The Patient in Room Nine Says He's God

by Louis Profeta

  If you sign the papers to put a G-tube or feeding tube in your 80-year-old mother with Alzheimer’s or other severe dementia because she is no longer eating, you will probably have a fast track to hell. I’m not taking about midway up the ladder to purgatory; I’m speaking of medieval inquisition hell. There is a special place in hell for sons and daughters who allow this to happen to the people who brought them into this world, nurtured them, rocked them to sleep, and held them to their breast during thunderstorms. There is a special place in hell for those who pop holes through the belly wall of their parents, shove plastic tubes in their stomach, and fill their intestinal tracks with a blended mixture of soy formula, Ensure, wheat germ, and sedatives. Because no one dies without a feeding tube, they die with them. The elderly will stop eating when it’s their time; forcing them to eat is a desperate attempt to salvage our time. Certainly there are exceptions to this rule. But this is the reality of a huge number of terminally elderly that are planted in a bed and fed like hothouse tomatoes, instead of being allowed to die in dignity. The boomers have placed them on dialysis, put plastic tubes in their lungs, catheters into their groins and bladders, wrapped them in diapers and called it “love,” then scurried off to tennis lessons and personal trainers.

  There is a special place in hell for those who, instead of holding the hands, and gently rocking those they love to sleep, instead choose to watch them wither away while feeding a mind that long ago died.

  So how do you convince a son or daughter to take them home, hug them, love them, clean them, feed them, and allow them a chance to pass away a little sooner in a family home? I’m not sure, but letting them know it’s OK to die this way may be a start. It’s OK to forgo a year in the nursing home for six months in the spare bedroom. Once those simple two letters are taken to heart, then all the pressure is off, and you can begin a wondrous journey of spiritual reconnection and reconciliation.

  There is so much that’s right in a family that takes in their parents. When they come to the ER, you can just see what a labor of love it really is for them. There is nothing more honorable, loving, and all-encompassing of God than that. Certainly it requires work and sacrifice. It will, however, strengthen the bonds of the entire family. It will bless your own children with the opportunity for them to be entwined with their ancestral past and that is as godly as it gets. There are so many more lessons to learn from these difficult acts of loving, kind nurturing, than from any other after-school activities. My mother took my grandma, her mother-in-law, into her home and cared for her for nearly 40 years. This is an absolute 100% free pass to heaven. While at times it was hard, she will tell you that she misses her every day and would do it all over again.

  If it comes time for my mom or dad, my mother or father-in-law to need a helping hand, my door will be open, the bedroom will be made, the bathtub will be modified, and the recliner will be ready for them.

  Chapter Twenty-four

  From the Mouths of Babes

  Over the last few years I have come to appreciate how much my children love to come to the ER and visit me while I work. There are many factors involved. Apart from them just wanting to come and see their dad, I know they relish the attention lavished on them by the staff. Also, I truly believe there is a component of pride, though they do not recognize it as such, in watching their dad work to save lives. I overhear them in conversations with their friends or in their school writings:

  “My dad saves lives.”

  “My dad helps people.”

  “Daddy…‘Mrs. So and So’ said to say hello, and that you took care of her dad, her mom, her husband, her son...”

  They will occasionally hold bandages while I splint, push a wheelchair for a nurse, or get a patient a blanket. I believe that these are the simple things that teach human compassion and respect. They teach a sense of responsibility for our elderly, a responsibility to the past. I watch these scenarios play out in public when my children hold a door for strangers, help with a grocery cart, or perhaps pick up a dropped glove. I try to teach my medical students that this is the true gold of being a doctor. It is not so much the skill, though it helps; it is the simple smiles, the attention to comfort, and an understanding nod or a comforting hand.

