WhiteCoat

I Love You Too, Honey

Through the waiting room monitor we saw a man pushing a woman in a wheelchair up to the registration window. We recognized the woman as someone who frequently comes to the emergency department for treatment of her chronic back pain. She also chooses to sit in a wheelchair and be carted around rather than expending the calories necessary to mobilize her protuberant derriere. Don’t be fooled. She gets out of the chair and onto the bed just fine.

This time, though, it was the husband who registered to be evaluated. He has had pain in his upper back for a couple of months and he finally decided to get it checked out. He hasn’t seen a physician in a “coon’s age” and smokes like a chimney. Yes he has had a cough. No he hasn’t had any injury to his back. Other symptoms? Well now that you mention it, he did started getting migraine headaches a few months ago but they seemed to get better with Motrin, so he didn’t pay too much attention to them.

lung-cancer-on-ctHis right lung sounded like crap, so we got an x-ray.
The x-ray looked like crap, so we got a chest CT. I added a head CT just on a hunch due to his headaches.
The CT scan of his chest showed a large tumor in the middle of his right lung.
His head CT showed multiple brain metastases.
Metastatic lung cancer has a generally poor prognosis. This will most likely be his last Christmas.

One of the toughest parts of being a doctor is telling someone that they have a serious illness. It’s like you can see the life force just drain out of people sometimes. Not a look that is easy to describe or that you’d ever want to see. Imagine walking into a hospital thinking you’re healthy – maybe you have a back strain – and having a doctor walk into the room and tell you have cancer. Like being hit with a brick.

I didn’t have the heart to tell him that he had metastatic disease. How do you walk up to someone you’ve never met before and hand them a death sentence?

Both the patient and his wife didn’t believe me at first. “Whaaat?!?!” they both chimed when I said that the chest x-ray looked like it could be cancer. I showed them a printout of the x-ray. The patient sat there with a blank look on his face. I can’t even begin to imagine what was running through his mind. Fear? Family? Kids? Death?

I tried to offer a glimmer of hope. “If it is cancer, there are a lot of ways to treat it. For right now, we just have to confirm whether it is or it isn’t and then work on getting you better.”

His wife furled her brow and crossed her arms. Then she let loose on him.

“I’ve been telling you to get this checked for months! Did you listen to me? NO! Now you’re going to check out and no one is going to be there to take care of ME!”

Maybe that was just her way of dealing with bad news. Still a wrong answer. I really felt like grabbing the wheelchair and dumping her onto the ground. Maybe a few good stomps on her back to show her how she just made her husband feel.

Tears started to well up in her husband’s eyes. That made me even more angry. I patted him on the shoulder, told him not to worry – we would take good care of him. Then I walked out of the room before I did or said something I would later regret.

After the patient was discharged, I watched the patient push his wife out through the lobby and out the front door – just as slowly as they walked in. The edges of crumpled discharge papers wiggled back and forth in his back pocket with each step he took.

Then I watched the tech crumple up the linens and toss them into the laundry bin. I’m betting a good portion of the patient’s life force went into the laundry bin along with those sheets.

His wife did as much to his spirit with those words as any gang banger could have done with a baseball bat.

I’m betting he won’t even make it to Thanksgiving.

18 Responses to “I Love You Too, Honey”

  1. Rogue Medic says:

    Selfishness can be amazing.

    I had a call for a suicide. Not necessarily the most selfish act.

    The dead guy, yes it was successful, had swallowed all of the pain medicine his mother had.

    2 days before.

    She is bed ridden. She has cancer. She was taking oxycontin. She has not had any oxycontin for 2 days and has not been able to get anyone to come help her for 2 days. No food. No medicine. No hygiene.

    For 2 days.

    What kind of person does that to someone they care about?

    Try getting an emergency refill of an oxycontin prescription on the weekend. I do not carry enough morphine or fentanyl to make a dent in her pain.

  2. igloodoc says:

    As one who has been in your shoes, I can say that a little more than your patient’s life force went in to the laundry bin. A small bit of yours went too. It is a demonstration of the extremes in the emergency department… the patient’s wife had no compassion, all selfishness and attacked. You, on the other hand, showed extreme compassion and selfless dedication to your patient, and said nothing because you knew he would have defended her, and upset him further.
    Your department will remember the selfish wife when she comes in the next time for chronic pain, without her husband. Few, if anybody, will remember what you did. From those of us who have been there… good job and thanks.

