My profession as a practicing family doctor has many wonderful positive qualities, including the ability to help others and to be an essential part of their lives, the academic challenge and pure delight of never-ending learning, the reality that my medical expertise provides reasonable compensation for me and my family, and the freedom to work almost anywhere in the world. However, like it or not, there is a very real negative that is a doctor’s recurring reality: sometimes you know too much. And this was one of those times.
As I looked upward to the mountain I had just traversed, the colors didn’t seem nearly as bright. My parking lot vantage point revealed more Gamble oak trees waiting for leaves than all the other trees already dressed in olive, jade, and emerald. The flowers and grasses were no longer visible, and there was more brown and gray than when I had been up at the summit. A cloud now covered the sun, and the sky had lost its luster. A sudden chill seized the air and I unthinkingly rubbed both arms for warmth. As the sky darkened with the threat of rain, I irrationally wondered, “Could mud season be returning?”
As Sick as a Person Can Be
May 30, 4:13 a.m.
Dear Family,
I am writing you in the late hours of darkness with a heavy heart after an utterly sleepless night. At the moment, I am an emotional cripple, unable to talk to anyone, even a stranger. So I apologize for using this group letter to communicate. An all-too-brief and impersonal communication will have to suffice until I don’t burst into tears every time I try to talk. Sadly, we are anxiously awaiting the confirmatory tests, but there is every indication that Nancy has the blood cancer called leukemia.
Last night, Nancy was admitted to LDS Hospital in Salt Lake City. Her skin was hot and the thermometer reading topped at 105.2 degrees. Purple bruises covered much of her body due to a deficiency of platelets, the type of blood cell responsible for clotting. The red oxygen-carrying blood cells were so severely depleted that Nancy’s blood count was barely more than half of normal, meaning she was quite anemic. And, hardest for me to witness, the bright aura that normally surrounds my bride’s demeanor seemed dimmed to a mere flicker.
Though her radiant smile retained its warmth, her normally gentle forehead lines were pulled tight with discomfort and her speech was flat and barely audible. In fact, the only words Nancy uttered loud enough for me to discern were, “Don’t say anything to the kids yet, Winnie. I don’t want Jaret and Jayna to worry.” As I held both of her hands and put my ear close to her mouth, all other sentences were just mumbles. She was in and out of consciousness.
Dr. Russ Morton, a doctor with expertise in blood diseases, was called to assume Nancy’s care. When, doctor-to-doctor, I asked him for the straight scoop in regard to what we were facing, he looked at the floor before engaging my eyes.
“Dr. Winn, Nancy is about as sick as a person can be. I don’t know if we will be able to get her into remission.” He paused, momentarily looked out the window, and before reengaging, took a quick gasp-like breath that could be heard across the room. “If we can’t achieve a remission, she won’t last the week . . . I am so very sorry.”
His definitive words were like the period at the end of the sentence. Final. No, they were worse. They were like the space after the period at the end of a sentence at the end of the paragraph at the end of the essay. Nothing more to add. Nothing more to say.
If you are a praying person, please add Nancy to your list. If not, please take a moment to visualize and remember a good time you had with her. Though she is physically weak, her spirit is strong as always. I know she will feel your love.
Sincerely,
Winnie
The Patient Who Stopped My Heart
May 31, 2:15 a.m.
Dear Family,
As I sit beside Nancy and watch her breathe from my almost comfortable hospital chair, I am actively trying to force positive thoughts into my being. I want to write something to balance yesterday’s note I sent you, so sad and so negative. I’ve always been an optimistic person, but this day has taxed me as no day before. My mind game worked. And I can now describe my “eureka” moment.
Though I often want to take each of my five-year-old patients home with me, absolutely enjoy the challenge of attempting to influence my all-knowing teen patients, and have had my heart warmed multiple times by those senior patients who share their vast wisdom and memories, in my thirty-one years of providing health care, only two patient encounters have made my heart skip beats, caused my hands to get sweaty, and left my mouth feeling as though I had been in the desert for a full day without water.
