Wading today through the new puddles of April, dutifully on my way to the train, I pass by a man in a black SUV at the exact moment that he lays on his horn. For seven full seconds. Seven. One Mississippi two Mississippi....all the way to seven. It's 6:35 in the morning.
A few feet front of me a woman is pushing a stroller, all wrapped up in plastic, through the cracks and pools of rain. She stops abruptly such that we almost collide and as I pass her she reaches out to the front of the stroller, screaming Goddamnit Johnny stop fucking with the plastic!
I am this close, I think, to buying a box set of Nature Sounds: Call of The Wild to Ocean Blue. Because the few intact shreds of my corpus callosum are about to explode.
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I am shy. I hate attention. I fight the urge and act of fainting whenever I have to talk in front of more than one person whom I haven't known for a year, minimum. I sit in the front of class because, when I have to ask a question (because I always have to ask a question) no one can turn their heads and look back at me, face me full and frontally, make my heart pound and sweat. I am not an eye contact maker. When people compliment me ever, on anything, I am always so shocked and mortified that I invariably say something really inappropriate and aprospo of nothing. "Oh wow, thanks. I actually stole this from an old lady. HAHAHAHAHAHAH". Hands flapping uncontrollably at my sides like an encephalopathic ostrich.
And yet, I walk now--in the hospital, on the streets, along the crowded sidewalks--belligerently making eye contact, unyielding in my hellos. Especially in the hospital, always in the hospital. It is, I can see now, the only way to survive. To force contact, to create connection, to make me human, to make us collective, to make me to others tangible and real. And when I say I would never have done this a year ago, it is both that never before would I have willingly, intentionally, systematically called the attention of a stranger onto myself and also that I never lived a life like this, feeling so separate from those around me. In this way, in this wonderfully curious way, I am so very changed by this city.
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My patient is dying, very painfully, of metastatic prostate cancer. It was diagnosed late, as it is with so many of our patients, after it had spread to his lungs, invaded his bones. He came to us like something out a textbook: elderly man presents to ER complaining of back pain. An xray is taken and on it you see lytic lesions in the lumbar and sacral vertebrae. What's the most likely diagnosis? But he, despite this sadly generic pathology, is nothing to me most likely. He is a 79 year old man, lucky enough to have a bed by a window, spending his days slowly in pain.
We met at the beginning of the week. In a rush of informality I was assigned to him, patient is in room *** go get his history and present his case. Almost as an afterthought, distracted by his discharge papers, the resident brushes me away to him.
I read his chart, review the CT, the MRI, the series of xrays. The lab work is dismal but nothing is worse than his films. He has a 4 x 3 cm metastatic lesion in the middle lobe of his right lung. There are lytic lesions in 4 of his 5 lumbar vertebra, and they have all collapsed onto each other. His has a lesion on the 4th and 5th cervical vertebra and they are threatening to collapse. If his spinal cord becomes compressed he will be a quadriplegic. If the lesions go any farther up, it may paralyze the nerve that allows the lungs to inflate. There is much to worry about with him. The least of which seems to be his pain. The constant, unremitting, intractable pain.
We sit in the thin grey light of early morning in a room with a window. Every movement for him is agony and I have forgone the physical exam beyond any region not immediately accessible. The bones of his sternum protrude out by inches, the inappropriate invasion of a distant enemy. This, he tells me, is where it hurts more than anything. All fundamental actions: breathing, talking, shifting his weight render him breathless and panting. I have felt this so many times before, this powerlessness, this inability to ever make it better, and I am no better at it today. It is everything I can do, it is a minor miracle and a major accomplishment, to get the resident to prescribe a pain patch, to consider a pump that he can press himself for some relief.
We stand in the dark part of the hall, near the wall at the back, outside the door, looking in. He needs to get well enough so I can send him to subacute rehab, the resident frets, I don't want him dying on my floor. And in that moment I am struck by such anger and awe, and it is all I can do to keep from wondering, as I peer into the face of one of my teaching doctors, if this is the inevitable outcome for me: worrying about my monthly statistics, angry that "yet another" patient has died on my shift?
