Photo trial

Sister Grace bites it in the bushes.

Just wanted to try posting a picture.

The Battle of How to Die Right

Mr. T is a far cry from B.A. Baracus of the A Team. He is a frail, cachectic Asian man with a bowel obstruction. He sinks into his bed to the point that he disappears. You would think he is dead until he eerily turns his face towards you and speaks in mostly inaudible croaks and groans. He has an NGT (nasogastric tube) pumping out the contents of his gut- bilious fluid that, for some reason, never fails to remind me of the "ooze" from Teenage Mutant Ninja Turtles.

In simple terms, Mr. T is about to burst. He already had one small bowel obstruction last month that required surgical resection of a portion of his 80-something year old gut. He's spent weeks trying to recover, but his tenuous convalescence was complicated by necrotizing pneumonia, abscesses, and underlying depression. And now he's obstructed again. About to take another spin on the merry-go-round. If he doesn't get surgery soon he will burst, perforating his small intestine and spilling bile, bacteria, and shit throughout his peritoneal cavity. Infection would set in quickly, and he would die a rapid but excruciating death.

Mr. T has chosen this. He is declining surgery, opting instead to embrace death, however unpalatable the process. His family wants him to stick around awhile, and thus the Battle of How to Die Right begins.

I was working with the psychiatry resident on call when were consulted on Mr. T-- a capacity eval. The gist of the question was whether or not Mr. T had enough neurons in his noggin to make the decision for himself. Is he of sound enough mind to decline the operation? We set ourselves to the task. We battered the old shell of a man with a barrage of questions and tasks, including gems like identifying a picture of a rhinoceros (the poor guy thought it was a hippo, he must be deranged! No points awarded, by the way).

After much contemplation and verbal hand-waving, we determined that Mr. T lacked capacity. We stripped his autonomy to give up on this world. So sorry Mr. T, but we simply can't let you die the way you want. We ain't in the business of lettin' folks die round these parts. Reflects poorly on our stats. Nobody dies on our watch, y'hear?

I believe it was the right decision to not let Mr. T make his own decision in the state of mind he was in. Nevertheless, why should he get surgery? What is the sense in prolonging this man's life? Is it to comfort ourselves so we can say, "we did everything we could."

He is old, decrepit, depressed, and disabled. Is it just of us to fix his bowels without fixing his brain? Is it inherently cruel to save a man from an imminent death only to destine him to a slower demise by depression? The Battle of How to Die Right rages on....

Dot's Death

Dot was my first patient who died. Emphysema had carved out her lungs like a pumpkin, and she had bacteria coursing through her vessels like rats in a sewer. She had infective endocarditis. Enterobacter had coated her heart valves, now gnawing at the adjacent myocardium.

An hour after I prerounded on her, she dropped her sats to the 70s on 100% nonrebreather. “Shit,” I thought, “she’s a CO2 retainer.” She needed oxygen, but the more oxygen she got, the more her respiratory drive would drop. Her eyes were vacant as I shook her and called her name. She was obtunded. Her face took on a shade of purple, like a terrified grape. They intubated her at the bedside. I escorted her sister to the unit, spewing calming words of reassurance like an idiot. I smiled knowingly, though I knew next to nothing.

I had lectures that afternoon, and it was a Friday. I suppose I was tired. I suppose I wanted to go have a beer and sit on my porch. I suppose I thought Dot would be right as rain after a stretch in the ICU. I went home instead of checking on her. I was sipping a PBR by 5:15.

She died around 5:30.

the tale of frank and doug

Frank liked cycling. Doug liked cocaine. Frank got a tumor. Doug infarcted his cord. Frank had left-sided neglect. Doug neglected hygiene. Frank pondered cycling. Doug pondered suicide. An unlikely pair, Frank and Doug. Best of friends. Hospital rooms forge strange bonds.

poverty on the church steps

(wrote this last fall)

There is a beautiful church down the road from my house. Replete with a majestic bell tower, magnificent stain glass windows, tall wooden doors, and intricate stonework. It stands out like a flower among the weeds of cramped old homes housing dirty college students like cockroaches in a tin can. As I rode by the beautiful structure this afternoon I spotted a homeless man resting on the steps of the church, his back propped against a stone wall to shield him from a harsh October wind. His belongings were strewn about him—his long burly beard his only real comfort as the days turned cold. I pitied him as I rode.

Across the road from the church I spotted a minivan. A middle-aged woman had her window rolled down with her arm outstretched, iphone in hand. Was she taking a picture of the poor homeless man? Was she that heartless? Was she some kind of soccer mom monster who relished documenting the misery of others? I glanced back at the homeless man, but his wind-shielding stone wall concealed him from view. She couldn’t even see him, I thought. She had simply stopped to take a picture of the pretty building… from inside her minivan… with an iphone. She couldn’t see the poverty behind the wall of the church steps. I pitied her as I rode.

Sunday Best vs. Winter Worst

My fancy clothes require adequate protection from the elements. I work in a hospital, sporting shiny shoes and dapper ties on a near-daily basis. Scrubs are my only occasional respite from the world of cuffs and collars. My Sunday best, however, is no match for winter's worst. As such, I layer up each morning for the commute. I am meticulous- zipping on my waterproof pants, tucking my crisp white cuffs into my mud-stained gloves, and donning a thin but warm hat that fits snugly under my helmet.

As I churn my way out the driveway on my jimmy-rigged single-speed into the slush filled streets, I feel the cold water flick onto my legs, my back, my face. My argyle socks and leather shoes are not spared the onslaught of winter's piss and spit, but the rest of me arrives warm and dry at the Emergency Room. I strip out of my "wet" suit, and emerge like Superman switching back to Clark Kent after soaring through the skies. I am indistinguishable from every other employee of this hospital who drove to work in their heated cars with windshield wipers and cupholders. We all arived safely, ready to tend to the needs of whatever patients may walk through the door, but I had more fun getting here.