  I must start by saying I love watching the faces of the nurses, medical students, and patients light up when these three precocious and, at times, inappropriate kids clamor into an already tense environment. You can quickly see and appreciate the change in dynamics in an instant. Everyone seems to slow down a bit, catch their breath, smile. The familiar phrases of “How’s school?” or “Coming to see your daddy?” and “Hey, did you bring all of us food, too?” fill the air. It is in all regards celestial music in a brutal setting. That is, of course, until they open their mouths…then all bets are off .

  An elderly lady sits lying on gurney, her eyes focused as Eli, then six, passes by. He stares intently at the web of lines and tubes snaking across her arm, and, of course, as most do, she flashes a conciliatory though somewhat strained smile to my child. The type of smile that says, “I was you once.”

  “What’s wrong with that old lady?” Eli asks, his voice slightly broken with the plight of innocence. “She’s sick,” I replied. My arm encircled his shoulder in a futile attempt to ease his concern. “We are trying to make her better.”

  He looked back at me with deep, inquisitive, questioning eyes…the eyes of a child…going on thirty. “If she’s sick, how come she’s smiling so much…can I get a Coke now?”

  So it seems God does have a sense of humor. I think it was his way of telling me to lighten up…the kid’s only six. He has a whole lifetime to learn human compassion. These are the words from God’s mouth to Eli’s mouth to my ears. What sweet music…the music of innocence.

  Chapter Twenty-five

  “Hey Buddy . . . You Don’t Belong Here”

  It did not make a whole lot of sense to me at the time. Looking back now, it still doesn’t. The man was in his seventies and had managed to scale the bracing of one of the many steel-girder bridges dotting the Pittsburgh area. Just prior to my arrival in the physician response vehicle, a fully equipped Jeep Cherokee loaded with rescue equipment, he took a header and plunged into the cold, murky water of the Monongahela River. A couple of fishermen in a small aluminum boat found the dead man floating on the river and towed his body to shore, where we could then drag him up on the bank. His pale eyes and mottled facial complexion were obscenely covered with river sludge and plant debris. On his chest, like a misplaced toe tag adhered to his rigor skin, lay beige and dimpled, a nitroglycerine patch.

  Sometime in the last few hours, this gentleman got up, ate breakfast, perhaps combed his hair and took a shower, put on his nitro patch, and scaled the bridge with the intention of killing himself, and he succeeded. The paradox was unmistakable: a lifesaving medication on the body of someone who had just committed suicide. It told me that during this brief period of time there was a conflict in this man’s heart between wanting to live and wanting to die.

  I’ve heard it said that nearly every survivor in their final leap from the Golden Gate Bridge regrets their action during the fall to the bay below. I think it is because in those four intense seconds they come to realize that all their life’s problems can be rectified, while their death will be permanent. I never know what to say to the survivors, be it from a gunshot wound, single-car motor vehicle accident, overdose, carbon monoxide attempt, or just the simple ‘ten Tylenol gesture’. Every encouragement seems so clichéd, each word of comfort so rehearsed, so I say the same thing each time. “As bad as it is now, is how good it can be in the future. Besides, you have all of eternity to be dead and only one chance at being alive, so why not milk it for all it’s worth?” It usually elicits a snicker that seems to say “never thought of it that way.”

  When it comes to successful suicides, the anger and despair on the faces of loved ones are beyond description. While all unexpected deaths are horrible, a suicide is perhaps
the worst of all. The ones left behind are not only faced with the realization that the person they cared about is gone, but also that person was not who they thought they were. The dead take on a different persona. They are no longer remembered as the loving husband, the doting mother, or the tender if troubled teenager. They become something else. The loving husband, who did not love enough to stay with her and the children; the doting mother, who let her children bury her; the teenage boy, who left his loving sister with a lifelong burden. They become the hyphenated dead, the family footnote. They not only kill themselves, but they slash at the memories that others once held dear, akin to finding out a parent is a child molester, or a brother is a killer. This is the reality of suicide.