In 1978, my first job as a newly licensed physician was providing primary care at a single-doctor clinic in Mammoth, Wyoming, just inside the northern border of Yellowstone National Park. I was a “single doctor” in two ways. First, I was the sole doctor at the clinic. Second, at the time, I was not married.
The work was exhilarating. Most of my patients were park visitors who came from all over this country and from the far corners of the rest of the world. Practicing medicine in a remote setting meant my head was often in a book. And as if learning on the go wasn’t enough of a challenge, I had several unusual duties that came with providing medical care in a national park—like accompanying the rangers on selected backcountry rescues when they thought having a doctor along might be beneficial.
On this particular afternoon late in August 1978, I assisted the rangers on just such a rescue. I was away from the clinic for about two and a half hours. During my absence, a sick thirty-year-old came to the clinic looking for medical care. My front office clerk, Amy, explained the unusual situation: “I’m sorry, Dr. Winn is on a backcountry rescue and we don’t know when he’ll be back. There is another walk-in clinic at Yellowstone Lake. If you don’t want to wait, you should go there.”
“How far away is Yellowstone Lake?” the patient’s accompanying friend, Patricia, inquired.
Amy replied, “With the normal summer traffic, oh, an hour and a half to two hours.”
Patricia conferred with her sick friend who, I was later told, was already a little green around the edges and not too excited about getting back into a moving vehicle. “Let’s wait a bit and hope,” she told Amy.
Mobile phones were still a figment of some technologist’s fervent imagination back then, but I did have access to a ranger radio. Right after the clinic patient decided to wait for my return, I radioed the ranger dispatcher to report we were fifteen minutes out and would be met by an ambulance to transport the backcountry patient to the nearest hospital, located two hours away in Bozeman, Montana. The dispatcher called Amy, who alerted the patient she had made the right decision.
When I arrived back at the clinic, transferred the wilderness patient with the broken leg to the ambulance, and went into the room to see my waiting patient, I was instantly captivated. My heart fluttered and my hands were moist. I had never experienced such a reaction before with a patient, or for that matter, a nonpatient. The woman sitting on the exam table had an inviting, gentle smile that paradoxically made me both nervous yet comfortable. Her pale-blue eyes seemed as vast as the sky. Her easy laugh, frequent despite her stomach discomfort, was infectious. And her inviting aura made my skin tingle and my mind wander. I shuffled through the encounter, talking as much about Yellowstone, her, and myself as I did about her medical complaint. The visit lasted over an hour, far more than the twenty minutes it should normally have taken for an examination.
After she left, my nurse asked if I was all right. My reply was simple. “I think I’m in love.” I had rarely ever used those words. My nurse was speechless. So she brought me an aspirin.
(I thought I was the only one awake at this hour, but I just got tapped on the shoulder by Nancy’s nurse’s aide, who brought me volumes of paperwork to read and sign. I’d better go. I’ll explain later why I am sharing my wandering thoughts from the middle of the night when sleep is so foreign.)
Fondly,
Winnie
A Life Turned U
pside Down
May 31, 4:26 a.m.
Dear Family and Friends,
After my first communication, many of you attempted to call. I apologize for not answering, but I purposely turned off my mobile phone because I remain a wreck, unable to finish a sentence without a box of Kleenex.
Numerous times over the years, I’ve heard the statement, “My life was turned upside down.” I now empathize, fully understanding those words. In the blink of an eye, every facet of my existence has changed. I am trying to sort out what to do with my kids, my medical practice, and most importantly, my beloved wife.
As a doctor, I am searching for a solution where there may be none. As Nancy’s husband, I want to share her pain and suffering or lie in her place. I have felt helpless, if not hopeless. But finally, I realized there was something I could do. As Nancy’s best friend, I can connect her to her wide array of supporters. In the last few hours, I’ve formulated a plan.
