Hello, Darlin'

"Hello, Darlin'

Nice to see you.

It's been a long, long time..."

As Conway Twitty's voice rang out from the patient's buzzing cell phone, the very focused intern began inserting a catheter through the abdominal wall where it would drain almost 4 liters of fluid from Mr. X's very distended abdomen.

Just as the catheter tip was reaching our fluid filled money spot, I thought about all the other times that song may have been the soundtrack to moments in this patient's life. Driving a date to the movies. Playing to an empty house after his kids went off to college. Serenading him now when he goes to his favorite local diner for pie. And then I thought about this moment. The one we all found ourselves starring in. The setting: a quiet ICU. The supporting characters: a seasoned attending, a couple of nervous interns, and one third year medical student, trying desperately not to contaminate my sterile gloves. The leading role: a man in his early seventies, currently grappling with the harsh reality of decompensated heart failure.

I originally began this post during my last week of internal medicine. And while there were moments that I absolutely loved working on the floor, there were also many that left me disillusioned. There have been stories that I've wanted to share on this blog, but ultimately chose not to. Mostly because I felt that my writing was inadequate. But also because coming home after ten-plus hours surrounded by sickness, the last thing I wanted to do was write about it.

A lot of those posts, like this one, would start off with a person, their story eventually interrupted rudely by an illness. And that's where it would stop. Because as much as I tried I couldn't find a nice way to wrap it up. A final point or "Scrubs-like" realization to conclude those posts would elude me. It just wasn't there. And I guess that's what made those moments in the hospital, like the one above, so heavy. Those moments remained absent in my writing because they did not exist in real life. Sickness is cruel like that. It so rarely provides the luxury of a satisfactory conclusion.

It is the singular commonality I've found in all the really sick patients I've seen. That no matter how many pack years they've smoked, how severe their coronary artery disease is, or how much their cancer has metastasized, no one ever imagines the hospital is how or where they will end. And when they do find themselves in those moments, faced with the end of it all, it just doesn't seem to fit. Kind of like Conway Twitty in the ICU.

"Thank you, darlin'

May God bless you

And may each step you take

Bring you closer

To the things you seem to find."