Finding my friend’s heart in the difficult patient

Months before I started medical school, my friend was involved in a major car crash. After six agonizing days on life support, his life-sustaining equipment was removed, and his body was sent on for organ donation. His memorial service was filled with poignant stories about this amazing individual’s contributions to society. He was a saint. At the closing of the memorial, it was announced that he saved five lives through organ donation, including providing a new heart for an extremely ill individual.

Five years later and nine months into residency, I was paged to clinic to evaluate an irate patient. Mr. F suffered from a chronic abdominal wound after a ventral hernia repair. Upon arrival at the clinic, the frustrated patient was fuming and complained that he had been waiting forever. After I made several failed attempts at diplomacy, Mr. F finally agreed to show me his abdomen. A bulge was present, and palpation sent fluctuant waves across its 2 inch diameter.

Mr. F insisted that this was an intra-abdominal process that required emergent surgery. I was unconvinced. Frustration was beginning to electrify my brain, and I could feel my blood pressure rising. The attending was supposed to have arrived by this point, and it was clear that my job had been to distract this patient until he was available. Mr. F had his agenda and boldly stated, “I don’t wait for doctors,” pushed me aside, slammed the door, and left.

New patient, old friend

By this point, I am fairly certain my face was red, my jugulars were about to burst, and steam was coming from my ears. I documented the encounter in the patient’s electronic health record and made certain to paraphrase his “kind” words. The attending found this encounter to be humorous, as he knew both the patient and me well. To punish my lack of sensitivity, Mr. F became my private patient.

Ultimately Mr. F’s seroma expanded, requiring opening and a wound vac. I had anticipated that our first round of wound vac placement was going to be as enjoyable as our first encounter. Mr. F’s impeccable timing pulled me out of the operating room. He complained that he had been going through hard times and that this abdominal wound perpetuated his misery. I irrationally thought, “Try being an intern. Life is not much better.” After the vac was set up Mr. F said, “Hey, thanks. See ya Friday.” It was a bittersweet victory. I had been given what seemed to be a compliment, but I also had to look forward to another visit.

Mr. F’s return visit was much more civil. He explained that he was a musician struggling financially but grateful for the heart he received five years ago. He explained that he met his donor’s parents and that this new heart gave him a better appreciation of life. I thought there was no way Mr. F could have my friend’s heart, but I had to ask. When he confirmed it was true, both of us were in awe.

This discovery precipitated a surreal conversation. It felt like I was talking with my friend. I left the clinic stupefied. I had vowed after my friend’s death to work to become the best physician possible. Now at the nadir of enthusiasm for my career, my friend the saint gently reminded me to not forget my promise.
In the end, life is not supposed to be easy, and of course, neither are all of our patients; but those of us who persevere will be rewarded, as will our patients.

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