Saturday, November 8, 2008


Classic post

Published a few years ago on my old blog

It was a sunny spring day as the bus turned the corner. It was a yellow school bus filled with young children jumping up and down in their seats. It was an average day in an average school year. Nothing about that day stood out. Let’s take a closer look.

The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered and jeans have patches on them. The lunch box is empty but no one around him knows that. His is quiet and withdrawn. He doesn’t play with the other children. He is much too thin. He will one day grow up to be a successful businessman and buy his mother a house. His children will not have to live like he has. But, of course, he doesn’t know that yet.
The girls sitting across the aisle from William are Suzette and Lisa. They like to sit in the front so they can rush off the bus when they get to school. They must each be about nine. Suzette is widely known as the school gossip. If something is going on she knows about it. She will grow up to be an advice columnist for a major newspaper. She always did like to tell other people what to do. Lisa’s rode is a little bit different. She will fall into a drug habit and get pregnant way to young. As her child is born she will clean herself up. She will never go to college or see herself as a success in her own eyes. But she will bring up a beautiful young daughter who will take advantage of all the things she never got to do.

Behind the two girls chatting are Terence and his best friend (who he currently is wrestling to the ground) Paul. Terence will grow up the class bully. He eventually will be arrested for armed robbery and during prison will find god. After serving his time he will work at helping released inmates find jobs. He will change many lives. Paul will be known as the boy who never took any chances or risks. Almost afraid of his own shadow. Until the day, at the age of thirty five, that he rushes into a burning building and saves three children before he collapses and dies.
Sarah screams across the aisle at Terence and tells him to stop bullying Paul. She knows in her heart that one day she will find Mr. Right and settle down and have five children. Seems a bit premature for an eight year old but…that is exactly what she does.

So many faces you could see if you were riding on that bus. Each with a unique story and future. But the point here is not them, but to take a closer look at the man sitting in front driving the bus. He is a beautiful and courageous man….. and he is dead.
Well, he is not exactly dead yet but he will be in a matter of days. Neither he nor I, his physician at the time, know this is going to happen. Neither does his wife, the lady sitting in front of me, who looks for the first time in two years to have found some peace over the death of her beloved husband. I ask her what has changed. This is what she says…..

The call from the cardiologist surprised me. She was in the ICU and was visiting our mutual patient who just had a routine bypass surgery that afternoon. The surgery had gone very well without complications. I could hear the concern in her voice as she asked me what to do. She had been talking to him when all the sudden he started seizing. I told her to give him five milligrams of diazepam immediately. Start a dilantin drip and get a stat head CT. She called neurology immediately. Both of us knew this couldn’t be good. "By the way is his wife there?"
He had come to my office at the suggestion of his wife. She had been seeing me for about a year. Like so many males in their fifties, he started the visit by telling me he didn’t like going to doctors. He had always been healthy and didn’t feel the need. But this chest pain he started to feel recently while on the school bus was bothering him. It had been about a month and he thought it was time to do something.

His testing showed coronary artery disease and he was sent to a cardiologist. She recommended a cardiac catheterization that showed extensive blockages in multiple coronary arteries. He was scheduled for a bypass surgery the next week.

The call from the radiologist confirmed our fears. There was a large tumor in the anterior part of his brain that had bled from the blood thinner that is necessary during bypass surgery. This tumor had been asymptomatic to this point. It was a benign tumor and likely if it could be removed the patient had a good prognosis. None of us had known it was there. He had none of the telltale signs. No headache, no visual problems, no signs on physical exam. It was just bad luck.

The neurosurgeons were antsy about taking him to surgery right away. It was Saturday morning and the blood thinner used in the bypass surgery was still in his system. Also this would be a complex surgery and they felt it would be better to wait till Monday when full staffing would be available. So he sat in the ICU and waited.
On Sunday night he started to feel a little nauseous. He sat up to call the nurse and said quietly….."Something is wrong". He then collapsed back on the bed and died. Likely the bleeding in his brain had restarted causing the brain to swell. The increased pressure then caused the brain to herniate which is incompatible with life. CPR was performed for about thirty minutes to no avail. His wife and daughter were called at home…..they had left the hospital a few hours before.

The next two years were a blur. There had been multiple visits with his wife. We had met together with the cardiac surgeon to go over what had happened. There had been tears and more tears. I felt horrible for her. I watched with time as the depression set in. We discussed medications which she decided against. We discussed therapy which she attended. The birth of her daughter’s baby, he first grandchild, was bitter sweet.

When she walked into my office two years later I knew immediately that something had changed. I could see it in the way she walked, her facial expressions, the way she talked. She had stepped away from the sadness and started to live again. We exchanged small talk for a few minutes and then I gently asked her what had changed. Her explanation was straight forward. And this is what she said…

Since her husband’s death, she and her daughter had been focusing on loss, focusing on tragedy. They were morning life that was taken away too early. After the birth of her daughter’s child they started to look at things differently. Her husband, she explained, was a bus driver for a local school district. Everyday he drove young kids to school. He loved it and he loved the kids. She figured that he had two ticking time bombs. One in his brain and one in his heart. Each of them could have instantly caused death while he was driving the bus. Each of them could not only have taken his life but the lives of all those precious children. She told me that now instead of morning his death, they celebrate all the beautiful lives that were saved the day he died quietly in the hospital. She said that now when they feel sad, her daughter and her sit down and make up stories of what would become of those young lives…you see….

The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered and his jeans have patches on them. The lunch box is empty but no one around him knows that……….


tracy said...

Wow. With each new story i fall deeper "in love" with your beautiful writing. Thank you, Dr. Jordan, for sharing your amazing gift.

Toni Brayer, MD said...

Just beautiful. Tracy sent me to your blog. As Arnold says: "I'll be back".