The Patient in Room Nine Says He's God

by Louis Profeta

  “Excuse me . . . do you live here?”

  I squinted at the sickly thin silhouette of an older man framed against the Caribbean blue. His wrinkled, overexposed, tanned hide was partially hidden by a baggy Speedo as he stood with his shaded face between me and the subtle bobbing of sailboats in the shallows.

  “I’m sorry . . . what?”

  “Do you live here? If you don’t live here, you can’t sit in these chairs,” he said defiantly. “We have lots of problems with cruise ship people taking these chairs. So you can’t sit here.”

  I had to admit at first I thought it was a joke; perhaps, it was Dave setting me up, or some Cayman candid camera. I laughed and looked around. “I mean it,” he stammered, “get the fuck out of here. You didn’t even put a towel down. No one wants your sweat on their chair.”

  I sat stone still. It was no joke, and in a few seconds I was about to do something I would surely regret. Mister this-is-my-chair-and-you-are-a-piece-of-shit had just lit the wrong fuse at the wrong time, and I was going to end the day by beating this old man senseless on the beach in front of his condo. I even looked around to see if anyone was watching us. Could I get away with it? Where would I hide the body? Do sharks feed in the shallows? What is the rate of decomposition of a male corpse in full Caribbean sun? Still, I was able to maintain a sense of self-control and just stared blankly at him.

  “I am just sitting here,” I said slowly, enunciating each word with the precision of a fine Swiss watchmaker.

  “No, you’re not,” he yelled, spittle flying from his tobacco-stained mouth. Just then this wisp of a man reached down, grabbed the legs of the chair, and dumped me head-first into the sand. I jumped to my feet in a rage. And then it hit me. With my quick ER physician reflexes and keen sense of observation, I quickly noticed the man’s breath had a harsh odor of tobacco and early-morning scotch; he was wearing a T-shirt with the name of a drug company known for hypertensive medication. A hyper-tensive, type-A personality, early coronary disease, high lung-cancer risk, smoking drinker, I thought.

  “Oh my,” I said softly, almost angelically; the voice of a revered saint was calling from my soul. I gazed at him with no malice or ill-will, just pure understanding. “You don’t know, do you?”

  He was instantly confused, looking at me perplexed. “What?”

  I reached and softly grabbed his hand, putting a hand on his shoulder, and leaned into him. “You have six months. It’s lung cancer, aggravated by your hypertension and early coronary artery disease. The alcohol is also taking its toll; you don’t know it’s there . . . but it’s there. You have six months left to live. I’m so sorry.”

  He staggered back, fear racing across his burnt face. I held my gaze tighter, my eyes never leaving his.

  “Six months,” I repeated. “You should make plans.” And with that I picked up my towel, righted the chair, and walked away, leaving the cowering shell of a man rushing to get away from me.

  Before you think that I had some psychic premonition, some heavenly sixth sense of foreshadowing, let me set the record straight. I have no idea if ‘Mr. Chair’ had lung cancer. And let’s be honest, if the tumor had been sticking a foot out of his chest at that instant, I doubt I would have given a damn. But I’ll bet on one thing for sure; he got a chest X-ray and a complete workup that week. And I bet he spent the next six months looking over his shoulder. I like to imagine that perhaps I stopped his world and he was a changed man, and saw the error of his ways. I tested this theory.

  Two days later Dave and I were walking back from one of the hotels when I caught sight of the man near where our first encounter took place. Dave, who thought the story was a hoot, clenched his teeth to keep from laughing, trying to keep me from straying from my path. The man was huddled near a palm tree, trying to hide from view. I looked straight ahead, pretending not to notice, until I was parallel to him. Then I stopped. Slowly, mechanically, I turned and stared right at him. I lifted six fingers, as he fled into the condo complex.

  Well, if this story makes you take me off your Christmas or Hanukkah list, so what. Some people do need to be put in their place or reminded of their humanity, and as I said before, I can be a son of a bitch at times. Occasionally, we all have trouble sorting out the heroes from the bums, or in my case is it the other way around?

