End Notes
An Underestimation
A patient demonstrates the strength of the human spirit.
By Ben Willenbring
“What do you think she looks like?” Dr. Ko asked.
“I think she looks like she’s going to die,” I said, immediately feeling uncomfortable making such a cynical statement.
But she did. She was the textbook picture of cachetic, her face like a back-room anatomy skull papered over with flesh-colored tissue. And she looked so damn tired, barely able to answer when we asked about what happened before she ended up at the university hospital. Then there were the scary lab tests and the images she brought from an outside hospital: an elevated CA-125 and a radiology report that talked about “peritoneal carcinomatosis.” She had tears in her eyes as we poked and prodded at her belly swollen with fluid. The room seemed heavy with the bastard specter of cancer.
We came to her bedside every morning with new ideas about why and how she was dying. There was pancreatic cancer and ovarian cancer and hepatocellular carcinoma and peritoneal tuberculosis and disseminated histoplasmosis and anything else we could conjure up from our textbooks and years of education. She tried to be strong but couldn’t hide her frustration about not knowing. One morning several days into her stay, she was tired of it. “I want to go home,” she said. “I’ve been in a hospital 26 of the last 30 days of my life. I want to see my house and my dog.” She didn’t want to hear our plan for that day or our attempts to comfort her (and ourselves) with words like “tests” and “results” and “imaging.”
Answers finally came. Her boozing had brought on cirrhosis, and she was cursed with pancreas divisum and the resulting chronic pancreatitis with an infected pseudocyst. But just as answers came, so did new problems. She developed acute lung injury. Then she vomited. Then she had diarrhea. Yet through it all, she held on to her sense of humor, inquiring about the “vampires” who visited her every morning to steal her blood and teasing me about my inexperience as my slow, clumsy hands worked to drain her swollen belly.
I remember the first day I saw her up and out of bed, walking around the unit. She had her fiancé by the arm, and the physical therapist walked slowly at their side softly offering words of encouragement. I stopped to watch and felt a bit like Martha seeing her brother Lazarus amble out of his grave.
Then, suddenly, she was ready to go home. Everyone knew it would be hard, and she did too. We talked about not drinking and transplants, and she said her sister wanted to be her donor and that she was done with alcohol. She thanked me, and I tried to tell her how much of a pleasure it had been taking care of her.
I wish now I had thanked her for what she taught me—how I tend to underestimate the toughness of the human spirit. The next time I have a patient with that look of death, I’ll remember her and have hope. MM
Ben Willenbring is a third-year student at the University of Minnesota Medical School.