I swipe my badge and enter the emergency department. As the door swings inward I am met with the typical scene of ER chaos. Patients line the hallways. Emergency medics speed past pushing an immobilized patient on a stretcher. Nurses rush from one curtained room to the next. I head towards a cluster of physicians standing by a private room. The group parts as I arrive, I am the ICU attending and I am the doctor they are waiting for.
The intern steps forward and quickly gives report. I am here to see a critically ill man with a history of metastatic colon cancer. My heart sinks. This will be a difficult case. This is cancer in the ICU. The young doctor tells me this cancer patient has recently received chemotherapy and is having severe side affects. He is in kidney failure and his electrolytes are severely abnormal. This is what brings him to the ICU. My intern further explains the patient has developed a bowel obstruction and needs to be seen by the surgical team immediately. I nod as the team follows me into the room.
At a glance I can tell my patient is ill. He holds his swollen abdomen as he grimaces with pain. The ER nurse has already placed a tube through his nose into his stomach which is now draining a foul black liquid, most likely bile mixed with partially digested blood. As uncomfortable as the tube is he admits he is feeling a little better now that the nausea-inducing stomach contents are being suctioned out of his belly.
To my relief, I see his vitals are stable. His abnormal electrolytes have not caused any heart rhythm abnormalities. The patient tells me the surgery team has already seen him and does not think he needs surgery at this time.
I start with a simple question. “How are you doing?”
He tells me a story I have heard many times before. He was diagnosed with early stage colon cancer several years ago. After a surgical resection of the tumor, he was deemed cancer free. Just months ago the cancer came back and metastasized to his lungs and bone. His current chemotherapy regimen is considered “palliative” and is meant only to slow progression not cure his cancer. The scarring from his previous surgery has worsened and blocked his bowels leading to the obstruction. His chemo has made his kidneys fail.
I recognize he is stuck in medical quicksand. One problem leads to the next leads to the next. Now he will be joining me in the ICU.
I listen attentively and nod as he describes the recent changes in his body. As he holds his aching belly he tells me his quality of life is “non existent” and “1 out of 10 at best”. He tells me he is frustrated and feeling discouraged. He tells me his chemo side affects are so bad he can barely tolerate them and he is ready to stop his treatments entirely.
“I can handle the nausea, vomiting, and weight loss,” he exclaims, “But the cold intolerance is the worst part of it all!” He then explains that since starting chemotherapy he can no longer tolerate touching anything even mildly cold without sharp jolts of pain and electric tingling. Tears come to his eyes as he describes his loss. He can now only drink warm liquids….warm water, warm milk, warm soda. We cringe together at the thought. He used to love cold milk, he tells me. It was one of his small pleasures.
“I even have to wear gloves to open my refrigerator!” he states with disgust. “Imagine that?! Thick winter gloves. And once I get something out of the fridge, it has to sit on the counter for an hour until it is warm before I can eat or drink it and the chemo has destroyed my tastebuds so everything tastes terrible!”
My nose crinkles as I imagine warm soda and warm milk. It is no wonder he is losing weight. I notice my team is becoming inpatient. They shift their weight anxious to wrap up and move to the next room. I know this man needs to tell his story and I will listen until he is through.
I am horrified as he tells me how recently while shopping at the grocery store he reached for a head of broccoli and because the broccoli was slightly chilled in the display case the moment he touched it he developed sharp and electric pain that continued for a full 15 minutes afterwards.
I am careful to control my facial expressions but inside my heart is aching. I can feel his demoralization. His suffering is my own. The thought of his daily agony is hard to bear.
I wish I could spend the afternoon at his bedside telling him it will be ok. I wish I could hug him and tell him I am also a survivor and understand shades of what he is going through. I wish I could be his friend and emotional support…but today I am not his friend, I am his doctor. Today it is my job to save his life.
I squeeze his hand and assure him I will be with him every step of the way. I tell him I am so sorry he has gone through such horrible experiences. I do my best to ease his mind. I show him empathy and kindness. And then I must fix his failing body. This is all I can do.
After I leave the emergency room his story stays with me.
I think of him on my drive home. And then I cry for him. Hot tears run down my face. I cry for his suffering. I cry for how unfair life can be. I cry because his story reminds me of my own. His desperation for a glass of cold milk reminds me of how desperately I wanted a shower in the weeks after my mastectomy. I cry for his losses and for mine.
I only allow myself several minutes of tears. Soon I wipe my eyes and say a prayer for him. “Dear God, please ease his suffering. Please send him peace. Please help me to be a good doctor.” And then I put back on my mask of invincibility and pretend to the world that nothing is wrong.
No one would suspect that this superhuman-appearing critical care doctor cried over a glass of warm milk. My team doesn’t know I’ve recently fought cancer. That’s one of the great ironies of life. We really never know what someone else is going through until we take the time to listen.
Today I took the time to listen. For a few minutes I hope he didn’t feel so alone. Sometimes just knowing someone cares enough to listen is enough to make a difference in your day. I certainly hope I was able to ease his suffering if only for a little while.
