Sometimes it only takes one. One wrong word, one missed moment, one poorly timed gesture, one misstep or quick step to break or make a human connection. Sometimes one pebble in a pond, like a butterfly’s puff of wing, sends that tiny ripple which can unsettle your whole ocean. The older I grow the more grateful I am for one wonderful patient among many who have colored my life of service from day one. His ripple continues to echo in a life of service and commitment to empowered patients in the sacred beauty of calling on people at home. If i had not taken an odd step, if i had spoken one more too many of my many wrong steps, I would probably not be the physician you see today. It only takes one. Thank God for those ones.
Mr. A. was a one of a kind patient, but don’t worry, for there may be an infinite number of kinds. Time may have blurred some of the clinical details, but his indelible impression on my practice remains. He was a person – let’s not reduce him to merely a patient – he was a person who could stand to live life in no box nor chain. This man before you, as a young intern, would ride that wild Cony Island roller coaster of life in brief snippets with A. over, under, and around 3 years of residency training.
It begins with an everyday tour of duty in the Emergency Room. A sweet little old lady with breathless bright smile, surviving her latest CHF & COPD complication, asks this young intern if he might have a look at her son. ‘He’s outside in the car. He won’t come in. He hates doctors and hospitals.’ Well, this does leave the question of how an intern in the E.R. seeing patients can step ahead of triage, out of the E.R. itself, leaving all oversight of attendings and likely all malpractice and legal coverage… but those, those are the d-mned questions that only now occur to an aged attending’s polluted mind. Thank G-d this young intern still cares about the patient and not the rules.
This is of course an Emergency Room rotation, he does have an emergency, and good lord here our patient sits idling in an aging Buick right at the curb between the ambulances. A big man, mind you, a full 400 pounds easy of Indian might, and don’t you go calling him a ‘Native American,’ he’d say proudly “I’m an Indyin…” with sores and pustules draining through the ratty wraps around his hands and wrists as he holds the car wheel… seems he cares for his mom in their double wide, offers ‘protection’ for you -know-what at biker events for a living, and has been shooting up cocaine or heroin for so many years the veins are long gone.
This first visit isn’t our last. Time will prove that these skin popping abscesses of MRSA have eaten the flexural tendon sheathes from palm to elbow. Heavy smoking still burns his lungs, sleep apnea keeps him up all night, and he lives a severely hypoxic life barely able to walk. He doesn’t offer much ‘protection’ to clients these days and he certainly can’t ride that full dress Harley on his front porch any more. Before our house calls and three years of training have closed the circle, though, he has offered me freebase in a spoon, driven from our office anoxic, delirious and half unconscious, and even scared attendings into calling the police to commit him for being asleep at the wheel.
The police, now, they actually responded to that last call and, having a greater respect for Mr. A.’s extensive career resumé, they did more than just knock on his door to say ‘hello.’ They called out the SWAT. With that cordon of armored trucks, men in black and a very, very angry patient (of course it would grow – what would this story be without that?) our relationship grew strong. Despite his odds and less-than-common career path, Mr. A. continued to return honor for honor, respect with respect, tolerating us even more than we learnt to tolerate him, and along the way, sometimes, he listened and sometimes he agreed to follow our advice. Years after he would likely have died he kept on and kept giving back, in his own way, to his mom and community.
Freedom, respect, honor, tolerance, education and empowerment are beautiful, tough, and vital, and we need more of them in this two way street between healer and healing. Mr. A. and real life teach us this. My rural practice in Franklin County continues to struggle to stay outside the box for ten years now and still running, negotiating life’s rapids with our patients, breaking the rules when we must, following a heart’s call to heal for the adventure and the fun of helping those who may be able to turn, if only with a little ripple and for a brief moment, from the darker side of this life we share.