Since talking is difficult for me, I will do my best to keep you updated with periodic messages. My letters may be interrupted, as the last one was when the nurse’s aide arrived in Nancy’s room. They may be disjointed due to the tiredness of my mind and body. More likely than not, they may be written in the middle of the night. There may be several in one day or none for several days. But I pledge to keep you connected to Nancy as best I can.
That said, there are a few more thoughts:
1. Feel free to ask me questions. None are too stupid. As a doctor, I will try to explain what is going on medically. For those of you with lots of medical knowledge, I apologize in advance if I oversimplify. For those of you to whom I don’t explain well enough, just ask me again.
2. When I write, I will try to present a short italicized summary at the end of each note. Please feel free to skip to my “summation” if you are in a hurry. Though I may include a story from the past (as with my last letter) or describe current events at the time I am experiencing them, reading my sometimes-random reflections is in no way required or expected.
3. My last request I will only say a single time. And I will put it in CAPS because it is so important to me. If you only want the brief overview, then only read the italicized summary.
HOWEVER, IF YOU WANT TO OPT OUT OF MY UPDATES, FEEL FREE TO RESPOND WITH “TAKE ME OFF THE LIST.” I UNDERSTAND COMPLETELY IF YOU DON’T WANT TO READ MY CONTEMPLATIONS. YOU WON’T HURT MY FEELINGS IF YOU OPT OUT. WE WILL ALWAYS BE FRIENDS.
My very best,
Winnie
Crazy in Love
May 31, 6:08 a.m.
Dear Family and Friends,
Though my legs ache with tiredness and my face has the numb and tingly feeling I often experience just before drifting off to sleep, ten minutes of no movement in my hospital chair does not turn my mind’s lights out. After a little ice-cold water from the hallway water fountain awakens first my lips and thereafter my brain, I have decided to finish the story about the second time a patient elicited strong emotional feelings.
The second time is right now. The patient is the one who lies beside me, fighting for her life. Now more than ever, I realize the depth of my feelings for Nancy. Even after twenty-seven years, looking at her in the early morning light makes me excited and completely (and fully) alive. I can hardly wait for her eyes to open so I can hold her hand and place a kiss on her lips. It feels just as it did when we had our very first date.
If you hadn’t already guessed, our first date was the night after Nancy’s visit to the clinic in Yellowstone National Park when she and her friend, Patricia, decided to see if I would return promptly from my backcountry rescue mission. It now seems like fate that she waited rather than going elsewhere. If she had left the clinic, our paths would have never crossed.
After a long-distance romance that brought us together a mere twelve days over the next six months (because she lived far away in the city of Boston), Nancy and I got married. My friends thought I was crazy. (They were right. I was crazy about my gentle soul mate. And I still am.)
Summary: Nancy’s illness has certainly led to a reaffirmation of my feelings for her. My love for Nancy is unwavering, as is my resolve to help her triumph in this battle.
Thanks,
Winnie
A Rock in the Face of a Storm
June 1, 11:13 a.m.
Dear Family and Friends,
A lot has happened in the past day. Nancy has received multiple transfusions—red blood cells to correct her anemia, platelets that contain the clotting factors to help stop the nosebleeds and bruising, and fresh frozen plasma that contains the blood products she was sorely missing. In addition, she received several liters of IV fluid because she was so dehydrated. At least temporarily, Nancy is feeling considerably better. The doctors and nurses simply shake their heads in disbelief when Nancy tells them, “Yes, I did work the whole day before my admission,” and “Yes, I drove myself from the airport to the emergency room when I was finished working.”
As I write, Nancy is peacefully snoozing in a cozy hospital bed. Sitting in a brown fake-leather hospital chair next to her, I am stroking the back of a delicate hand while avoiding the attached IV for the antibiotics and medicines she is receiving. Nancy has a clear plastic tube attached to her nose to administer oxygen, and there are wires extending from her chest, legs, and arms to three different monitors checking many of her bodily functions. Intermittently, one of the monitors will make a loud, irritating beeping sound indicating that Nancy is not breathing fast enough or that her heart has missed a beat. Each time one of the alarms sounds, my heart skips several beats even though I know that the alerts rarely reflect a serious problem. Nancy does not awaken for the alarms.
