as he took back his driver’s license, dirty fingernails and all.

As I got up to take my lunch break, he pointed to me and said, “This is a really good thing you’re doing here. You.”

Editor’s note: The patient’s name has been changed to a pseudonym to protect his privacy.

Millin Sekhon Millin Sekhon (1 Posts)

Contributing Writer

University of Miami Miller School of Medicine

Millin is a medical student at the University of Miami Miller School of Medicine. In her spare time, she loves to practice yoga, read novels, paint, draw, and drink tea.