"... Four... five... six...," I count to myself from my patient's doorway.  I can feel a drop of perspiration actually rolling down my ribcage. 

Eight.  The palliative carebear doc pauses for eight seconds before asking my dying patient another question.

Palliative care, the angels of ... dying.  They help keep the dying patients comfortable.  They help keep the families sane.  They help me not have to come up with a dozen different ways to say, "Not dead yet" every day.  The methodical ones almost seem to have an internal stopwatch to measure the mortal minutes remaining.  Others are big ol' teddy bears that make you feel like they really do care, bear. 

Still ... eight seconds?  I've heard of pregnant pauses but this one was delivering octuplets.  It can't take you that long to consider the next generic question when you have these "end of life family meetings" every day.  Maybe the palliative carebear doc is thinking of what he has to pick up on his way home tonight.  Maybe it's his way of giving his sparse words two tons of importance.  Regardless, it works and I appreciate their help. 

It is a mixed bag of relief and guilt for me after the towel has been thrown in.  I tend to think I can make everything a little better with a little tinkering; I think I can make the kidneys a little better; I think I can suppress this infection; I think I can get that fluid out of his lungs - oops, I lost the kidneys again - back to square one.  I think therefore I am in internal medicine.  Will it help in the long run?  I'm not sure, but shouldn't I try?  Sometimes the cold hard answer of experience is no.  There will not be another Christmas for you.  You will not be around for Ocean's Fourteen or see how many more doctor cocks Meredith places into her vagina this season on Grey's Anatomy.  Your remaining hugs and kisses are in the single digits if not nil by now.  Sometimes the futility is obvious.  Sometimes I don't feel 100% that it is.  But as long as the patient (and family) is comfortable with just dying, I can live with it.  

Surgeons have called internists "fleas," because we are the last thing to leave a dead body.  That's because they're the first ones to leave when someone gets too sick.  We call them ... surgeons.

[I'm just being coarse for effect there.  They have their life-saving role and we have ours.  They even have their show, Grey's Anatomy, and we have ours, House MD.  Really, which doctor would you prefer?  A loose-labial intern with more bacteria in her cooch than a chronic diabetic foot ulcer, or a drug-addicted pompous ass who will save your life just minutes before the next time slot.  Okay, maybe I should have gone with J.D. on Scrubs although I've always had a little crush on Maura Tierney from ER.]


"Your new patient, Gonzalez, just arrived across the hall," the nurse says from behind me and below me (she's very short).  "His heart rate is 157 and he's short of breath." 

"THANK GOD," I almost say out loud despite my atheistic proclivity.  At least now I have something to do other than count seconds of thoughtful pauses and pretend I haven't heard the happy-sad stories of how strong/noble/rebellious he/she used to be.  Eventually those stories all sound the same, just with different places and names in the blanks like Mad Libs. 

By the time I'm all done with Speedy Gonzalez, the family meeting is over. 

"I asked him how he feels about all this," the palliative carebear doc says, "And he said 'like I'm on an anthill.'"

"... That's it?" I ask after realizing there is no punchline or explanation to his Rosebudian response.

"His family doesn't know what that means either." 

Is he reflecting on our significance in the universe?  The dutiful but meaningless scurry back and forth in our lives.  Or is he developing a bedsore on his bottom? 

Regardless, those were his last words on this anthill. 

....

"How are you feeling today, Mrs. Butz?"  I ask another patient who came in a few days ago with blood coming out of her rectum. 

"I feel all better.  I'm ready to go home." 

That's what she said.  *rim shot*

Actually, that is what she, the gastroenterologist in this case, said.

Sometimes the ants win too.

 

RAMPANT HORNINESS AHEAD