He was 52, married, with a lovely wife and three children, a girl and two boys, and was, as liver patients go, a deeper, creamier, richer looking yellow than any patient I had seen in a long time. He was also dead, a fact which I did not have to go all the way up to the sixth floor to tell them, the family. They had been with him night and day throughout his hospitalization. They had all been there when he took his last breath.
The problem I was having with the man was he was three years younger than me. It was nothing new, pronouncing the death of someone younger, but his condition seemed to create a unique new awareness in the back of my mind for the first time. I have seen all kinds of patients die, kids, young people, very old folks who "have lived a long, fulfilled life" and not ever thought much about any of them. But this guy was different.
The questions kept coming and I couldn't answer them. Was it the way he looked: healthy, firm, younger than me, in good physical shape, like a fun guy, with an interesting face carrying a permanent smile, even in death, well-proportioned in this day and age of fat, sloppy, overweight and out of shape people for whom all of life was a spectator sport.
Was it just his age? Was it the injustice of the disease that had started in his colon with a small, cancerous polyp, spread to the lymph nodes and then into his pancreas and liver and stopped the vital functions of digestion and protein synthesis and bile excretion (and a thousand other things the liver does) from continuing to function properly? He certainly looked intelligent enough to have done all of the right things about a serious problem like colon cancer, especially if he had known it was growing inside his body and getting ready to kill him just as surely as terrorists mow down innocent folks in middle eastern airports. I mean, the cancer didn't "know" him any more than a Palestinian terrorist on a shooting spree knows a Canadian tourist as they both walk through the Rome airport, one looking for a vacation, the other looking for a victim.
Yes. Maybe it was the innocence combined with his lack of awareness and ability to have taken preventive or curative measures that disturbed me so. He never had a chance. It was like choosing the wrong summer to take a trip to see the Vatican, or the wrong night to be in the German cafe where the bomb went off and killed two US servicemen who had just gone in for one last beer to end the night.
That, however, didn't seem to be the whole answer to why he kept drifting back into my consciousness for weeks on end — weeks after I had walked into the room, checked his pulse, noted he wasn't breathing and said "I'm sorry, he's gone" to the family. I looked right into his wife's eyes when I said it. I was on the side of the bed nearest the door and she was sitting on the opposite side, holding his cold, yellow hand and gently stroking it as if to say "everything will be all right very soon."
It was worse than looking into the urban chasms surrounding the observation deck of the Empire State building. It was stomach-churning, sick, like the empty feeling of stark terror you get when you are looking in to a dark room wondering what made the floor creak, who is lurking there, what is going to happen to you, who is going to hurt you and how bad is it going to feel, how alone you will feel when you are in the dark being beaten up and unable to fight back. Even if you don't walk into the room because your fear the dark and the pain, the mugger will snatch you by the arm or the coat or whatever is lose, drag you into the pitch black and cause you deep, acute, sharp, screaming agony that will follow you for the rest of your life. It will be such a deep hurt your life will never be the same. You will never pass a darkened room without feeling a surge of devastating panic. You will be fearful from that moment on because you are now aware you don't know what will happen next, ever, to you or to the loved ones you depend on and want to share your life with.
I knew a psychiatrist in Kansas City named Vic who taught me the secret of psychiatric diagnosis, the complexities, the intertwined and complicated methods of how to put a psychiatric label on a patient . . . how to do it quickly and accurately. Vic said the way to do it is to get in the room with the patient, clear your mind of all thoughts, ask the patient to start talking . . . Just talking about anything . . . and "listen with your eyes closed to how the patient makes you feel." You "ignore the words and listen to the music." If he talks and you feel angry, he is hostile. If you feel wild and agitated, he is manic. If you feel down in the dumps, he is depressed. If you feel crazy and confused and like things are unreal, he is schizophrenic.
I thought of Vic at the very moment I looked into the eyes of Pumpkin's wife. I felt such fear a mental block was raised immediately. Now, I thought of Vic again, as terror flooded my brain a second time, I realized what had been going on each day since Pumpkin died. I hadn't been worried he was three years younger than me, or that I could be harboring some sneaky damn disease that was creeping up behind me like his colon cancer did to him. What I had been feeling was his wife's total emptiness, despair and monumental loss of a 30-year companion and best friend. My own anguish was compounded by a wave of nausea when I thought back to the moment when I babbled "I'm sorry, he's gone," comparing those powerless words to the profound depth and breadth of the pain caused by this breach in her life.
I vaguely remembered the void in the eyes of Pumpkin's children. I swept across their gaze as I turned to leave the room. The suffering was almost overwhelming as I realized how correct Vic had been . . even more correct than he could have known . . . more than Just a single patient, you can diagnose a whole room full of agony in one quick glance across the faces of a group.
Pumpkin was still alive in their minds, which made the loss much more acute . . . the pain was nearly killing them, too. What Vic didn't tell me was how deeply I might feel the patient's pain that I was trying to diagnose. What he didn't KNOW to tell me was I would feel the pain of all four people into whose eyes I stared that night. Maybe it was a good thing he didn't tell me . . . or did he keep it from me by design? If I had known before hand, I might not have gone into the room at all.
At the time I didn't know why this common on-call episode had been so different from all the rest. All I knew was it was hard to sit still and write the last note in the chart . . . the one where you have to say "Expired at ..." and then write down the time. I scribbled it as fast as possible, walked quickly to the elevator, rode back to the second floor, went straight to the call room and threw up.
Now I know the answer: I looked at death and didn't even flinch; I looked at life and felt what wives and daughters, sons and husbands feel when someone dies.
If I don't quit looking in their eyes from now on, I'll have to give up medicine.
