Each Day, Same Story
Editor's Note: Jennifer Reckrey is a family medicine resident in New York City. Each week, while she was an intern, she recorded some of her experiences as a brand-new doctor.
I have been his primary doctor for the entire three weeks he has been on the hospital floor. Sometimes he drives me crazy. Once or twice I've asked my senior resident to take over for a bit so I can hide out, catch my breath and try to get some of my other work done. Yet despite his daily demands and my hours of exasperation, I have never felt this connected to a patient before.
Over these weeks, I have watched his health slowly but steadily deteriorate. He first came to the hospital because his home oxygen wasn't helping as much as usual when he got short of breath while walking. A week later he needed his oxygen whenever he felt anxious. Now he's short of breath all the time. Without a face mask constantly pumping pure oxygen, his skin turns ashy purple and he slowly becomes agitated, then delirious.
When I got to work this Sunday morning, the night team told me that overnight he had refused to wear the oxygen mask for hours at a time. Now he was sleeping with the mask in place while an aide sat watch, but I knew it wouldn't last.
Then the call came. He was off oxygen and quickly slipping out of control: he had just thrown his breakfast tray at the aide.
Coming down the hallway, I could hear him screaming. From the door, I saw his arms flailing as he fought to pull himself out of bed. His eyes were wild, and though he looked right at me, there was no recognition. I inched closer, not sure what would happen if I got in his way, but afraid that he might throw himself onto the floor if I didn't stop him.
All at once he lunged towards me and grabbed my arms. He pulled me close, wrapped his arms around my waist, burrowed his head into my belly and began to sob. The embrace was hard and awkward: me standing, him teetering on the edge of the bed. I wanted to pull away, but his grip was too tight. Entwined with him like this, I suddenly felt overwhelmed. I wasn't a friend, but I didn't feel quite like a doctor either.
After a moment, I managed to grab his left hand and twist him away a bit. Though his right arm was still locked like a vise around my waist, his head now pressed against the bulge of papers in my lab coat pocket. I fumbled for his oxygen mask and eased it slowly onto his face. His gasps turned to breaths, and through the tears he began to speak, first in jumbled words, then more clearly.
"I saw her dead. And I saw you dead. What is happening? What happened? You were all dead. And I was dead, too."
With time and oxygen and deep breaths, his color returned a little. His eyes began to focus again, and the crowd that had gathered to help drifted back out of the room. He slowly let go of me and crumpled, muscle by muscle, back into his bed. Still frightened, he begged me not to leave him alone.
I knew that there was no reasoning with him. I had already tried. If logical explanations had been enough, he would have agreed to take the right medications weeks ago. He would have followed up with the right doctors years ago. And he wouldn't have neglected his health in the first place. But things were what they were. All I could tell him was that, yes, I would stay for a while.
I pulled a chair next to his bed and sat silently, knowing that this gloomy calm was a temporary one.
Staying is the easy part.
At that moment, it feels okay to have nothing to show--no tangible improvement--for the time I've invested in this patient. At that moment, we're simply stuck with one another for a little while longer.
At that moment, I let go of my need to see things get better--and realize that, most of the time, things just get different.
About the author:
Jennifer Reckrey is a second-year family medicine resident who graduated from SUNY Stony Brook School of Medicine. "I still remember this patient so vividly; the whole experience was (and still is) haunting. He was a young man with AIDS who lived and then died (about two weeks after I wrote this entry) in his own way, by his own rules--in a manner that was tragic, but at the same time admirable and honest."