The Patient in Room Nine Says He's God

by Louis Profeta

  Since then, Carlos has been a guest in my home. He comes with his wife and children and picks jalapeño peppers from my garden. We play basketball on occasion, and he has even cooked for me on my birthday. He tells my children what a great dad they have. His praise is really unnecessary, but I can tell it’s his way of saying thank you; however, the occasional tuna sashimi appetizer is more than adequate.

  What Carlos doesn’t realize is that I am just glad that I can bear witness to the triumph of the human spirit. I am thankful that God has blessed Carlos and his wife with a young healthy son. I am grateful for the soft touch and kisses of my sons. With the patience of Job, this spiritual man who came to this country and struggled to pursue the American dream has found a new spirit. He has risen from tragedy, arisen from despair, and made me proud to be a part of his world.

  Chapter Twenty

  “You Gave Me Forty-eight Hours”

  We do funerals better. I mean it. Jews know how to put on a good funeral. You die; you’re in the ground in 24 hours—no embalming, no flowers; there is a simple wooden box, and you go home. Everyone comes to visit for the next week or so, and they feed you. I have always insisted what bothers me the most about dying is all the good food I would miss out on.

  I feel uncomfortable at Christian funerals, and I admit it. I feel bad that families have to spend days cooped up in a foreign mortuary, away from their own kitchens, their bedrooms, their homes. They have to cope with their worst life tragedy in an alien world of garishly framed European prints, stenciled landscapes, and artificial flowers. They spend two or three days dressed in their Sunday best, standing in lines while throngs pay tribute in a well-choreographed reception line of gentle hugs, tilted heads, and ‘so sorry’s’. So when I decided as an afterthought to pay respects to the husband of a deceased patient who I treated in the ER, I was a bit apprehensive, and not just because it was a Christian funeral. I was afraid he might blame me for his wife’s death.

  CPR was ongoing when the medics brought her into the ER. They reported that she suddenly dropped while talking to her husband. He came in with the medics as they performed chest compressions, refusing to leave the room. It was around one or two o’clock in the morning, and she was our only patient. It was evident from his demeanor, his posture, the way he carried himself that he was someone who was used to being in control. Probably a well-to-do businessman from the north suburbs, the type that knows so and so, plays golf with you-know-who, and is the man with courtside seats. But that night he was out of his element; that night he was only a man about to lose his wife.

  She kept going in and out of ventricular tachycardia and ventricular fibrillation. Her heart was beating at a rate so fast her brain failed to get enough blood. I kept administering shocks of electricity, and shots of lidocaine, bretylium, magnesium, and procainamide —anything to keep her in rhythm. I even tried to run a pacemaker, but to no avail. This went on for nearly two hours. And then, as suddenly as her soon-to-be-fatal heart rate had started, it slowed and began beating with the smooth regularity of normalcy. Her blood pressure stabilized and to the untrained eye she appeared fine, pink, and well perfused. He was so relieved when the nurse pronounced that her pulse was stable and her pressure good, and the oxygen was perfect. But I knew that her brain was dead, her soul was gone, and we were left with a beautiful shell of a previously vital woman who would never again hold the hand of her child, her husband, or her mother.

  I tried to be quietly optimistic. “We have to wait, we’ll get her down to the big house (our other hospital), and we’ll see what happens over the next few days. It’s too early to tell how much, if any, brain damage she may have suffered.”

  “Then we need to hurry, get her moving. Let’s go, let’s get her transferred, Doc.” I let him take some control, make some phone calls, and be a player. Mr. So and So showed up with his wife, dressed in pajamas, looking nothing like the imposing figure of corporate hierarchy that he portrayed in public. They came as simple friends awakened in the middle of the night by the pleas of someone they loved. They stood to the side and let the chips fall; the transport team came and gently slipped from the ER in the wee hours, with their friend in tow.

  She died 48 hours later, her husband and family by her side. As I drove home a few days later, I passed the funeral home that served as her final open house. I had never called on a former patient, since ER doctors are footnotes in their lives. We are the ten-minute silent heroes, whose names never stay on the tongues of those who seek our charge, our responsibility. We are not invited for dinner, given tickets to games, or offered use of condos in Vail. We show up, do our job, and fade into the background from whence we came.

