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| NOW
5 - Dinner
6 - Prepare CT Perf
7 - Prepare CT Perf
8 - Read CT articles
9 - Histology of Bone Lecture
10 - Call M and D and S
THANKSGIVING
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| Fraser’s pub, on the outskirts of the University of Michigan, has a lingering sense of history clinging to its dimly lit stone-wall interior. A college waitress, dressed in a tight white tee, hungry for a good tip, strikes up a conversation with Julius, while I, a politely dressed younger Asian man, sit in the corner. She’s leaning over the table, real close, elbows down and face perched on her hands, debating the crunchiness of Fraser’s fries with my volunteer. She didn't know that he’d tasted those greasy chips years before she was even born.
Julius has frequented Fraser’s over the twenty-plus years he’s spent in Ann Arbor, since graduating from the UofM in the early eighties, to the present as VP of sales for a microchip company in town. It is one of the few bulwark constants in his life remaining after he was diagnosed with leukemia six years ago. I can tell that he’s comfortable here.
“You see that bench over there? When one of the old QB’s were back in town, I’d see him with Bo. You know, Schembechler – having a beer on that bench on a big game weekend. Yep, this was one of his haunts.”
After we drank half a pitcher of beer and ate two huge burgers, we got down to business. The topic of the day was family.
He had met his first love when they were both very young, at a bar, not unlike Fraser’s. She was a coy and fun waitress, maybe a bit culturally flat, but they fell in love somehow, married, and had their only child, a son.
I could tell from Julius’ expression that this part of the story was difficult. He made little eye contact, but instead gazed at the UM memorabilia strung along the walls of the old pub, as if consoling himself that everything was alright because Fraser’s, at least, was still the same.
“She was never a great home maker, certainly not a caretaker. I raised our son almost entirely by myself. Every thing from packing lunch before school, to picking him up from soccer games. The only thing that I give credit to my ex-wife for was forcing me to see the doc, who diagnosed my leukemia. People often ask me why I’m so nice to her, why I didn’t fight for anything during the divorce. I usually tell them that, as much as she deserved it, how can you get mad at someone who saved your life?”
The restraint in his voice gave me the sense that Julius was sincere. His wife of twenty years had left him, and he missed her.
Julius had not yet told us much about his son, and I’d always assumed he didn’t have much of a relationship with him. I asked him for more details.
His son, as Julius put it, “has something just not right” about him. He graduated from high school as a quiet B/B- student, and went onto college but never finished his freshman year because of poor academics. He then worked odd jobs back home, and eventually faded from view. After the diagnosis and the divorce, he changed his cell phone number, and didn’t tell Julius where he was living or where he worked. It had been six months since they last met.
“I once wrote him an email asking him how he was, and then literally two months later he’d write back with one or two lines ‘I’m doing well. How are you?’ I’d then ask him why it took so long for him to reply, and he would say ‘What do you mean? It’s only been a week since you wrote me.’ His concept of time is off. There’s something just not right about him, something not right in his head. I don’t take it personally from my boy.”
If it were me, I’d say that the son was an ingrate for purposefully ignoring his father. Perhaps he was egged on by some depressive disorder, but nevertheless it was hurtful and of very poor taste. Julius' ex-wife would have received a similar judgment.
But Julius was exceedingly forgiving to his ex-wife and son. Outsiders like me might be able to assign blame, but it seemed that he would not. Instead, he seemed to only feel a little regret over how everything turned out.
They were two people who had been sources of happiness through most of his life, and he was their source of happiness for most of their lives. Unfortunately, they were driven apart by an unanticipated circumstance. If most of your life’s dreams had all of the sudden been cut short, its understandable to want to withdraw from people, because your high and perfect expectations are not going to be fulfilled. Julius understood this because he experienced it, and that’s my best guess of how he is still kind to his son and ex-wife even after they had left.
It was akin to feeling that the waitress felt when she mistakenly handed Julius the check at the end of the meal. He looked at her, then slid it over to me, an emissary of the American health system, to pay.