  Chapter Fourteen

  The Crackhead, the Grifter, and the Pinstriped Felon

  As bad as it sounds, some people just never die, as much as they want to end it. Every ER in America has them: the crackhead, the grifter, and the pinstriped felon. They are the walking dead, those who live just a few inches above the dirt, constantly knocking on heaven’s door, or more often pounding on the gates of hell with a ferocity few of us can comprehend. Some have everything, and others have absolutely nothing. Some may at first glance seem beautiful, full-breasted with supple lips and soft skin. Some are even finely pressed versions of model citizens clad in pinstriped suits. Still others are dirty in soiled undergarments and wet socks, frosted with renal failure and crack cocaine. All of them want to die, but never pull the trigger. And, unlike those with depression, they never admit having a death-wish to themselves or others. On some level they seem mad at the world, adamantly rejecting any help. They actually seem to enjoy your disdain of them. It is what makes them feel alive, connected. They often fuel your animosity, only to weep in self-pity and apologize for their behavior just at the point you are ready to throw them out. You’ll forgive them, only to have them assign blame to you for all their ills, and the vicious cycle will start all over again.

  They are the moral felons who in many instances never commit a real crime, or have never been caught. They might forge a bad check here, forget to pay a debt there, or lure the spouse of a friend into a lurid sexual affair only to reveal the relationship to all who will listen. You search for adjectives to describe your feelings in regard to their behavior, but nothing seems to fit. Then, it hits home; you just don’t trust them. A thousand interactions allow those of us in the ER to pick them out very quickly. We have psychiatric labels for them. They are called sociopaths; they have atypical bipolar disorder, borderline personality disorder, and a host of other psychological complexes.

  And while I have never verbalized any of the above in the sanctuary of the ER, I am certain these opinions have been voiced at one time or another, perhaps over the second scotch. I have caught myself almost falling prey to counter-transference (psychological terminology for becoming angry with your patient). But unless your name is Jesus or Job, it is almost impossible to refrain. I have been known to walk into a room to treat such a patient with a medical student, nurse, or resident in tow, shaking my head in disgust. I stop in front of the closed door, look at the student, wipe my hand across my face, and say, “Time to put on my concerned look.” And with a flick of my hand, my demeanor will change, and I will shift into my doctor cum actor persona. I tell my students that it is okay if, at times, you don’t really care: just try not to act like you don’t really care. Providing healthcare is not about how you feel, it’s about how the patient feels.

  I have a friend, a well-known physician, who never seems to get upset. “On the contrary,” he tells me, “I get angry all the time, especially when dealing with hospital executives on finance issues. I am a black belt when it comes to polite, passive-aggressive communication. ‘I see’ means ‘go %&*#@ yourself’. ‘That’s interesting’ means ‘you’re a moron’,‘ and ‘that’s really interesting’ means ‘you’re a complete moron’.”

  I think it’s a brilliant way of getting angry without displaying it. It fulfills a great human need to honor your feelings and express your anger, even if the other party is unaware of it. For interactions with your mildly difficult ER patients, these mechanisms work just fine for both parties. But for the grifter, the crackhead, and the pinstriped felon, this is child’s play. They are clued in to such behavioral modification since they use it all the time. They have been master manipulators since the day they sq
uirted out of the womb. They are precision athletes, pioneers of deceit. While some are capable of great professional accomplishments, most are practitioners of profound disasters on the interpersonal sphere. Their personal lives are sometimes a sine wave fluctuation from wealth and accomplishment to bankruptcy, addiction, and stress center admissions. They will be your friend and ally one day, and the next day they would just as soon put a bullet in your head, pour arsenic in your tea, or destroy your reputation through lies and innuendos. So as a physician your only real defense is to determine that they don’t have a life-threatening problem, avoid contact as much as possible, get Social Services involved quickly, and get them the hell out of your ER, before they have the opportunity to become a tsunami destroying the morale of the entire department.

