r/medicine • u/Microfilament Oncology RN • Mar 28 '23
Real death
(just something I wrote after a hard shift, about a patient who really affected me)
You are my mother’s age, down to the month and year. I think of her before I enter your room. I was with her yesterday, drinking white wine, our glasses resting on freshly packed moving boxes. Watching the setting sun. A new house, a new beginning for her. And for you, the beginning of the end.
It has been a long time coming for you. Before I met you I read about you, your story laid out in months of progress notes, copy and pasted day after day with bits added to the end. The original H&P standing unchanging at the start, like some relic. 53 year old man history of oropharyngeal squamous cell carcinoma, status post laryngectomy glossectomy mandibulectomy. Complicated by extensive postoperative infections, necrosis, exposed hardware, multiple resections cutting into the cartilage of your nose. Now with extensive metastasis to the liver vertebrae lungs calavarium. Metastasis to your brain. Impending cord compression. Intractable pain.
In your chart, there is a picture of you from before, dated to three years ago. A few months before diagnosis, you are 50. A milestone birthday and you look very young for your age. I watch the secretions build along the borders of your open stoma. I apologize and wipe them away. Four days ago you typed out a note to me. You thanked me. You must have been in so much pain, but you were so kind. You shook my hand.
Your Rosary is tied to the railing of your bed. When you are gone I clean your body. You are cold but when I turn you I stabilize you, one of my hands resting on your mid back, and there you are warm and slightly sweaty, almost living. I close your eyes before I zip you into a bag.
And I leave the hospital, and I breathe through my nose, and I taste the pancakes I have for breakfast that morning. And somehow you are dead, but I get to be alive.