Wednesday, December 27, 2000:
Reading (at home): The History of Korea.
So Sad: Dear Grace
....
WORSE THAN COAL
"I’d get my affairs in order if I were you," I finished telling Mr. Torch. (This was two days before Christmas.)
"Yeah, affairs. Right," he chuckled to himself.
Nothing makes you as sober as hearing you have only weeks to months to live.
It seems to me that when you know your life is running short, a person has two conflicting impulses. One is to take all you can out of this world before you lose the chance. And the second is to calmly accept your fate and be satisfied with your life.
Our team had surrounded his bed. The good news was that he could go home today. The bad news was that he had three masses in his brain and one in his lung. We came by to specifically tell him these "masses" were probably all cancer. He would get the final biopsy in a couple days as an outpatient.
Mr. Torch looked like an uncomical Christopher Lloyd, with an intensity around his eyes, and white hair that resembled flames coming off of his head.
"I don’t want to get to the point where I don’t know who I am anymore. Will the radiation do that to me?" he asked.
"It might."
NOT A CREATURE WAS STIRRING
(not even a neurosurgeon)He had gone through two biopsy attempts already, with no good results. No one wanted to put a needle in his brain (not even the neurosurgeon) unless all lung options were exhausted. It’s not as easy as it sounds. Today he could go home for Christmas and come back for a new approach in a couple days.
"Well … it’s been a real bummer," Mr. Torch said as we all said goodbye.
We shook his hand, and quietly left, with nothing really good to say.
... I’m sorry you’re going to die? ... Hope you enjoy your last Christmas? ... Bad luck, man ... Someone really wants to see you soon ....
He said it all already. A real bummer.
LESSON o' THE DAY
Outside in the hall, I thought I heard the intern laughing at something. She was usually upbeat and cheerful, and post-call at that. Residents are the most giddy and emotional after a sleepless night on call.
I turned to hear her echoes. She was barely keeping up with our team, and weeping loudly the entire way. Hiding her face with her arm.
We all had liked Mr. Torch. He always seemed serious and dignified.
It was so unfair. It always is.
I knew how she felt, and a fraction of it was welling up in my eyes. I turned around and continued our trek to the next patient, my team following my precedent.
The lesson of the day being : Keep walking, eventually you'll find someone you can actually help.
PROBLEM
Later that afternoon, the intern called me with a problem,
"The nurse says he can’t afford his medications, and the case worker said they can’t reach financial aid until next week because of the holiday. What are we going to do?"
Insurance problems. For a hospital-based doctor like myself, this was all beyond my realm of expertise or interest. We had people for this sort of thing, but they weren't here today.
"Jesus, where the hell were the case workers last week? … hmmm ... I’ll take care of it, thanks," I told my diligent intern.
"That much?"
I called the pharmacy to find out how much his prescriptions would cost for a month.
It wasn’t an exorbitant amount, more than a Dreamcast, but less than a Playstation2. More than I’d spend on a non-relative, but less than a blood relative.
I knew Amy would understand, but I wasn’t going to tell her until later just to be safe. I mean, is there a better time or a better case for charity? The guy had not one, but three brain tumors. The medication would keep him peeing and keep him sane for as long as medically possible.
Was this charity or mercy?
I wondered as I punched in the PIN code.
CHOOSE YOUR POISON
"So, where are you going to stay?" I asked Mr. Torch, now decked out in real clothes. All rumply, and all black, curiously.
"My wife’s place," he answered. He was separated and hadn’t spoken to her in a while. I wondered about the dynamics of that. Hi honey, I'm home.
We talked about his situation for a bit, and I nervously took out the money and put it in his shirt pocket. Doctors aren’t encouraged to do this sort of thing, otherwise every poor person and/or drug user might expect it, I've heard from experienced elders. And who knows what he was really going to do with the money.
But in his case, an alcoholic death seemed just as therapeutic as an irradiated brain tumor death. To me, at least.
"What? You really don’t have to do this. I mean, you’re a doctor –" he started.
"No, it’s okay. The medications are really important for you. This is just for the meds. And make sure you call your doctor and the financial office next week," I said and stepped away.
"Yeah, I will. Thank you … and Merry Christmas to you," he sat soberly at the edge of his bed, and waved. I rushed out.
Amy had picked out the gifts for my mom, and our nieces and relatives. I totally had nothing to do with any of the gift shopping this year. My gift was to a complete stranger I would never see again who would probably be dead in a month or so.
It kind of figured.
I still didn’t feel much better, but it was all I could do.
At least I didn't have to worry about gift wrapping.
HISTORY BOOKS ARE WRITTEN BY CHILDREN
(Director's Cut)It would have been nice if that was the end of the story, but real life doesn’t always work that way.
An hour later, the nurse called me, saying that Mr. Torch still couldn’t pay for his prescriptions, and that no doctor had seen him that day, and that no one gave him any money either.
"Your intern said that you gave him some money, right?" the nurse asked.
"What?! Yeah, I stuffed it in his shirt pocket an hour ago. I don’t believe this!" I was surprised and upset.
"Unbelievable isn’t it? He completely denies it. Should I send him home anyways?" the nurse confirmed.
"Yes, he is SET for a month. I just don’t believe this."
I wanted to tell myself that it was his brain tumors that made him forget. But he had been completely clear-headed since we started the steroids. Maybe he was lying on my behalf or something, right? No, I don’t think so either. He figured he could squeeze another stone and get more blood from it. I decided to surprise him and call his room.
"Hi, Mr. Torch, this is Dr. Scott. I just talked to you earlier, remember?"
"Oh yeah … hi."
"The nurse says there’s a problem. What’s going on?"
"Oh, nothing. We were uh, just talking about the prescriptions."
"... I gave you enough for a month, you know that right?"
"Oh yeah. Thanks."
"Yeah, well, see you later," and that was that.
He hadn’t forgotten anything.
I was disappointed. Not just in him, but in people in general. Did he think he could lie his way into another "charitable contribution?" Is this how a dying man wants to be remembered by the people who were taking care of him?
I actually hated him that day. It had nothing to do with the money. It wasn’t just a betrayal of me, but of my hope for what people are or can be. The belief that a man can live his life and die with dignity. He didn't choose to die, but he could choose how to live his remaining days. How he would want to be remembered.
I don't know why it bothered me so much. I mean, HE was the guy with brain cancer, for Christ's sake. I expected him to live up to some heroic ideal, like the historical leaders you read about. And when he couldn't, I reacted like a child (internally).
Like a child who had learned that his father was just a man.
Maybe I was the selfish one for expecting more from him, or anyone for that matter.
Maybe the brain tumors made him do it.
CANCELLED
A couple days later, the senior resident informed me that Mr. Torch had cancelled the rest of his doctor appointments.
Our team stood silent for a moment, and contemplated this.
I forgave him.
Sometimes, it's all you can do.
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