  I usually am able to identify them by a silent whisper that I hear very plainly in my ear: ‘careful’. It’s the asp in Eden sending out a long hiss of caution: ‘careful’. Because whatever they say, what they mean is: “My chief complaint, the problem that brought me here, pales in comparison to the underlying pathology that defines me.” But the law is plain: We must, and should, see all comers. We must and should do our best to provide the best possible treatment. We must and should maintain our objectivity and do our best to provide comfort. However, we must never be forced to suffer from physical or emotional abuse or the threat of such. And we must never allow the care of others in the ER to suffer the ranting of a few lunatics. I feel the ER should never give a green light to the worst display of human behavior or let it go unchallenged.

  “I want to talk to the nursing supervisor,” the voice screams with spittle and vile hatred. “I’ll sue you fucking assholes . . . all of you. I’m going to call my lawyer now.” You see only a seasoned pro would ask specifically for the nursing supervisor. Others with valid complaints simply inquire about whom they need to talk with to air a concern about patient care, etc.

  So you wait for the sine wave to ease back down to a baseline, perhaps take a dip down into the realm of actual civilized behavior by offering a meal tray, the opportunity to smoke, a free cab voucher, some lighthearted discussion, or a few pain pills; then you quickly discharge them to the sanctity of their own personal hell, just to get some respite from their bizarre antisocial behavior. You feel no sense of guilt for those who ultimately refuse to care for their self, their family, or what few friends they have. And they certainly don’t care about you.

  All you can do is to offer them a chance for change, protect the others in your charge, and like the battlefield medic who must choose by their injury between those you can treat and save and those you can’t, you can’t restart every dead heart, even the ones that haven’t stopped beating yet.

  Chapter Fifteen

  Harry Carter’s Shoes

  He was, in all practical purposes, the first patient whom, for a prolonged period of time, I had ever cared for and with whom I had established any real bond, and the first to die under my supervision. He gave me a lesson in contrition and showed me that everyone has a soul, a spirit capable of reflecting God’s goodness, one with the potential to impact the lives of others, even if that exchange was just a brief, seven-word sentence. Harry left that mark on me and changed my life forever.

  His life must have been very hard. He was beaten and bruised by time and through service to his country, and spent his final few months cooped up in a dark windowless room at the Pittsburgh VA Hospital. He was in my charge for nearly a month. I spent a good deal of time with him because he was sick as hell. Harry was about forty, had a form of bone cancer and hepatitis, and required an untold number of blood transfusions. His years of intravenous drug abuse had ravaged his veins, and he was covered with sores and scars of prior battles. His eyes were yellow with liver failure and contrasted sharply against his dark black skin. He was tall and sinewy, and well over six feet with a head of hair like Don King’s. His room had the constant sickening smell of sweat and bloody stool, which tended to keep the nurses from working too hard to provide care, which for that VA, unfortunately, seemed to be the norm rather than the exception. I recall discovering one of my patients there dead and stiff in rigor mortis, a condition that takes time to set.

  Harry had low platelets (cells used for clotting blood) and consequently suffered from ongoing rectal bleeding, which for a man of his stature was humiliating, not to mention uncomfortable. He was constantly soiling himself and required a lot of nursing attention. As fast as I could put blood into Harry, it would break down or leak out from some orifice. His final weeks were certainly horrible, but this guy never complained. He always had a smile when I saw him and a new joke every day. He called me “Doc” and always made an effort to tell me what a good job I was doing. Each morning I was met with a “Hello” or a “Good morning, Doc,” and he made sure to send me on my way with a heartfelt “See you later” or “Have a good day.”

  Unfortunately, all our therapies came to no avail. He failed chemotherapy; he was not a candidate for a bone marrow transplant, and all we could do was to keep replacing his blood and platelets. During one restless night, his movements pulled the only workable IV out, and I was forced to put a central line in Harry. This is a very large IV line that you place in one of the major veins leading back to the heart. In his case I was putting it into the subclavian vein, right under his collarbone. This procedure was painful and difficult. He was a big man, though markedly volume depleted and anemic, had numerous prior central lines, and was a mass of scar tissue from prior surgical sites. I spent a long time trying to place the line. He was restless, short of breath from severe anemia, and difficult to keep still. It was a frustrating procedure, and during the course of his movement to get comfortable, I proceeded to stick myself with a contaminated needle.

