Heme Onc is tough.
I wrote this after my first week in heme onc. The sadness on the floor is so pervasive, but it’s admirable how many people try to bring joy and carry on the best they can. I had to write down something to deal with the many thoughts and experiences that heme onc had generated in my mind...
I do not know what broke my heart first. Was it the yellowed man sitting up in bed, a stack of books next to him, a fruit basket crammed on the table. Next to that rests a water bottle labeled BOTTLE 2 FINISH BY NOON. A slender women, presumably his wife, is sitting in a chair next to the window. The blinds are pulled open to reveal a vast gray sky, an even drape of clouds creates a monochrome ceiling outside the fluorescent lit room. The wife is taking notes, vigorously, in a spiral notebook. The hair along the edge of her scalp is greasy enough to curl and stick to her face. She has a cardigan tied around her shoulders, she is wearing matching jewelry, but her eyes are wild and the pen in her hand is shaking. He thought he had a stomach bug 2 weeks ago at their New Years party. But he has metastatic lung cancer, clumped onto his pancreas and liver and with a haloed spot in his brain. He never smoked a cigarette.
Perhaps it was the sweet woman with dark hair and a sharp appearance, waiting outside her husbands door. “We need a family meeting today.” She too is polished, hands folded across her chest, nails done and pants with creases. But her eyes flicker too fast, she shoulders are too high.Â
“Yes yes” says the attending with his bowed head and compassionate nod. “We will do that. Now let’s see the patient.”Â
We walk into a room and are greeted by a man in restraints, his face is contorted and he growls at us. But my eyes can’t leave his neck, glittering with rows and rows of staples over scabbed gashes. As we move closer, I see the deep cuts across his neck, his arms. We lift his gown to check his abdomen where a checkered pattern of lacerations is sprawling to each corner of his torso, dappled with sutures and staples, glimmering at us while he writhes and grunts at us. The doctor gently pats the man, tells him he is doing better. The cuts are healing, but he has no white blood cells. He is psychotic, he cannot speak. The kind wife nods graciously as we leave, we will see them this afternoon to talk.
Maybe it was the man in bed, his breathing heavy, his eyes closed. A tube comes from his nose and green juice pours out of it, liters each day. He has conformed to his bed, hasn’t gotten up in days. His arms look red and puffy today. Under his gown is a similar redness, hot to the touch. It’s a new rash. It’s called as cellulitis, he is started on more medication. A plump women with freshly curled short hair sits next to him. She is enthusiastic to see us, bubbling with news to share. Her husband really wants to go home, she can tell. He also made a droplet of urine, she saw it in the bag. He doesn’t like when the nurses roll and rotate him, but oh boy he likes it when the TV is on! Her eyes glimmer. We shake his shoulders gently, we call his name. He slits open his eyes and groans at us, it’s a high pitched sound, his mouth doesn’t move and his eyes close again. “Oh he’s just a riot!” She laughs at her husbands humor, then looks at us suddenly. “He wasn’t like this at home. He never complained. I think this got him.” And tears pour out of her eyes, her forehead wrinkles and she sobs. We hand her tissues. The kind doctor tells her that her presence is indeed felt by him. He tells her we all hope for the best, but this will be a long recovery. We walk to the next one.
Or maybe it was the family hopeful that their father was stepped down from the ICU. He was breathing on his own, he was moved into his new room. But then his heart began racing, the beats were irregular, and he started to breath so fast. “Call the family” the attending ordered. He gasped for breath and the gurgles from within his chest were so loud. We all had to wear yellow gowns and gloves and masks since he was positive for a respiratory virus. We try to hold his hands with our latex hands, stroke his shoulder, but he is panicked and could only breath with all his might, fluid seeping into his lungs. He tried to pull out his cannulas, his tubes, his IV. We soothe him while holding down his arms. His eyes glaze over. We all watched the monitors, the oxygen saturation just went down and down. The family came in. They sobbed and told him it’s okay to go, it’s alright to leave them behind. He was DNR, we gave him morphine and lots of oxygen and unplugged his tubes and cords. We ripped off our gowns and gloves and masks as we left the room to see the next one. Later that day he died.
That was Day One.