  In these situations I have witnessed parents pulling out their hair, spouses physically punching the dead body in anger, children throwing furniture into the wall. Their despair goes beyond simple loss and instead morphs into incomprehensible ferocity at the source of their bereavement. They become the most upset at the ones whom they loved the most. Perhaps this is the reason why in traditional Jewish lore, the suicide victim is buried on the fringes of the cemetery, away from the other graves. It is as if the rest of the faithful dead are saying, “You do not belong here; you did not honor your gift on earth.” And while it may seem cruel to the surviving family members, on some level I suspect it serves a greater purpose. It reaffirms to the living that the sanctity of life is undeniable, and our commitment to its preservation should never waver.

  Chapter Twenty-six

  Bowl Away

  It never ceases to amaze me how people respond when someone dies in public, or when they witness a severe trauma or become privy to a very ill individual. It can run the gamut from a sense of profound sadness and sympathy to a response that is nothing short of being inconvenienced and lacking all semblance of human decency or class. There are the gawkers, the criers, the screamers, and the prayers. There are the helpers, the hinderers, the ambivalent, and the idiots. I have even witnessed parents hauling young children over to the scene of a catastrophe, keeping moronic voyeurism alive in the family. I’ve seen all of these people at some time in my career and often all of them at the same event.

  Over the years I’ve kept my perspective while on the street; I try to help without intruding and make sure I leave when I’m not wanted. I’ve stopped at many accidents with my children, and I have always made sure that they are out of the line of fire and especially the line of sight. Unfortunately, they have been exposed through direct contact, stories, or dinnertime banter to situations only adults should hear. I worry about them at times, but they seem well adjusted. I’m trying to keep them as children for as long as I can, but it’s hard these days.

  A few years ago at a major league baseball game, the umpire suddenly stood up, backed away from the plate, and fell over dead due to a sudden heart attack. Medics, fans, and players worked feverishly to save his life but were unsuccessful. I anticipated that there would be a moment of silence, some sort of long delay, before some schmuck got on the intercom and made a typical generic comment about, “Well, I’m sure Umpire Bob would have wanted us to play on.” Instead, something beautiful and unexpected happened. They cancelled the game. Imagine that. Finally someone had the guts and the decency to stand back and say, “Today is not the day for cheering. It is a day to mourn.” And maybe the umpire would have wanted the game to go on . . . perhaps. But the game can always go on at a later date. In addition, families of athletes and celebrity friends should not be put in the awkward position of having to say, “Oh, it’s okay. I’m sure my husband . . . my father . . . Umpire Bob would have wanted you to play on.”

  When a tragedy occurs, especially at a high-profile event, people need to be given a chance to stand back and take stock of their lives. They need to go home, sit with their loved ones, and reflect on the wonderful gift of life. They need to explain to the children in attendance about what happened and how precious the gift of life truly is. And that applies to the guy selling peanuts, the fan in seat section 9, as well as the celebrity throwing out the first pitch.

  That’s why, when the bowling continued in lanes three and five, framing the dead body on lane four, I was thrown aback for a few seconds—that is until I started laughing hysterically.

  The aging man bowled a strike, turned and high-fived the other players on his team, and then dropped DRT, as one of my former residents would say: Dead Right There. It was a heart attack, a stroke, or arrhythmia—something killed him. He was obese and in his late fifties, clad in a blue gaudy bowling shirt and khakis. We arrived at the bowling alley in Pittsburgh in a specially outfitted emergency physician vehicle. Typically, our runs were cardiac or respiratory arrests, fire or motor vehicle accidents as well as entrapments, shootings, baby deliveries, and so on. Joanne, the other physician, and I grabbed our equipment and rushed inside to the sound of balls hitting pins with that unmistakable resonant ceramic clashing. He was dead on lane four. No one was really doing much of anything when we got there.