  “Damn it, Harry, you have to hold still. I just stuck myself!” I glared at him, ripping back the sterile drape. I snapped my gloves off and tossed them onto the floor in disgust. Then, I proceeded to squeeze as much blood out of my wound as possible, washing and scrubbing it with Betadine, hoping that this IV drug abuser was not HIV positive. Harry remained quiet, and then I heard it . . . those seven words, the most painful words ever spoken to me.

  “I’m sorry, Doc . . . are we still friends?”

  I stood stone silent. Here was this guy dying of cancer, a grown man lying in a diaper full of bloody stools, having someone drive a large needle into his neck, lying in bed day after day in a shit-hole of a room, with no friends or visitors, and all he can think about is hurting my feelings—whether or not I was still his friend. I was so ashamed of myself I could not even look at him.

  In that instance Harry Carter had shown more class and more compassion than I had shown in my entire life. “Harry,” I said, finally looking at him with my hand on his shoulder, “of course we’re still friends, and I’m the one who should be sorry. I didn’t mean to snap at you . . . I was just frustrated when I couldn’t get the line in, knowing you’re sick . . . and . . .”

  “It’s okay, Doc. I’ll be still, and you can go ahead and try it again,” he interrupted me.

  I looked over and smiled; he had more confidence in me than I had in myself at that age. “Okay, Harry. Let’s give it another shot.” And with that, the line slid in more easily than any I have placed since that day.

  But a few weeks later, I had to sit with Harry and explain that he was going to die, and that we just could not give him blood faster than he was losing it. “Okay, I guess that’s it,” he simply said. “You did all you could do . . . I guess it’s time for me to go.” Tears welled up in his yellow eyes. I called his next of kin and let them know he would probably die within the next 24 hours.

  About five hours later, Harry’s respiration rate sped up as blood left his body, and he soon became air-hungry and delirious, and he slipped into a coma. That’s when he walked into the room—his son, most likely. He was a tall, robust younger version of Harry, a specter from the mean Hill Street Blues of Pittsburgh. He was dressed in a bul
ky coat, a ball cap, his collar protectively pulled up, hands tucked in his pockets, sheltering himself from the world. I watched from afar as he pulled up a chair, lowered his head, and held Harry’s hand for a short time. Then, he got up, reached down, and picked up Harry’s high-top tennis shoes and left the room without saying a word. As I sat with Harry while he died, all I could think about were his tennis shoes and how hard they would be to fill.

  Chapter Sixteen

  I Went into Medicine for the Money

  It’s true. I went into medicine for the money. Yes, I know what I said at my interview for medical school.

  “So, Mr. Profeta, tell us why you want to attend Indiana University and become a doctor.”

  “Well, sir, you see, when I was younger, I was involved in a horrible accident…blah, blah, blah…and, well, I saw the way my doctors took care of me…blah, blah, blah…and it had a huge impact on me…blah, blah, blah…and, well, sir, I have always loved science…blah, blah, blah…and I did a lot of soul searching…blah, blah, blah, blah…and that’s about it, sir. I really hope to be able to fulfill my calling and become a physician.”

  Now, if I really had been able to answer the question honestly it would have been something like this: “Well, sir, I have always been insecure and trying to look good in the eyes of others. We never had a lot of money growing up and I was always envious of the kids whose parents had big houses, belonged to country clubs, and got to go to Florida on vacation. I knew I didn’t have the stomach for office work so I thought, how could I make a lot of money, get respect, and act like God at the same time? Then it hit me: I’ll go into medicine. I mean, let’s face it; you have a great gig here. You make good coin, get the best reservations, and even ski trips to Aspen. Well, I want that too. And I’m smart, top ten percent of my class. I mean really, how tough is it?”