Punched in the face

The last time I had been punched in the face I was 13 years old. I don’t remember the fight, only the humiliation and the hematoma I had to explain to my parents the next morning. So 15 years later, standing in a dank stairwell of the Veterans Affairs hospital, Hines, IL, with one ear listening for the footsteps of security and one eye watching the loose end of an IV flailing from the wiry arm of Mr. M, fist clenched and cocked toward me, I was less than optimistic about what was about to happen. Eventually, and to the dismay of the nursing staff, Mr. M was dissuaded from punching me or escaping the surgical intensive care unit.
Everyone remembers difficult patients. They stick in a physician’s memory like scars or chinks in the armor of years of professionalism and objectivity that we wear every day. Mr. M was a difficult patient, but perhaps not my most significant one.

A reminder of my father

Mine was my father. I should say that he wasn’t my father, but he reminded me of him. My father underwent esophagectomy for cancer when I was a student. I vividly remember checking on him before checking in on my assigned patients.

Dr. K was that patient—a popular, respected rheumatologist at a neighboring hospital. So when he underwent surgery for cancer, we knew he’d be well cared for and have a prompt recovery. Of course, he didn’t. His condition took every possible turn for the worse. He suffered one complication after another and languished for weeks. His family relentlessly sat vigil and his wife hovered at his bed, constantly looking to him and to us for evidence of recovery. But it wasn’t her I couldn’t talk to; it was him. For all my attempts at detached objectivity, I could barely bring myself to set foot in his room. Being confronted by him was like being confronted by the mortality of my father, and it reduced me to a helpless child.

Like my father, he was a physician. He was intelligent and experienced. He knew his prognosis worsened with each setback. I saw this realization in his eyes. I saw how he kept it from his wife and children. I saw my father in this strength, in the will it took to put everyone else first despite his pain. But I also saw that behind this façade was a real person. And he was a real person suffering with the physical pain of incisions and tubes, along with the psychological pain of boredom, hopelessness, and the isolating knowledge of a death to which he was not yet resigned.

In the ensuing weeks, we kept to our routines, and maybe that was what ultimately allowed us, physician and patient, to persist. Dr. K got better, grew strong enough for rehab, and left the hospital. I never saw him again but heard that he retired from practice.

Reflecting back, I regret my failure to care for him to my best capability. I didn’t know how to untangle the patient from the emotions and memory he conjured.

I still don’t.

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