  Though I didn’t know her or her husband, I was somehow drawn to the funeral home. I tried to drive past but the wheel turned itself, the car slowed, and I parked alongside the façade of Someone and Brothers. The parking lot was packed with Bavarian vehicular opulence, and I immediately felt a stranger. I was dressed in jeans and a brown Avirex bomber jacket, completely out of my comfort zone amongst the black suits, dark glasses, and shades of grey. I filed into the line watching, listening, and approaching the man as he stood next to her casket. It seemed a sea of sterile handshakes, one after another, gentle pats, tilted heads, and ‘so sorry’s’: one after another, one after another. I could feel the inquisitive eyes of his family and friends on me, wondering who I was. As he shook hands with the grey suit next to me, he glanced in my direction with a look of confusion. He did not know me. He talked with the grey suit some more, and then suddenly stopped cold, looking at me again. He dropped the grey hand and turned to me, putting both arms on my shoulder, and pulled me close to him. His eyes filled with tears, he could barely breathe.

  “You gave me 48 hours with my wife that I would not have otherwise had, and for that I am eternally grateful.”

  I may be born into a thousand lives, live a million years, and see a billion sunsets, and this will always remain one of the most comforting, sincere, and gracious things ever spoken to me. I have had a few years to reflect on this event and in no uncertain terms, I feel the same about my own wife, my own children. Every minute of every day that I can have them near and that I can hold them is that much more special. My children push me aside at times, overwhelmed with the hugs and kisses. But one thing is for sure; when I die, I want my epitaph to read:

  “Here lies Louis; he used up his allotment of hugs and kisses.”

  Chapter Twenty-one

  F.O.P.

  My initials are LMP (Louis Mark Profeta). It is monogrammed on my briefcase. Unfortunately, in medical jargon, ‘LMP’ also stands for ‘last menstrual period’. You will find it on all of our charts. I have patients who are routinely SOBs…or ‘short of breath’. They frequently go long periods of time without having BMs, or suffer acute MIs due to CAD, PEs, CVAs, TIAs, SBOs, or DVTs. Some go through DTs since they can’t get ETOH. We get EKGs to rule out VT, SVT, LVH, WPW, or IHSS. I order EEGs, CTs, MRIs, TEEs; place IVs and CVP lines; do LPs; and provide O2. We give TPA, MS, LR, or D5W, often by IVP in hopes of being able to DC them ASAP. Unfortunately, they often end up getting a PTCA, CABG, or TAHBSOs in the OR after leaving the ER. Many end up in the ICU if they are not OK. Occasionally, though, they arrive DOA… UC? I love taking care of all sorts of patients…except one type…the F.O.P.

  In most ERs ‘F.O.P’ stands for one thing: ‘full of poop’. In our ER, it means something else…’friend of Profeta’. I grew up on the north side of Indianapolis, a city of about one million people. My parents grew up here, as well as my wife’s family, all of our uncles, aunts, and so on. The Jewish community is small: about three to 5,000 people. Because we can mostly pretend to trace our roots back to Abraham and Sarah, they all think they’re related to me. And if there is one thing we Jews are good at, it’s working the system; whether it’s getting dinner reservations, Pacers tickets, or being bumped to the front of the ER triage line.

  Now, if you take those individuals aside, an
d then add all of the other people I know from my neighborhood, and the forty years I spent growing up here and attending high school just down the street, sprinkle on my kids’ school, sports, my parents’ friends, my siblings’ friends, and throw in one degree of separation for another 2,000 individuals, that makes a solid seven to eight thousand people that know me directly or indirectly….and they all live within about ten miles of our ER. I have never worked a single shift in our ER where I have not cared for someone that I have known. It has become so routine that our ER has created its own acronym…F.O.P.: ‘family (or friend) of Profeta’. One Christmas party, or should I say, ‘holiday party’, as my partners call it, so as not to make me feel isolated, the nurses gave me a faux hotel guest registry book.

