Still Here Kid

by Haley Newman, SOM Class of 2017

Second Prize Winner 2016 Gerald F. Berlin Creative Writing Award

             Mr. M got sick about three months before I met him. He went to his primary care physician at the Veterans Association Hospital because he had noticed bright red blood in his urine. He was sent to Umass and the urologist discovered a large papillary tumor with pooling blood and several clots in the left kidney. They placed a catheter, a thin tube to drain the bladder, with continuous fluid running through it to prevent the clots from occluding the flow of urine. Mr. M remained attached to this irrigation—a pole and four large bags of saline constantly running through the catheter—for the next four weeks of his hospital stay.

Every morning I went in to check on him. He had wispy gray hair that went down to his neck in the back and a bald spot on the crown of his head. He wore big square bifocal glasses and his Vietnam Veterans of America hat was always sitting on his bedside table, along with a bags of Lays potato chips and a Snickers bar. His stomach was distended. He had one tattoo on his left triceps that said just his name: Tim. After the radiation treatments started, he also had bruises on his left abdomen where the beam made its entrance in attempt to ablate the cancer cells. On physical exam, some days he was more tender to palpation than others.

At first he never looked me in the eye when I asked how his night was, if he was in any pain, or if he needed anything that I could help with. But after a few days he turned the television on mute as soon as I walked in and he looked at me when he said, “They haven’t even brought up my breakfast yet,” or, “My pain is the same. I can handle it without more of those damn pills,” or, “Still here, Kid. Still here.”

I could tell he looked forward to our visits. I asked about his nephew who came to visit Mr. M with eight boxes of Chinese food. We talked about the weather. We talked about his pain. We talked about his frustration with being stuck in the hospital without a clear end in sight.

His clinical course was slow and complicated. On top of the tumor, he developed an acquired inhibitor of one of the body’s natural clotting factors. Essentially, this meant he was at a very high risk of bleeding, which precluded him from having surgery to remove the left kidney entirely—the mainstay of treatment. Instead, for the next three weeks he underwent daily radiation sessions and treatment with steroids and other immunologic and chemotherapy drugs. The goal was to suppress his immune system to decrease his body’s production of the clotting inhibitor so that he could have surgery without excessive bleeding. At the same time, this put him at increase risk for infection, which could also delay the surgery.

At times, he maintained a positive outlook. One day he was being wheeled back from radiation and as he passed by the oncology team he gave us all high-fives on his way down the hallway. Other days he was frustrated to be in the hospital and felt like he was completely in the dark with regard to the plan for his care. “What’s the deal here?” he said. “Who’s in charge of this damn show?”

Eventually, on the very last day of my month on service with the oncology team, he was discharged home. The plan was for outpatient visits for immunotherapy and a follow-up with urology to schedule the surgery.

He put on ripped jeans and a faded, light blue t-shirt, and his Veterans of America hat. “Get me the hell outa here,” he said, giving me the thumbs up.

Unfortunately, he wasn’t home for long. The inhibitor level increased again and his surgery was re-scheduled and cancelled twice. Because of the medications that were suppressing his immune system, he developed a severe form of pneumonia and he was hospitalized in the intensive care unit.

He also had underlying post-traumatic stress disorder, which was exacerbated by the long hospital course and severe infection. He became confused, disoriented, and combative with anyone who came in his room. I went to visit one morning and with his eyes closed he screamed, “Get out! Get out! Get out! Everyone get the hell out!”

I went back a few days later when I read in the chart that his mental status had improved with a high-potency antipsychotic medication. He said he was glad to see me. That was also when he told me the story of how at 17-years-old he witnessed his commander get shot, carried him commander off the battlefield and went back to lead the platoon. He also told me that while he was still in Vietnam, both of his parents were killed in a car accident and he had nowhere to go home to. After they died he stayed in the military for nine more years before coming back to America.

I believe he told me all this because that’s who Mr. M is: he is a strong, brave veteran of the Vietnam War who fought to protect his friends. Yes, he is a 69-year-old man with cancer. Yes, he is status-post 20 cycles of radiation therapy. Yes, he recently recovered from an episode of pneumocystis pneumonia and encephalopathy.

But that is just who he is in a hospital chart, just a small snapshot of his life in room 621.

Now when I picture his hospital room, by the oxygen tank and IV pole I also imagine combat boots and a bulletproof helmet, and I see a kind, generous man who bravely defended his country.

Regardless of everything dehumanizing in the hospital—the blue johnnies, the tubes and IV lines, the meals on trays and red help buttons—these individuals are not just patients. They are unique people with powerful stories, and their identities should not be erased by their illnesses.

Ultimately, it’s not only recognition and alleviation from suffering that we want from our doctors. We want respect for living the life we’ve had and what we are proud of. Instead of exacerbating the dehumanization of illness, doctors can help to prevent disease and the act of dying from usurping one’s personhood by learning more about our patients as people. Instead of talking only about suffering, we can be there to help reflect on who these individuals are outside the hospital, and in so doing offer the respect they deserve.