I read the latest progress note: ¨67-year-old male with metastatic lung cancer. Mildly agitated. Pain controlled with morphine.¨
I walk into a single room to see a frail man looking worn beyond his years. I introduce myself and ask if it is a good time to chat. He looks away and tells me that now is not a good time. I can see he has just received his lunch tray. Fair enough. I would not want to be interrupted while eating lunch. I tell him I will check back in a half-hour.
While I wait, I begin writing my note and under the “subjective” heading I write, “mildly agitated.”
Thirty minutes later, I return to find him sleeping, slouched over with his hand in his cake, the fork pristinely clean in its setting, his food untouched. With a loud but pleasant voice, I wake him. He is disoriented. He realizes his hand is dirtied but decides to persevere with lunch. He stumbles, unable to perform the complex twirl and scoop needed to gather spaghetti onto his fork. I offer to help but he declines.
I sit down next to him and grab the newspaper, not wanting to make him self-conscious by watching him eat. I casually flip through the paper, occasionally reciting interesting headlines. Out of the corner of my eye, I can see that a few more attempts with the fork are unsuccessful. I tell him I am just going to get the noodles on the fork but he will do the rest. He struggles still. I grab the fork and bring it to his mouth. He hesitates but then concedes.
Again, I walk away, not wanting to make him feel uncomfortable.
I stroll over to a push-pin board with many cards and letters from loved ones. I see a typed letter that begins, ¨Dear Dad.¨ I read about lost time, missed opportunities, and a childhood memory of a fancy car from a much simpler time.
I ask him about the fancy car and he smiles. I tell him I am from Detroit and my father once had a ‘64 Ford Mustang, red with white leather interior. He smiles again and with limited breath says, “Yeah, Detroit has great cars.¨
We chat about cars and sports as I offer a few more servings; he accepts. I tell him we need to get the nurses to change the television off the soap opera channel. He laughs and tells me that his father likes to watch soap operas.
Looking at him and seeing how old and frail he appears, I am surprised to hear that his father is still alive. Without thinking, I ask how old his father is and I immediately feel regret and shame for reminding him of the years of life he will be missing. Quickly, I tell him how great it is to still have one’s father for support. He nods and we continue chatting.
A few more forkfuls and his plate is nearly empty. “I’m full,” he says. I look up at the clock and I see that I have to be at a meeting soon. I turn to him and say, “Thank you for allowing me to read your letters. You are clearly loved.” His eyes widen and he reaches out with his cake-covered hand to grab mine. We sit hand-in-hand in silence.
I can’t remember how the embrace ended, or how exactly I said goodbye, but I remember re-writing my note. Changing “mildly agitated” to “pleasantly engaged” could not possibly capture what transpired.