  3. Nurse K says:

    Ah, a good piece of writing.

    Soon, there will be a repeat ER visit or two for the husband and the wife will try to monopolize the conversation about her medical problems and, when he’s admitted, insist someone wheel her upstairs too. He’ll just be the little cachexic guy who sits silently dying in the bed while she jabbers on about herself.

  4. Chrys says:

    My mouth just dropped open while reading this. If I had been that guy, I think I would have turned and walked out of that ED, leaving her there in her wheel chair. She’s got wheels to get home.

  5. [...] May 27, 2009 did a little reading. i read this. then i read [...]

  6. SeaSpray says:

    This is so sad for so many reasons.

    Completely moronic, insensitive and selfish on her part.

    I’ll be devils advocate for a minute.

    We really do not know what goes on behind closed doors. He could be the lamb in the public’s eye but a stubborn tyrant at home.

    Of course her “me” comment was a dead give away and you have seen them over time. And it could be her defense mechanism… but I feel for the guy.

    Rogue Medic -THAT is one of the most cruel stories I have heard. Suicide can be considered a selfish act because of what it does to those left behind. But to do all that…beyond selfish!

    I have to think…they were not in a normal state of mind.

    WhiteCoat..you were terrific. I’m sorry these kinds of encounters have to take place.

  7. Liz says:

    That’s incredibly sad. I think you’re right in that he’ll pass on sooner rather than later.

    It’s why I really hope that there is something better waiting for us on the other side.

  8. when my father had a massive MI my mother who had a little problem with alcohol attempted suicide…2 parents in ICU. guess that’s why I’m a nurse high tolerance for inappropriate behavior.poor guy.

  9. Tex says:

    I wanted to comment, really I did…something about the poor man’s remaining time in this world…how maybe something beyond would be of comfort.

    But all I can see is his wife, in the coming years, arriving by ambulance with her chronic pain….
    and bitching about how if her husband had listened to her…..

  10. That’s so sad and horrifying at the same time. It ought to qualify as some sort of “official” abuse, covered by those Joint Commission screening questions.

    We have a friend who has survived four recurrences of an aggressive cancer. She is not privy to cutting edge drug trials or treatments, continues to work, and considers herself “no one special.” But, being a kind and compassionate woman, herself, she is supported by a loving nuclear family and an incredibly large and caring extended group of “family.” I think that support has made all the difference for her — and wish the husband in your story had such a resource.
    [I don't mean to say that surviving cancer depends on a person's character or extent of loving support -- no way. It is more that having someone, *anyone*, to help share the burdens creates a better quality of life.]

  11. Dr. Gwenn says:

    We put people under enormous stress in the ER and see people at their worst. What we have to remember is that we have no idea what lives they have lead outside the ER or what they are like when life is calm.

    Many people when faced with a terminal diagnosis in a loved one panic, especially if somewhat limited. Do we know anything about her medical history? Do we know anything about her financial situation? She may have good reason to panic. Not only is she losing the man she’s been with for a very, very long time but he may be leaving her in a bad situation. So, before we toss her under the bus, remember there is another side to this story.

    The man is the patient and we have to be compassionate for his situation. But, we have no way of knowing as ER docs if he’s a truly nice guy or has been a good provider or husband. All we can do is be compassionate to the entire family and not prejudge anyone’s reaction too harshly.

    I guess the question I would ask is this. If you found out your wife or husband had 2 months to life out of the blue, how would you react? My husband is my soul mate…I can tell you my reaction would be not so great, at best.

  12. Helena says:

    Very sad story but well written. The thought of that man will be with me today. Thank you for sharing.

  13. Well written…sad though, especially with that scary looking CT.

  14. Pattie, RN says:

    I have to disagree with Dr. Gwenn. People under stress react, IMHO, with who they really are!! Think of quiet, bookish men who become combat heroes, saving the lives of those around them. Think of motorists who risk their lives for a total stranger. Sadly, this poor gentleman made two horrid mistakes in his life–smoking and marrying this self-absorbed witch.

  15. steph rx says:

    Reminds me of a joke.

    Why do men die before women?

    Because they want to.

    Very sad, and sometimes true.

  16. Emmanuel says:

    Added to my RSS, Thanks!

  17. KJ says:

    You handled that well. Sad, thanks for sharing.

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