  I love my family and friends, don’t get me wrong, and there was a time that I enjoyed the notoriety, but let me paint a picture for you: I work a ten- to twelve-hour, brutally tense and stressful shift. I come home exhausted, hoping to spend some downtime with my family, only to be met by a pile of messages to call ‘x’, ‘y’, and ‘z’ about their health questions.

  “Ms. Schwartz’s daughter is in town and has a sore throat. Can you call her in…”

  “Martin down the street has a question about which orthopedist…”

  “Your mom wants to see if you can get the results of her pap smear…” and on and on, and on.

  Early in my career I made the mistake of opening myself up to all this, by being approachable. I have to admit…the reasons were not always admirable. I was always searching for the angles and the favors, but mostly I loved the attention and the affection that helping these people brought me. I would do a favor, see their kid, etc…and they, in a sense, owed me one. I have never been really good at making friends, and this somehow filled the void. It made me feel needed and loved. This is what some insecure people do. Other physicians may become raving tyrants, highly overestimating their own self worth….this was never my style. I knew I was insecure, I just didn’t know how to fix it….time and age just sort of worked it out. Now I’m mostly just a temperamental prick… albeit an honorable one.

  However, I was left with a dilemma: The medical favors and accessibility for the myriad that felt they could call me on my free time no longer did anything for me other than take up my time. Once I became content with my lot in life and secure in who I was, I did not need this attention, and in some cases, it left me feeling taken advantage of, taken for granted. Worst of all, many times the individual tossing my name around like a tennis ball was really not that close of a friend. Even worse, they would interject my name around in a manner that was disrespectful to the other doctors or nurses caring for them.

  “If you don’t hurry up and get me to X-ray, I’ll tell Dr. Profeta.”

  “I’m very good friends with Dr. Profeta, and he said to make sure x, y, and z is done.”

  All of this verbal garbage on their part was always pure bullshit, but in the beginning, many times, the nurses were unaware of this. I had to literally tell them, “If the individual is really that good of a friend they would have called me at home and I would have relayed a message, or come to the ER myself.” I told the nurses to simply hand the phone to the patient and tell them to call me at home. Very rarely has a patient taken the bait….usually the F.O.P.s shut their mouth. On a couple occasions I had to lay the law down to some so-called F.O.P.s, and tell them where they really stood on my friendship scale and let them know they were never to use my name again. Usually, these F.O.P.s were seeking drugs or causing some other problem in the ER. I assure you, there are no classes in medical school on how to deal with this…you’re on your own; besides, I’m not sure physicians in academia have friends anyway.

  What has confused me even more is this: How do you handle social situations when you are intimately familiar with the patient/friend’s inner personal problems? As would be expected in any cross section of our society, there are issues with drug abuse, HIV status, depression, alcoholism, spousal abuse, infidelity, and a myriad of illnesses and neuroses that permeate our culture. My position simply brings them to light in these F.O.P.s. I have had to sign commitment orders, pump the stomachs, do pelvic or rectal exams, treat sexually transmitted diseases for people I consider friends and good acquaintances. Unfortunately, I have also had to pronounce some of them dead. It goes with the territory I guess, but it makes for uncomfortable Christmas open houses, Fourth of July celebrations, and even foursomes of golf.

  A few years ago, the situation was so out of control that I snapped and requested….no, demanded…that my wife stop making friends.

  “I have enough friends. Every time we make more friends, I just have to start working harder. In fact, I want to downsize. I want an ‘F.O.P. clearing sale’. I don’t want to be invited to anything, and I don’t want to meet anyone new. I just want to stay home, cook, watch TV, and play with the kids. Oh, and while we’re at it, I am no longer answering the phone. You will play the role of triage nurse. If people call, just tell them I’m asleep, out of town, or recovering from a scorching case of herpes. In fact, use that excuse for all of them. ‘I’m sorry, Dr. Profeta is recovering from a scorching case of herpes, but I’m sure he’ll be happy to take a close look at your child’s sore throat.’” Alas, if only I had herpes! I even felt myself wishing for herpes…“Honey, could I please get herpes for Hanukkah…after all, all of our friends have it…I know.”

