Walking on Sunshine

Early morning. Black coffee grounds flecked and laced throughout the frothy beverage. It was month three of my internal medicine rotation and I could only help but to think my insides looked like this cup of Texas Tea. Black, bitter, and needing something sweet to bring it back to life

Walking through the hospital wards, I lingered, hollowed out from the fourteen hour shifts. Guant, pale, a diet of peanut butter, graham crackers, and dishwater coffee had left me with a wicked vitamin D deficiency. Bones now probably like swiss cheese with the strength of David Bowie’s will power in presence of cocaine.

I was a shell of a human being, donning the dunces cap of a third-year medical student, a short white coat. Along with a plastic smile, that at most, made a lack luster attempt to humanize me. I was ready to seize another day of internal medicine rounds with arduous task of dodging my attending with his “guess what I’m thinking” questions.

Hello and good morning M3! Chirped my attending.  Christ, I thought. I’ve been on this rotation now for 89 days [yes counting down since day 1]. Couldn’t he call me by my first name, at the very least? How the hell is he so spritely in the mornings? You’d think this guy would have combusted already from duration of sunshine that he had been walking on for the past three months since I had been with him. I wasn’t fortunate enough to have that happened but I continued to count my rosary beads.

M3, I want you to see this new patient. Her room number is 909. Do you think you can handle it? My attending asked. Absolutely! Thank you sir! I replied with my “M3” default answer to any and every question my attending asked. God, why do you do this to yourself Will? I thought as I turned away cringing at the realization of this Stockholm relationship I had with my attending. Anybody in this sort of a relationship, outside of medicine, would be well in tuned that this was abuse. “Maam, do you want to press charges? We can bring him in for assault. I can’t leave him because I love him?” A brief snip of a COPS episode bubbled to my memory as I made my way to room 909. I could only help to think I was the victim in this episode, titled, Internal Medicine at Prince George’s Hospital.

My foot steps echoed throughout the stair casings as I made my way up nine flights of stairs. Good night, I thought. Chest heaving, my lips purpled, clearly I’d be the next cardiology consult if I didn’t lay off the peanut butter and graham crackers. Finally, I’ve arrived. It was the ninth floor. Right foot in front of the left foot, repeat until I make it to the patient’s room. Be confident. Smile? [if appropriate]. I had a running script in my fore front of thought as to how I wanted other’s to perceive me upon my entrance to whoever and whevere it may be. Nursing station, patient’s room, being by myself and secretly dancing to Mariah Carey’s song Emotions.  However, the sight of loose stools, vomit, mucus, all proved to be my kryptonite that would quickly dissolve my facade of confidents and surely would reduce what little left of confidence my attending had in me.

I made my way down the dimly lit hallway that slithered like entrails throughout this nearly extinct beast that they called a hospital. As I approached the patient’s rooms, I could smell the soft notes of iron that carried throughout the immediate air. Oh no! I quietly thought. Loose stools? Hematemesis? Both? What does hematemesis mean again? Jesus, keep it together Will, I continued to think quietly to myself. “There is blood and stools everywhere!” The nurse yelled as she left room. Confidents gone. Bracing myself, deep breath in, I walked into what appeared to be a prelude to the gates of hell.

Indeed. The nurse’s depiction of the weather cast of heavy stools intermixed with blood proved to be true. In the center of this beautiful canvas, laid a thin, whittled down, female. Sheets stained with blood and fecal matter, mixed, and taking on the appearance of a sticky tar that bled through her sheets like an oil slick. Black hair that sharply contrasted against her porcelain skin, delicately draped over her muscles that were strapped to her protruding bones. There were evident signs of wasting, anemia, clearly there was something draining this women of life. Cancer I thought. I started pouring over the differentials that would reveal a plausible etiology for this patient’s presentation.

Lost in thought, the back drop of my imagination took on the form of ancient Greece where I met Socrates and Hippocrates. We spoke in ancient tongues and really just getting back to the basics of philosophy and medicine that I thought may prove to help in me discovering this patient’s underlying ailment. This often occurred when I began thinking about differentials. I thought by thinking about smart people I might become guilty by association and reasonably intelligent as well. What I didn’t consider was that these were merely just figments of my imagination and that an underlying diagnosis of ADHD my be at large.

Anyway, back to Hippocrates. “I have colon cancer.” A rickety voice crackled and tore through my streaming consciousness. My running dialogue wound like a VCR tape and the figments of my imagination that were guiding me to a brilliant diagnosis, evaporated. Damn it. I thought. I probably have ADHD.

I looked at the patient. She laid in the throws of death. Her ribs rattled with every bit air that ran across her lungs She wasn't sating well, O2 saturation in the 80's and her skin and lips carried a matching cadaver blue hue that' was suited for a corpse. Her lungs were laden with mucus as evident of the pops and cracks as the thin membrane of her lungs tore from the sides of her ribs while being pulled down by her diaphragm upon inhalation.

Oh wow i thought. She looks bad. Really bad. There was no other word to sum up her situation except for BAD. I looked at her room and there was a picture of a young youthful female, beautiful. "That was me before I got dealt this awful hand." I had a pang of empathy as I was reminded that not only does God act in mysterious ways but death can be a bitch too.  When was this taken I asked Mary. That was about 12 months ago and about eight months ago I was diagnosed with colon cancer that had mets to my lungs. She smiled. At that moment, I didn't see sick a lady but a well being with a good soul. I imagine how she would have been without this illness. Alive, healthy, heart strong, skin plump and radiant. Did she have kids? What did she do for a living? Did like David Bowie? Who was she and why was she playing with my emotional cords. And then a sound that cracked the stagnant hospital air, "Bleeeeep." Mary was crashing.

The electronics in the room sounded an orchestra of alarms that led to an outpouring of. Medical staff and nurses into her room. The senior internal medicine resident entered the room and in a bellowing (look at me,I'm awesome) tone, move out the way M3. This was the only time I was happy to take this title and leave this disaster of a situation. I watched as they attempted to resuscitate Melanie. Her eyes staring ahead. Lights were on but no one was home. She was coming back from this I thought while I watched the resident wail on her sternum. Pupils began to dialogue "pupils are blowing out the nurse barked to the resident. Blood pressure now steadily dropping. Systolic 100 Diastolic 65. Systolic 85 diastolic 53. Systolic 65 and diastolic 45. IV fluids now! The residence panicked. There was no coming out this I thought. And with that, Melanie's blood pressure plunged to depths unmeasurable by machine. Heart rate flat lined. That was it. Melanie was gone. Yikes! Okay who wants lunch? My attending chirped as he road in to the patients room on a ray of sunshine.