“I hope you accept Visa?” I asked the waitress.
“Yep.” she said curtly.
A different waitress came back with the receipt for me to sign. (I gave her a fair tip, 15%)
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| 11 - Brainstorm the days events (a practice in OCPD)
12 - (Overly Administrative) Meeting in DCDO
1 - Self Study, Radiology Lecture (temporary color blindness hour)
2 - Self Study, Anatomy of Foot (eyes are)
3 - Self Study, Anatomy of Foot (watering)
4 - Self Study, Histology Lecture (korean accent interpretation lesson)
5 - Dinner (yum)
6 - Something nice (from la)
7 - Something nice (corazon)
8 - Men's group (lacking urge to go)
9 - Men's group (all those married guys, and then there's me.)
10 - Call M and D (been a while)
11 - Call S (can't wait)
"Here we are now going to the south side..."
- Moby (washed up)
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| Mr and Mrs. H have been married 57 years and both are in their eighth decade of life. They lived an adventurous life, he traveling the world as an academic political scientist specializing in latin American culture, and she as a teacher. They lived in Spain, Mexico, Argentina, Maryland, New York, and finally Michigan.
Neither has any illusion about their current situation. As an introduction, Mr. H said “She is doing well, it’s my body that’s falling apart right now.”
Three strokes had left him paralyzed in his left side, a diagnosis of aortic stenosis, heart rate in the low 40 beats per minute, and chronic knee pain, Mr. H is near the end of life. He seems to have come to a calm acceptance of this fact. He mentioned during the interview that they were considering placing a pacemaker, but “we decided against it. I’m not sure my heart is going to be beating for much longer.” Mrs. H nodded in quiet consent. She has relatively few health concerns. Sometimes she has issues with bladder control after her thyroid was removed, she has a prosthetic hip which is working wonderfully, and a bit of arthritis like most women her age.
Mrs. H has taken the role of caretaker because Mr. H can no longer walk. I surmise that she is likely going to outlive him for a number of years because of her remarkably good health.
It was hard for me to comprehend how resigned she was to his encroaching death. Would she not fight for his health, just a few years more, to see out their 60th anniversary?
Her quiet acceptance of his condition mirrored the ideal that I think all physicians should strive for. The asymmetry of health, between the unwell patient and well physician does not necessarily mean that the physician should push the patient to follow every possible scenic detour to delay arriving at their final destination. Mrs. H loved Mr. J dearly, more than any physician or anyone else in the world could ever, and she could let him progress. So could I, if that is what my future patients ask of me.
Mrs. H showed us the door as Mr. H remained sitting in the chair. It was a hard image to cope with to see him there while the rest of us stood up to leave, but I know even harder for Mrs. H. | | |
| I was sitting in the room with the patient, a pleasant middle aged man, slightly overweight, with a case of multiple myeloma.
Dr. M was very professional, but not any more. She introduced herself briskly to me and the patient, then stood in the corner of the room and wrestled with paperwork. Without looking up, she asked the patient a few questions, and made small talk about the Tigers game. Then, after a quick physical exam, she left the room as painlessly as she entered.
The patient too looked inert. He sat on the examination chair and never left it throughout the visit. He raised his arms when he was told to do so, so she could check his lymph nodes. Then he asked about the result of the PET scan, which she promptly supplied.
Dr. M’s deflated approach to the visit was unsettling for me. It rattled my expectations of how a physician would interact with their terminally ill patient. Perhaps she was tired. I had come in the late afternoon, and it was the middle of the week.
I thought to myself how if I were the physician, I would have aimed for something more, aimed for one moment of intense empathy that would leave both me and the patient glowing with trust after our encounter.
On the way to the door leaving the room, Dr. M added a word of explanation to me. “We’re very social with J. It’s been six years, one stem cell transplant, and two rounds of chemo.” The patient looked at me and nodded solemnly to agree. I began to understand a little better the doctor-patient relationship that was there, floating just an inch above my comprehension.
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