In February, a man was admitted to internal medicine with pneumonia. His workup portended lung cancer—a stubborn pleural effusion, a persistent hyponatremia, 50 years of Pall Malls. I often lingered in his room, auscultating his lungs, measuring chest tube drainage, reminding him to drink less juice. He always joked that he was going to escape our clutches. One day, between crackling breaths, something compelled him to unleash a torrent of Korean War anecdotes and anticommunist beliefs. “I don’t believe in handouts,” he said.
“You and me both,” I thought.
“I don’t want chemo. When I’m done, I’m done.”
The man smoked even while hospitalized and evaded all attempts to limit his fluid intake. Yet he was charming. I thought about his wife and kids and wished he would choose the chemotherapy. And I agreed with him—I didn’t believe in handouts.
But wait? Didn’t I become a doctor to help others? What happened to the caring platitudes about “making health care a right” and “helping the underserved” that I had recited at my medical school interviews? Those interviews seemed like a lifetime ago. When did I turn into Ebenezer Scrooge?
I’m in my third year now. No ghost of patients past has visited. I never saw the man with the Robitussin addiction again. But others like him have appeared, usually during the dead of night on call. I find I’m bothered less this year. Maybe I’ve gotten used to it—not to the crime or drugs or unemployment, but to people’s basic differences. Recently I asked a patient about his tattoos. He was demanding Xanax for his “panic attacks,” which lasted “hours,” and wouldn’t leave without it. Explaining his tattoos, on one arm, he told me, was a Norse god, and on the other, a skull. “Wow, that’s interesting,” I thought. Then, as he opened his ham sandwich, we moved on to how I could help him.