  Still, my approachability and published phone number set the tone of being a doctor who can be relied upon to help out in a pinch, make special effort to see a friend, stop by their home, or have them stop by mine. I availed myself in the ER to abiding by their request to be seen only by me, instead of having a medical student or resident first examine them, and to do all the documentation, further increasing my workload in the department. I could be relied upon to call in a script for amoxicillin, or someone’s hypertension medication, when their own doctor wouldn’t call them back. Or I would simply make myself available for a second opinion when they would feel confused, ill-informed, or scared. There was a time when I relished this, but over the years it changed to feelings of emptiness. I was doing all of these favors, and to be honest, I could have cared less for the people I was helping. At times, I felt like a priest taking confession, offering counseling and support, while at the same time wanting to smash a brick over the head of the person sitting on the other side of the screen. I admit it. One day, it all caught up with me, so I did something I never ever do: I asked for help and confided in my neighbor and friend, Reid.

  Reid is a fascinating individual. He went to school at Brown, the bastion of liberalism. When George Bush won the last election he went into a deep depression and threatened to move to Canada or Nicaragua. I, of course, tried to comfort him by turning his car radio to Rush Limbaugh, by inviting him to Republican fundraisers, and by putting ‘Bush/Cheney’ stickers on his car. I even carved a pumpkin in the silhouette of a large penis and put it in his front yard while he was on vacation. This was after he put a ‘for sale’ sign in my front yard with the number 696-6969 as the inquiry line. By the way, cars stopped in front of his house for two straight nights taking photographs of the pumpkin my three sons and I carved.

  Reid may be the funniest, most entertaining person I have ever met, and he has become a great source of comic relief and a great friend. He is also one of those new age hippies/venture capitalists who has made a lot of money in the steel industry and has used his good fortune to start a charter school for the under-privileged, and a school and clinic in South America. He also does all of these cognitive psychology and group counseling session seminars. At times, I think he would be better suited for Berkeley, since his ideology in the heart of Indiana sticks out like a rabbi in Saudi Arabia. He recommended the name of a cognitive psychologist to discuss my dilemma.

  I decided, with much prodding, to give it a try. I attempted to ‘peel off the proverbial layers of the onion’, as the psychologists like to call them.

>   So I walk into the office, and bingo, I recognize the guy immediately….he exercises at the same place I do…go figure. So I sit down and get right at it.

  “Doc…here it is…I help all these people, friends, relatives, and acquaintances….but I just don’t give a fuck when it comes down to it. I hear their problems, their complaints, mind you on my free time, away from the hospital, and…I could just care less. For the most part I want to slap them across the face and tell them to stop whining. Funny thing is…I don’t feel that way at work. There is a different set of dynamics there. I love, absolutely love my patients in the ER. I thrive there. I’m a different person. I get them coffee, blankets, anything to make their visit more pleasant. I truly want to help in the setting. But once I leave, man…I’m Mr. Hyde under a papal façade.”

  “Do these people that intrude on your free time know how you feel about taking the time to address their needs, to help them?” he inquired.

  “No, I cover it up pretty well. That’s why they keep coming back, I guess.”

  “Sure they do…you have been enabling their behavior. But let me ask you something…Is it really a huge burden on you, or is it something else that is bothering you? Perhaps the realization that you just don’t empathize with their plight…you just help.”

  “No, it’s not that big of a deal. To be honest, most everyone is very appreciative. Like I said, though, it’s like, once I leave work an empathy switch goes off in me. Big deal, huge burden?…No…it’s not that big a deal to me…to them it is. I just have no real feelings about them or their plight either way. I’m sure it would be different if they were real close friends or family with life-threatening problems. But most of this is just simple stuff ; offering reassuring words, making them feel important in the ER…what I like to call mental masturbation. I watch TV and I see all these commercials to sponsor some poor kid in the Sudan or El Salvador or in ‘Who-gives-a-shit-istan’ and the people seem so enriched to be doing what they’re doing, helping, crying, looking so spiritually fulfilled…”