It is so different for me to be holding a patient’s hand to give comfort rather than to feel a pulse, inspect a rash, or examine some form of irregularity. I try to ignore the monitors, the bedside chart numbers, and the conversations between the many nurses, lab technicians, X-ray specialists, and doctors who constantly enter our room unannounced to check on Nancy’s status. My forehead sweats and I swallow my words so that I don’t offer an observation or give advice. When one of Nancy’s nurses asked the respiratory therapist a question this morning, I almost raised my hand like a middle school student. I am clearly out of my element.
Critically, sitting in this room is not about me. I focus on Nancy and not only stroke the back of her hand but hold it lightly between both of mine. I am pleased that her hand is no longer hot to my touch. For much of the day yesterday, I ran cold water over my own hands before holding Nancy’s. She smiled once between naps and said, “You really feel good, Winnie.” Despite her eyes closing before I could reply, those were the best words I heard the entire day.
I silently wonder as I watch her sleep, “What are you thinking, Nancy?” Though she looks peaceful, I worry about the fevers, the subsequent body aches, and the weakness she must feel. I lament, “What is it like to know you are facing terrible, terrible odds?” When I adjust Nancy’s head on the pillow in hope of making her more comfortable, she often doesn’t even awaken. A singular question lingers in my mind: “What more can I do?” It echoes time and time again. I am panicking.
But you know my Nancy well. There is a wisp of a smile on her lips, her face is serene, and her forehead is smooth. She is a rock in the face of our storm. Before drifting off today, she tapped my shoulder to motion me closer and then whispered as if telling me a secret, “Winnie, I’m worried about you. You need to eat something. You need fresh air. I’ll be all right for the half hour it would take to leave the hospital. Didn’t you notice? There are others who can watch over me. Isn’t that why we’re paying all these hospital workers who keep interrupting my TV shows?”
That’s my Nancy. Only she could incite my first laugh in over two days.
Summary: The resident doctors just walked in the room. I will write more and summarize later today.
Hurriedly yours,
Winnie
The Importance of Kind Thoughts
June 1, 9:29 p.m.
Dear Family and Friends,
After reviewing what I sent you last time, I realize I did a horrible job. A recap is in order, especially since many of you have asked if it is appropriate to forward my correspondence to others—which it is. My “Friends and Family” recipient list is multiplying rapidly due to your efforts. Thanks for letting me know of others who have an interest in our journey. Also, thank you for the many kind thoughts you have sent to us. I read each message to Nancy, though only when she is asleep.
Why when she is asleep, you might wonder?
Two reasons.
First, Nancy’s body is working so hard to fight the leukemia that she naps just about all the time. She falls asleep in the middle of our conversations, and she has not stayed awake for an entire TV show even if it is only a half hour in length.
Second, and more importantly, Nancy has never liked being the focus of attention. She doesn’t quite approve yet of me writing you because she has difficulty with fuss from others. When she finally comes around, I will reread each and every one of your kind thoughts during an alert period. Like me, she will be overwhelmed. And she greatly appreciates your notes and prayers.
So, the recap:
As many of you are aware, about two months ago Nancy ended her furlough from American Airlines and returned to work as a flight attendant for ASA (Atlantic Southeast Airlines), a Delta Airlines affiliate. ASA has a Salt Lake City flight attendant base. For the first time in thirty-three years, Nancy didn’t have to commute for her job to another city like she did with TWA before it was absorbed by American.
On day one of the three-day trip she was working before her hospitalization, she developed a nosebleed that started and then stopped spontaneously. However, on day two she experienced another bloody nose that didn’t stop as easily. By day three of the trip, she had developed a rash, bruising, and a high fever. She went directly to the hospital from the airport when she arrived home two nights ago. She was feeling so sick that when she arrived at the emergency room, she left her car at the entrance because she didn’t possess the strength to park and walk back from the lot.
Night Reflections Page 3