“You can’t lie to a liar,” you said, but in more colorful terms. You were sitting up in your bed and I had just interrupted your breakfast. “You can’t lie to a liar, so just tell me the truth, Doc. What’s going on?”
You were my first patient on my first inpatient rotation as a third-year medical student, which meant that I had absolutely no idea what was going on. I was mostly concerned with trying not to faint during presentations on morning rounds. I stared at your bowl of Cheerios, the cereal beginning to turn the skim milk a pale yellow. Your brow furrowed in annoyance behind your thick glasses.
I tried to put your story together in my head: you came to the hospital because your skin was yellow — not white like it should have been — and your urine was brown — not yellow like it should have been — and your stool was white — not brown like it should have been.
I did not know what was happening. I felt exactly how I’d been trained to feel when I didn’t know the answer to a question: I felt I was failing you. But I promised I wouldn’t lie to you.
“I don’t know,” I admitted, “but based on your story, I’ll suggest some tests to the whole team taking care of you. Whatever is happening, you and I will figure this out together.” Legally, I felt compelled to add, “And I’m not a doctor yet, I’m still a medical student.”
You chuckled, “Okay, buddy.” Your brow softened, relaxed into the face that I would come to know over the next month.
When I learned about jaundice in medical school, I concentrated on the mechanism, the risk factors, the potential causes, the lab values. I learned to look for subtle yellowing of the skin and sclerae on the physical exam. I was wholly convinced that I would never appreciate these changes in skin tone.
The bilirubin I imagined depositing in your skin did not turn it an artificial yellow like I had naively envisioned; instead, it blended naturally with your complexion, highlighting certain parts of you. I saw your face, with skin like aged parchment, into which vignettes were brusquely etched. I saw through your thickened lenses, which magnified your eyes like two movie screens showing old war movies in tones of sepia and amber, projecting unspoken sights from Vietnam. I saw your palms, rough with callouses, and when I shook your hand at the end of our interview, I felt that those flaxen patches sought to tell a story, but I was still learning your language, too blind to read it yet.
“We’ll just take this one day at a time then,” you said, as our hands fell apart.
Every morning, I checked your bloodwork, paying particular attention to a graph of your bilirubin levels. After a couple of weeks, there was a significant steep descent back toward normal. I liked to imagine these levels as a countdown to you getting out of the hospital and getting your life — not just your labs — back toward normal.
By this time, I was trending toward a new normal myself. I now had some idea of what was going on: I knew my way around the hospital and no longer felt like fainting on rounds. I became more comfortable in my routine. You settled into a routine, too.
I remember on a particularly busy morning, I rushed through a physical exam.
“Doc,” you reminded me, “Aren’t you gonna check my lungs?”
I had become too comfortable.
I checked your lungs, embarrassed that I had forgotten such a crucial part of the exam. I was comforted by your familiar breaths, calmly and reliably cycling in and out.
“No changes,” I reassured — though more for me than you.
“I got your back, buddy,” you winked.
The only thing that seemed to change was your daily visitors. Usually your daughter. Your ex-wife and her new husband. Your brother. Your son. Your friend from the casino. Every day, in between other patients, lectures, meetings and other academic obligations, I’d say hello, meet a new friend or family member, and chat, catching scant slivers of who you were outside of the hospital.
At the end of each day, I’d check in on you.
“Get out of here, they’re working you too hard,” you’d say. I would see you the next day, and we’d start all over again. One day at a time.
There were good days: your new room, your procedure, your grandchildren. There were bad days: your fall, your diagnosis, your prognosis. On my last day, I had to finish an assignment, which involved interviewing you. You didn’t want to talk at first, but once you started, I watched as you played clips from the past in your head, like you were showing me reels of your home movies in tones of sepia and amber: joining the Army, working after the war, watching football with your family.
I watched as you changed the reels, projecting crisp clips of your future: vacations you’d take once you were better, celebrations you’d be a part of, dreams of what you would do with more time.
I tucked my assignment away and just sat, hoping to one day hear that these dreams had become memories.
When I got up to leave, I reminded you it was my last day. You offered your hand and said, “Goodbye, buddy, I love ya.” We shook hands, and I felt your rough palms, warm, honest, against mine.
I sat in my car and watched as the sun, tired after a long day, began its descent toward the horizon. As it declined, it turned the sky a stunning pastiche of orange, then pink, and then — just as it lay its head down for a well-deserved rest — it let out one last gasp of brilliant yellow before succumbing to the dark blue of night.
Image credit: Cheerios (CC BY-NC 2.0) by stormgrass