by B. Robert Meyer
(All names have been changed to protect confidentiality.)
I am doing paper work in my office when I get a phone call from a nurse on one of our medical floors. She sounds frightened. “Doctor, we think you need to know about this. Do you remember Mrs. Morales who was on our floor a year ago? She died in the hospital”
I do recall her.
“Well, this afternoon her son was on the floor and walking around asking to see the people who took care of her. He was walking back and forth and seemed very upset. He said she died here one year ago today.
“We didn’t know what to do and so we called security to come up. But before they got here he became upset and left the floor. He said he would be back tomorrow and wanted to talk with someone about her care. He seemed angry. We asked him if we could help him but he did not want to talk with us. He wanted the doctors. Why did he come back here? We are afraid he is stalking the doctors. We spoke with patient services and with security and they said to let you know.”
I did remember her. It was early January when she was admitted from the emergency room with an abdomen that was massively enlarged. Her belly was tense as a drum and the veins on her abdominal wall were easily seen. She lay in bed with her head up at 45 degrees. If we lowered the head of the bed, she would complain she could not breath. She had trouble moving at all, and if her abdomen was disproportionately large, her arms, legs, and neck were contrastingly thin and wasted. Her chest allowed you to see and count her ribs one by one. She was eating very little if anything, and complaining of nausea and on occasion some vomiting. Her abdomen was constantly painful. If you had to guess her age you would have over-estimated by decades. She was 54 years old.
The story she told was that she had been at another hospital where they told her that she had cervical cancer and that there was nothing to be done. She was quite angry at the care she had received there. She told us that she had been going to their clinic regularly for more than two years, getting all the testing that could be done and telling them about her discomfort “down there.” But, she maintained that they did nothing and ignored her complaints. Eventually, she had been admitted to that hospital, only to be told she had extensive cervical cancer and that there was nothing to be done. She had then come to our ED for another opinion.
Sadly, we were able only to confirm the grim outlook. She had a partial obstruction of her intestinal tract by tumor, as well as large amounts of tumor throughout her abdomen. We asked our gynecologic oncologists for input. They had nothing to suggest except to keep her comfortable. She would not be a candidate for surgery. We spoke to our medical oncologists who suggested that a trial of chemotherapy “might” provide very transient relief. They also thought it might make her sicker.
I sat and talked with the patient about what she wanted to do. She was a deeply religious mother of two sons, an immigrant from Mexico, with a devoted husband. I initially assumed she was Catholic, but when the priest stopped by to see her, he discovered she was a member of a Pentecostal group. She had no worries about her oldest son, she told me. Her husband would also be ok. However, she worried desperately about her younger son. He was her favorite, a senior in high school, and her illness over the last few months had hit him particularly hard. He was sleeping more, getting up late and missing school. He had always been the one she worried about, and she now worried he was losing focus and brooding. He was quiet when visiting her in the hospital room, wore a leather jacket, considerable jewelry, and heavy boots. He seemed a sullen and angry young man.
When we sat down and talked about her goals, the patient was clear. She wanted to live until June when she would see him graduate from high school. She was willing to do anything it took to make that a reality. That meant she would try radiation therapy to the abdomen and chemotherapy as well if that might help. “I need to live until June to get him through school.”
We tried. We spent the next several weeks trying to get her “well enough” to be given those toxic drugs we call chemotherapy. She never got that healthy. She had intermittent episodes of complete blockage of her intestines that would require a tube into the stomach to relieve her symptoms. She also had severe pain. Her belly never really got smaller. Some days it looked a bit better. Some days she would even have a bowel movement. We tried to give her some nutrition. But a day of success was usually followed by two or three days of failure and another episode of obstruction. While her belly got larger, her arms, legs, and chest became even thinner. She looked more and more like a wraith. We made it to mid-February. Her family, her church and her caregivers all prayed for her and for her recovery. But that did not happen. On her last day on this earth her family and church members gathered round, and the room was filled with sorrow.
Her younger son stood apart in the corner.
So what to do about the young man who had now suddenly appeared one year later on the hospital floor, pacing and upset? I asked the nurses to call me if and when he arrived the following day and to ask him to wait in the large family room on the floor. They did so, and I went up to the floor to speak with him. He was dressed as I had seen him last, with a leather jacket, jewelry, boots and tattoos. What was this rebellious and angry appearing young latino male suddenly doing on their floor one year after his mother died demanding to speak to the doctors? The nurses and unit manager were nervous. When I arrived on the floor they let me know of their concerns. They had already called security and had asked them to be on the floor in case of trouble.
I am also nervous, but ask to speak to him individually. As I enter the room, he is sitting in a chair staring straight ahead at a spot on the floor a few feet ahead of him. There is a grim look on his face.
“Hello Roberto, I am the doctor who took care of your mom when she was sick. How can I help you?”
He looks straight ahead and does not immediately answer me.
I ask again … another pause.
And then he begins to cry….
No, that does not do it justice.
He sobs and sobs and sobs.
I pull up a chair next to him and sit down.
I put my hand on his shoulder.
He slowly returns from his tearful place and turns to face me.
“I am afraid that I killed my mom.”
“Why do you think that?”
“The day she died I tried to get her to drink some water. She was thirsty. I helped her to try to drink … but … (more tears … she coughed a lot of it up. I think I killed her. I can’t sleep at night. I have been having nightmares about this. I feel so guilty. She might have lived. I am so sorry … I killed her.”
He is now in a paroxysm of tears. I have come without tissues and he is having to use the sleeves on his winter coat.
But I do not want to leave the room.
The sleeves are fine and will have to do.
Time passes as we sit together.
Nurses poke their heads in the door.
I wave them off.
“Roberto, you did not kill her. Your mom was sick. She was going to die. You did not kill her. You did what any loving son would do. You tried to help her. I guarantee that you did not do anything wrong when you gave her the water. “
He continues to sob.
Gradually it begins to slow….
He again returns from his pain and looks at me.
“Did I ever tell you how she told me over and over again how much she loved you?”
The sobbing seems to abate a bit. He looks up and straight at me really for the first time since I entered.
“Really?”
“Yes”
“I loved her back….” More tears follow. A bit gentler it seems.
I had to ask him:
“Did you graduate from high school?”
The answer: “Yes”
“She is proud of you in heaven.”
Bob Meyer is a retired general internist and medical educator who practiced medicine at several teaching hospitals in NYC over a 45 year career, including 28 years at Weill Cornell.