12/22/05

We're having a big gathering of family this year, as usual.  But somehow, my Christmas seems a little less full compared to years past, in that this will be the first time in 18 years that I haven't been on call.  Most would be confused by that statement, thinking that I should feel relieved.  But allow me to share with you why Christmas is such a special time for me, in terms of having a greater appreciation for my purpose as a physician.

On Christmas Day, 1987, I was working the end of a 36 hour shift in the ER at LSU Medical Center-Shreveport.  Thank goodness, they don't allow interns to do that anymore.  It was not a particularly pleasant time for me...I was broke, sick with the flu, spending my first Christmas away from family, and otherwise feeling sorry for myself. 

Around 2:30 Christmas morning, I was about to collapse of exhaustion.  Our triage nurse emptied 2 liters of IV saline into my veins to keep me going and suggested that I take a nap, since the ER had been finally cleared of patients...a rare occasion in a Louisiana charity hospital.  About 15 minutes later, as I was drifting off to sleep, she interrupted my attempted slumber to inform me that a poor, rugged looking farmer from an outlying rural community had presented to the ER with a complaint of a "stubborn cough".  Irritated, I barked at the nurse that a cough was not an emergency, and that he could be seen in our walk-in clinic the next day.  She then proceeded to tell me that he had hitchhiked to the hospital to see his wife, who was hospitalized with terminal cancer; and thought while he was here, he should get his cough checked out, since he didn't know when or if he could return later.  Upon hearing this, I begrudgingly agreed to see him, acknowledging that the nurse would not have bothered me if the situation hadn't warranted it. 

Upon greeting this man, I couldn't help letting go of my grumpy attitude to hear his story.  He was instantly likeable and interesting, and seemed to be content just talking to someone.  He impressed me as a salt of the earth, self-educated, hard working, God loving man with bedrock values and a delightful sense of humor.  As I progressed to the issue at hand, I learned that his cough had persisted for several months.  He hadn't seen a doctor in years.  He appeared to have lost significant weight, as I noticed that his belt had been tightened several holes.  Yet he didn't seem sick, certainly not in his heart.  He was happy to be spending Christmas with his wife of 40 years, and realized that it would likely be their last visit together.  Anyway, I ordered a chest X-ray for further evaluation of his cough, particularly since he had associated weight loss and a longstanding smoking history. 

The results of the X-ray were not good.  Even as a psychiatrist in training, I could tell that he had a large, suspicious mass in the upper lobe of his left lung, which was suggestive of cancer.  The radiologist on call subsequently confirmed this and also pointed out numerous additional lesions consistent with metastasis.  In other words, he had terminal cancer. 

Around 4 am, I had to break the bad news to this pleasant gentleman.  Strangely enough, he reacted with a serene facial expression.  Perplexed, I questioned whether he understood his diagnosis.  He calmly responded, "Yes, I know. I'm going to die, and soon."   I further queried him as to the reason for his paradoxical peacefulness.  He elaborated, "You see, doc, I woke up this morning, got on my knees, and begged the Lord to grant me 2 wishes...to see my wife today, and to not take her away from me.  And He has answered both of my prayers.  He sent an angel to take me to the hospital, and He's not taking her away from me, but letting me go with her." 

After hearing his explanation, I immediately lost my composure and began sobbing like a grandmother.  He told me not to be sad, and I reassured him that I wasn't.  Rather, I let him know how overwhelmed and inspired I was by his devotion and love for his wife, and by the strength of his faith.  Since that encounter, I've commented many times that I've learned more from my patients than they have from me. 

The tough old farmer and his wife died within a month of one another.  That Christmas in the ER resulted in an epiphany of sorts for me, and while I've retreated to my narcissistic complaints many times since, I've had that experience to reflect on, which is usually enough to bring me back to a moral center.  And I thank God for that.  Being on call every Christmas since then has kept the experience fresh on my mind, and I will miss it this year, but sharing it with you has allowed me to relive it once again.  May you also experience the true meaning of Christmas, and in the words of the immortal Tiny Tim, “God bless us, everyone!”