Commentary – February 2013
Tex Med. 2013;109(2):49-50.
By Michael K. Williams, MD
He showed up on time, precisely on time, for his first visit at our clinic. I walked into the exam room and shook his hand, introducing myself. A 6-foot, 2 inch, slightly rumpled, 64-year-old professor at the university shook mine. His words were carefully thought out and measured as he described his reason for seeing me. He got immediately to the point.
"I've been swimming three times a week for the past 24 years. Here is a graph of my times in the 100-meter freestyle."
He carefully unfolded a piece of 12-by-24-inch well-worn graph paper and laid it out on the exam table for my inspection. As a 40-year-old beginning swimmer, his times (he informed me) were "atrocious." He went on to demonstrate, tracing his forefinger from left to right, the near-linear improvement in times over the ensuing six months as he achieved an increasing level of cardiovascular fitness. From then on, it was a long, nearly horizontal line with a barely positive slope over the next 23 years.
"You will notice, doctor, the invariable ravages of age. Natural, of course."
"Of course," I nodded in agreement.
"But, please, take note of this." He tapped his capped fountain pen on the last two months of the graph. The barely positive slope had taken an abruptly upward thrust, approximately 45 degrees to the horizontal. The rise was equal to the run.
He replaced the pen in his shirt pocket and sighed as he removed his bifocals. He slowly ran a hand through his long white hair, as if pondering the meaning of the cosmos, then looked directly at me for 10 seconds before speaking. The look of concern on his face began to change. In those 10 seconds, he morphed from a worried patient back into the scientist he was, surely a more comfortable posture for him. His face had assumed the visage of boyish curiosity, so often displayed by people of exceptional genius.
"These recent times in the 100 meters are totally unexpected, and, I must say, somewhat disconcerting. There's something wrong with me. What is it?"
Spider had been hollering, thrashing around, spitting and cussing in ICU for 2 weeks. It was the worst case of DTs I had ever seen. But he slowly improved over the next five or six days and somehow survived the ordeal. At the end of that hospitalization, he told me he knew he had had a brush with death.
"I saw that ol' hag," he said. I didn't understand his comment.
"You know, doc. That witch. I saw her the other day." He was describing some of his hallucinatory visions over the past week or so. Conspiratorially, he leaned over toward me and lowered his voice. "She's butt ugly, too." He then resumed his normal level of conversation. "But she let me pass! I don't know why, but she did. I didn't deserve to live, but she let me go."
Spider and I had known each other for several years. I had tried to patch up the results of his tendency to engage in pleasurable excess on several occasions. He had never held a legitimate occupation, but got by on cunning and a little larceny. He had taken great pleasure in detailing his life's pursuits, with cocky bravado, in the course of his office visits with me before his ICU admission. But that was then. Now, before me stood a changed man.
"Anyway, I made my mind up. I'm gonna git right. I'm givin' this ol' life up. Yeah! I'm gonna git right. Doc, I know I shoulda died. I know how close I came. I'm turning this thing around, you wait and see."
We talked about this and that, medications, sobriety, and follow-up at the office – all the usual stuff at discharge time. I got up to leave.
"I'll see you in three weeks, doc!" he said as he jauntily waved good-bye.
I didn't see Spider in three weeks. I saw him in three years. I had wondered what had happened to him during that time. Now he was back in a familiar exam room in my office, but this time in an electric wheelchair.
Before I had a chance to ask "what happened?" Spider started the conversation. "Hi, doc. 'Member me?" His clawed right hand maneuvered the wheelchair joystick expertly, as he wheeled back and forth in the room in a series of jerky arcs. Spider, the long, sinewy, muscular, charmingly sociopathic Spiderman, was now quadriplegic.
He didn't wait for a reply.
"Yeah. I moved to Florida. And I got a job! Can you believe it? Me, with a job? Yeah. I drove a fertilizer truck down there. That's how 'this' [he gestured toward his neck with the other contractured hand] happened. Flipped the damn truck on a rainy day roundin' a corner. And I know what you're thinkin'. But I was as sober as a judge. I told you three years ago that I would alter my lascivious ways, and I did," a note of unabashed glorious triumph in his voice.
I sensed that, somehow, his profound change in his approach to life mattered tremendously more to him than his all-too-evident recent physical affliction.
A career in medicine teaches one many things about humanity. With the professor, I had witnessed the interaction of emotion (fear) with coping mechanisms (intellectualization) in a person.
In Spider's case, I learned about irony. And about the capacity in all of us to purposely seek a new direction. And about acceptance of adversity. I learned these things from an ex-drug-dealing, recovering alcoholic.
Physicians learn about humanity, what it means to be human, by interacting with thousands of patients with a near-infinite variety of backgrounds. A list of my patients over the years includes world authorities in astronomy and petty criminals and just ordinary people with boring, or comic, or tragic circumstances.
Based on these interactions with people, the picture of humanity that forms in our minds is constantly evolving as we ourselves age. Over time, these interactions blend with our own preconceptions, biases, and personality to manufacture a reasonable personalized portrayal of what human beings are all about. What a gift! What other profession affords its members the opportunity to have a front-row seat at the human parade? The thousands of patients who come our way over the course of a career in medicine present us with the opportunity to understand, better than most, the nature of Man.
I think physicians, burdened with ceaseless administrative challenges to overcome and the humdrum of routine, too infrequently appreciate this hidden, precious gift we receive for discharging our clinical duties. But it is worthy of our appreciation, as the subtext of these patient encounters (what it means to be human) is as important to our own existence as the main plot (what causes this person to suffer) is to our patients.
I have been so fortunate to have witnessed this wonderful variation of human experience. I am grateful for what all of these people have given me, their stories, their hopes and worries, the private looks into the richness as well as the impoverishment of their hearts.
Doctors frequently receive thanks from appreciative patients, expressions of their personal inherent kindness and goodness, for the many good works that we do for them. But as I think back about the past 30 years of work, I wish I would have thanked my patients more often for all they have given me.
Dr. Williams is assistant professor of clinical medicine in The University of Texas Southwestern-Austin Department of Internal Medicine.
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