Thursday, November 10, 2011


The clanking of the wheel chair destroyed my memory of Tim's last visit.

He was healthy then. His long torso sat on top of spindly legs. He strode into the exam room confidently. Although he described burning in his chest, his gait and demeanor were unhindered. He seemed reassured that the work up in the hospital was unrevealing.

The cardiologist's report from the outside facility said that he had clean coronaries. He showed me the bandage on his groin to prove it. Eventually he was given the label of gastroesophageal reflux or anxiety.

His chest pain was worse then ever, but he could manage as long as it wasn't life threatening. He grinned at me as I took out my stethoscope. His exam was normal. I thumbed through the hospital records. His cardiac catheterization, chest xray, ekg, and lab reports were normal.

We discussed different treatment options and finally decided on watchful waiting. As I ushered him out of the office, I had no inkling of the torment that would soon befall him.

Hours later, he collapsed in his living room.


Ya, I know he has chest pain!

The caller annoyed me. I just saw Tim in the office. Why was he in the ER now?

The last thing I expected to hear was that he suffered a devastating heart attack, and was being resuscitated. I rushed to the hospital to find him in the Intensive Care Unit on a ventilator.

His status wavered from day to day. His wife and I talked about the poor prognosis and the likelihood of death. But as the days passed, Tim got stronger. When sedation was weaned, we removed the ventilator.

Tim's mind was as sharp as ever. But he couldn't talk, and he was having trouble moving his right leg. The lack of oxygen during the initial days in the ICU took its toll. Tim had suffered a stroke.

I wrote his discharge orders with a heavy heart. He was transferring to a rehab facility and then a nursing home. I didn't have privileges at either location, and I would have to surrender his care to another set of physicians.


Months later, Tim was leaving the nursing home and returned to my office to reestablish care. His eyes rested on the ground as his wife pushed him into the room. This was one of his bad days. I could sense the depression before I even talked to him.

I felt a great compulsion to apologize. I wanted to say that I deeply regretted not sending him to the emergency room. I wanted to explain that even when all the protocols are followed correctly, the body is a fickle master. Even the bravest of lion tamers occasionally gets bitten.

I couldn't feel the ache of the tooth marks nor the restraint cast upon his soul. It is only with great hubris that the physician pretends to understand the reality of illness.

So I sat silently next to the wheel chair and put my hand in his. A promise to unlock the bodies secrets would neither be offered nor accepted. Instead I looked him in the eyes, and gave the only thing I had left.

I'll be right here.

You're not alone!

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