  We immediately began CPR, shocked him a few times, and gave him heart-starting drugs, but this guy’s heart had no electrical activity at all—straight as an arrow. It was a typical pre-hospital cardiac arrest; I’ve been on so many now I can’t count or remember them all. What struck me, though, about this death was that the bowlers on the adjacent lanes continued rolling. Here we were, hovering over a dead man on lane four, and the bowling teams from Joe’s Bar and Bill’s Auto Painting couldn’t have cared less. In fact, someone actually pushed some of our equipment out of the way so as it would not interfere with their game. One man rolled a strike in lane five. He yelled out, and there were a few pats on the back followed by a fist-pumping gesture, only a few feet away from where I was trying to put a tube in the man’s lungs. I placed the tube and looked over at my colleague who was checking for breath sounds.

  “How would you like dying on a bowling lane while everyone just kept bowling beside your dead body?” I asked Joanne, with a great degree of disgust in my voice.

  Without missing a beat, she glanced up at me and answered with a grin, “Depends on how much I liked bowling.” And with that simple response, she burst my bubble of indignation and in addition caused me to bruise my lower lip biting it to keep from laughing so hard. As we covered the blue-faced man in his blue shirt with a white hospital sheet, I could’ve sworn I saw him smile.

  Chapter Twenty-seven

  www.helpme

  At first I thought she might be faking it, as she sat slumped over in the wheelchair. She was young, thin, and pretty, as her husband hurriedly pushed her into the ER. I meandered into the room with minimal urgency, swallowing the last bit of my low-fat turkey sandwich from Starbucks mixed with a gulp of decaf coffee. I gave them a quick, “Hi, I’m Dr. Profeta,” and then kicked down the lever holding the bed rail up and reached across to help the young woman onto the gurney. She flopped heavy in my arms, like a wet bag of newspapers; this was a slap upside the head, telling me her condition was very serious. While I talked to her husband, I quickly did a primary survey: assessed her airway, looked at her pupils, yelled for a stat head CT scan, sank an IV line, and checked her blood sugar. The saliva was thick in my throat; something catastrophic was happening to this young mother of two small boys, and after some 50,000 patients I knew pretty early that I was not going to be able to fix it. As we rushed the young woman off to get a CAT scan, I went back and forth with her husband.

  “She’s had a severe headache for two days, vomiting . . .”

  “Does she use any drugs, or have health problems . . . diabetes?”

  “No, she’s completely healthy; doc, is she going to be all right?” he asked.

  “Don’t know yet. Has she complained of fever, double visions, night sweats?”

  “I . . . I . . . don’t know. Is she going to live?”

  “Is she on any medications?”

  “Should I call her parents?”

  I knew what the CT scan wou
ld show before the first digital image fully materialized. A digital hourglass hung on the computer screen; the sand was running out. Her brain was bleeding, and this was going to end with her death.

  Now I could stop this story here, and you would be left with another tragic tale, the sad death of a young woman with much life yet to live. Instead, I am going to tell you a heroic tale of how this woman’s plight was thrust into to blogosphere and into the conscience of nearly 200 physicians around the country. And how they scrambled to this woman’s rescue, walked side-by-side in cyberspace-consultation and how they cried with me and her husband when she died.

  To set this story, I have to go back a few years to an innovative young physician who had had enough of the plodding routine of a surgical residency program at a prestigious Boston hospital, a clinical arm of Harvard University. I suppose he had one of those ‘AHA moments’ where he said, “What the hell am I doing here?”

  And while most weary young physicians have that same AHA moment, often several times each day, few have dropped out of a prestigious surgical residency to start a blog site. His website was to be for physicians only, a place where they could escape, discuss politics, blast lawyers and insurers, lament about Medicare, and share clinical pearls—essentially talk about all those things in the cyber equivalent of the high school chess club. Over time, though, it has become a social escape for tens of thousands of physicians wanting to ‘get things off their chests’. It was in cyberspace that this young woman’s fate hung, her last days, hovering between the touch of her family and an electronic bulletin board blasting her condition along the wireless modems of these thousands of physicians, all hell-bent on trying to save her life.