You call me on a Thursday to tell me / You were diagnosed with leukemia in October.
While the professor moved to the next slide, my face visibly blanched. All I could hear was the drowning sound of my own heartbeat thumping in my ears. Is this true? I thought. Nothing we can do? Only five years of survival? Did this apply to my grandpa Baba? But Baba has been sick for six years!
There were seven of us standing around the table as the attending surgeon debrided the infected fascia. The vascular surgeon came in the room and barked at us to identify the structures before us. “What’s that artery?” he interrogated us. “I’ll give you a hint,” he said, “there’s a deep and a superficial.” We named the sural nerve and iliotibialis band and the great saphenous vein. As we clamored around the table, I suddenly thought of the Rembrandt painting: The Anatomy Lesson of Dr. Nicolaes Tulp.
The incidence of chronic disease is strongly correlated with aging. According to the Information Theory of Aging, aging results from a progressive loss of genetic material due to gradually worsening cellular repair mechanisms. This cellular erosion leads to a nearly interminable list of diseases, including but certainly not limited to cancer, heart disease and neurodegenerative disease.
Allowing natural death gives the elderly and terminally ill the opportunity to control the end of their life, providing empowerment and a sense of peace during their time of uncertainty. This patient and her family’s forethought allowed us to provide medications to ease her pain and discomfort. When she closed her eyes for the last time, her body relaxed into the sheets, and I pulled the blanket up to her shoulders. Her family said goodbye, and then I began to perform post-mortem care.
They did not want to disclose that I was dying. Out of respect for my family’s wishes, my cultural values and ultimately myself. But they forgot to respect my right to know, my right to choose which way to go, my right to see tomorrow and the fading of the sunset glow.
“There’s a great neuro exam in room 5147,” my resident said as I dropped my bag in the call room. “Why don’t you go check it out?” I clutched my reflex hammer in one hand and googled the components of a neuro exam with the other as I headed towards the stairwell.
Gloves first, then scalpel blades gathered, / instructor books and an atlas. / What yearning and churning my mind feels, / unsure what learning to expect.
A hospital bed rolled in. It was Marvin. His last walk. On rounds we would say, “Twenty-two-year-old with gunshot wound to the head. Waiting for organ donation.”
After hours of struggle, noise, / knife and clamp and lung flapping wetly / like a broken bird wing in an open chest, / there is this part, the dismantling.
“We kept him alive to let his family say goodbye, / and sometimes that’s the biggest victory.”
Telemedicine should never replace in-person care, especially in the patient-centric hospice environment, but when used appropriately it can provide benefits not found in any other care environment.