thanksgiving in the hospital

I finished working at the VA hospital a few weeks ago, and started at the Yale hospital for my second month of medicine. I told my 90 yo patient in the hospice unit at the VA that I'd come by and see him every so often after I left the VA. The last few weeks have been so incredibly busy that I kept saying, tomorrow will be a better time. I finally went back today. He'd passed away.

This possibility had crossed my mind since I last saw him, but wasn't palpable; he hadn't been actively sick when I last saw him and people in hospice at the VA can have up to a six month prognosis. I'd envisioned visiting him for months. When someone else was in his room, I walked further down the hallway; maybe I'd remembered incorrectly. I walked slowly back and slowly found my way to the board with patient names and rooms, and slowly scanned it up and down for his name. I wasn't frantic like I might imagine I would be. Everything sunk slowly but not steadily, like steps down a ladder where you don't feel the space in between until you feel the suddenness of the next piece of metal. I walked around more trying to decide what to do, as if there were any options. I thought about looking him up in the computer to know for sure, but I couldn't remember the zillion passwords. Finally I asked the front desk, and they said, yes he passed awhile ago.

I wonder how it was, and most of all I wonder if he was sad near the end, whether he'd ever come to accept leaving life, a reality he was still mourning when I saw him last. I remember so much of what he said, not just because sometimes it was funny or sweet or touching but because always it was true. One night when I was on call and saw him, he was so surprised to have a visitor in the evening. He told me that it was late, someone would snatch me, and to be safe. Lying frail in bed the way he cared about my vulnerability took me home safe. Watching Jeopardy on television, he'd say he knows all the answers but "sometimes the game isn't there." Held up his fingers like he was sifting sand that wasn't there, and looked at me: see, nothing.

Needless to say I feel awful for not being able to say goodbye, for failing my promise. As students the one thing we have more than others is the time and the awareness for good intentions, and the one thing I feel I can offer is the drive to follow through with the intention to care. Yesterday someone reminded me that we can always find time for what's most important; it really is a matter of will. I'm sorry that I didn't have it in me, that I disappointed once more. Even as all these things give more reason to try harder, I sense that circumstances and fallibility align such that I'll disappoint again. One, try harder not to; two, figure out how to proceed once I have.

*
I spent Thanksgiving in the hospital this year, and while I complained about it and missed my family all the while, it was ultimately a source of gratitude. I admitted a patient with lung cancer that's spread all over; when I asked how he was feeling he started sobbing. Upon questions, he said he was worried about his family. Upon more questions, he kept repeating that he just had so much love for them. So much love, it can be hard.

Across the room from him is a patient our head physician is taking care of, I've gotten to know him since he's been here for awhile, and my doctor allowed me to be part of an end-of-life discussion with him. She says he's sweet, you can tell that life's been unfair to him. It sounds strange to call that sweet, but I know how she felt; I think she meant the hardship people carry that endears you to them. He has no car so his wife can't come visit him, and few resources, so that they couldn't find other transport. But on Thanksgiving his grandkids visited and they had a car, so his entire family came to see him. That was nice to see. It was also difficult. As this was the only time his family came, the doctors took the opportunity to speak with them about the same end-of-life issues that they'd discussed with the patient the day before. Like my hospice patient, this one hasn't let go yet, isn't ready to accept that his lungs, heart, kidneys are failing, when his thoughts and feelings are so clear and functional.

The Friday after Thanksgiving, I was on my way out of the hospital and I told him I'd miss him over the weekend. He said well then you should work over the weekend. I said I'll come by to see you. He said that's very nice but you won't. I laughed and said I would. I did, after I drove back from the VA after finding out about the hospice patient; a schedule and route I'd planned in my head this morning before I knew anything, and after I knew, I fought hard against using my guilt and obligation as motivation. And when I saw this patient who is not so well but still alive, and he said, maybe I'll see you tomorrow? -- there's no need for any other reason.