A Saturday Off

My first year in practice I applied the headache adage to a patient (see posting on Sept. 10). The patient was a fine strapping young family man and upstanding member of his community. I would later apply another medical adage to him. The worst diseases only happen to the best people. For the last three years he has largely been under the care of his oncologist and neurosurgeon for the god-awful tumor that turned out to be the cause of his headaches. I saw him on the occasions of his gall bladder attack, a bad case of poison ivy and a few other mishaps. It doesn't seem fair but having cancer does not protect you for other illnesses. Lately he has been in the hospital rather a lot. His headaches got worse. He got a blood clot in his leg. His heart rate went up. None of this is particularly unusual for a person receiving active cancer treatment and each problem was being addressed with reasonable success.

Friday evening I rounded at the hospital and saw him last before going home. He was surrounded by family as usual and thanked me for my visit as I was going out. On my way home I spoke with the physician on call for the weekend and gave him my usual telegraphic but droll sign-out on my hospitalized patients. My comments went something like "bad disease, perfectly stable, consults aren't letting on as to their plans, pain control, blood thinners, ride hog on the specialists." Later I was sitting stuporously in front of the television probably watching a pledge drive when my cell phone emitted the special ear-splitting screech I've assigned to certain other doctors. I climbed down from the ceiling and wrestled the phone to the floor thinking "this had better be important." My colleague was audibly upset. Breathlessly but concisely he relayed to me. "Your patient just arrested and died." He repeated this in various ways in response to my disbelief. "I thought you'd want to know" he said before hanging up.

Next I called the hospital and had the "What the Hell Happened" conversation with the tearful nurse. I learned The Oncologist had happened to be there when the patient arrested and that he was still talking with the family. I phoned My Beloved and asked him to return with the car right away and spent the next half hour sitting on the back stoop watching darkness fall in the back yard. He had been dead about an hour by the time I got to the hospital. The Oncologist was sitting at the nurses station staring at the counter top. I'd never actually met him before but at that hour the odds of a middle aged orthodox physician sitting in this particular nurses station being anyone but him were slim. I introduced myself. He had been present for the entire "cataclysm" as he called it. After a clipped and clinical review of the events we established that we were in agreement on the most likely cause of death. As we went down the hall he said to no one in particular "He was the last patient I needed to see before I could go home." According to him the family was still in the "screaming and crying phase" and indeed they formed a crushed and weepy group around his corpse. His mother burst into tears and fell into my arms when she saw me and eventually had to be passed off to the priest. The others spoke with strangled voices and gasping breath. The room slowly filled with people who one by one embraced the man's wife who sat next to the feet of the profoundly still body of her husband and then joined the living tableau of mourners standing around the room.

I don't really remember the transition to the next scene but quickly I found myself in a small conference room listening to The Oncologist discuss the issue of an autopsy with the new widow. She listened intently asked a couple of questions and then dismissed The Oncologist tipping her head towards me and saying "I'd like to speak to Doctor now." "What do you think I should do?" she asked me after he left.

Last for me was the ceremonial paperwork. The autopsy authorization signed and witnessed. The death pronounced and certified for the department of records. The discharge summary dictated although the patient was being discharged to the morgue. Some "nerve pills" called in for the grieving mother. I left the hospital with the knowledge that when I awoke in the morning I would not enjoy the secret pleasure of a Saturday without having to round but would think instead of this devastated family.