He'd been in the hospital for what felt like a million years. The complicated problems we treated him for required lots and lots of invasive interventions. He'd take a step forward but then there would be a setback. And we'd be back to square one.
That said, I loved seeing him each day. His attitude was mostly positive and, at least when I saw him, he was cheerful on most days. Whenever I greeted him, he'd respond by calling me "sweetie" which I loved. I really did. And after so many days of him calling me "sweetie," eventually I started calling him "sweetie," too.
One day it was recommended that a big meeting take place to figure out his discharge plan. The medical doctors were all there along with the social workers and case managers and pharmacists, too. And everyone was talking and thinking and pow-wowing on how to help get him out of the hospital safely. That discussion was pretty discouraging, too. Not even so much because of the nature of his medical problems. It had more to do with his very unstable living situation and lack of family support.
So we talked and talked about Sweetie and tried to come up with some way, some how to get him safely discharged. But it all kept feeling like a gamble no matter how many permutations of gameplans we developed.
"We could have him get some home health visits. What do you guys think about that?" one person would say.
"But he doesn't have a home for someone to visit."
"What if we had him go to a personal care home?"
"But he has so much equipment to take with him and so much stuff is still connected to his body. I'm worried that it would be too much."
"A nursing home?"
"I guess maybe at some point. But this isn't really long term and he has a lot of unique aspects that might make a nursing home gun shy about taking him on," another countered.
"He also has no funding which makes it even harder."
Which was true.
So eventually Sweetie got well enough to get some of those lines and drains disconnected from his body and he seemed to be going in the right direction. By the time all of this happened, I was off of the service, but since everyone knew I was invested in him and his progress, I was told immediately when a plan was finally made to discharge him. On the day of his discharge, I sent the resident a video message to show him. I wanted him to feel encouraged that he'd be okay.
"I hope he comes back," I said when my resident notified me of his discharge.
"I hope so, too," she replied softly. But then she added hopefully, "But you know what? He's following up in one of your resident clinics. So maybe he'll come, you know?"
"Did you show him the video message?"
"Sure did. And he was smiling from ear to ear." And when she told me that, I was, too.
Outside of a few of the more complicated aspects of his medical problems being taken from the equation, his living and resources were still very much shaky and worrisome when it came to things like keeping follow up visits. But eventually, the bullet just had to be bitten, you know? And no matter how careful we are with every single thing, there are just so many little, bitty things that we cannot control. Like, at all.
And so. I guess I am writing about him because this is an age old story if you work in a safety net hospital like Grady. You care for very sick human beings with all of your might, you learn their stories and begin to really, truly care about them. You root for them and wish that there was just some way that you could safely put them inside of your pocket to protect them from all of the hard things that can't be fixed by our order sets or allayed through the power of our prescriptions. And when they leave you, you still worry-wonder about them--hoping and praying that the pieces will fit together and they'll find their way back to you.
I wish I could say that the patients always did. I wish I could. But I can't.
When I looked into the computer and saw that Sweetie had been given an 9:20 AM appointment, I groaned out loud and smacked my face with my hand. "Ugggh!"
"What?" a nearby intern asked.
"It's just a patient that I'm scared won't make a follow up but needs to. And 9:20 on a Monday at Grady is hard."
"Not if he knows somebody who cares about him is here waiting for him."
And that was all that intern said which stuck in my head like a very, very stubborn piece of gum on the side of someone's favorite shoe. I quietly thought about that idea--someone caring about you--and what that means to everyone in everything that they do. And suddenly I felt hopeful.
Let me be clear: Of course, most of our patients have scores of loved ones who care about them. And even those who don't have many people, care enough for themselves to slug it out. But I've learned from my experiences at Grady and also just through living that mattering is everything. And I hoped with all of my heart that Sweetie knew that it mattered to me if he kept his appointment with us. I really, truly did.
It's heartbreaking when it doesn't work out. Such a sinking and defeated feeling when you keep refreshing the screen and hoping that the heavens somehow opened up and dropped your patient into the waiting area. Especially the ones that have permanently stolen a piece of your heart and who you believe needed you as a surrogate shit-giver.
Sigh. I'm rambling, I know.
But yeah, it sucks when you leave it all on the field and lose. And it hurts when you worry and wonder and worry-wonder for weeks and you call a disconnected phone or look for some sign that your patient has reappeared in the system somewhere. But they haven't.
But you know what else? It's exponentially more awesome when it does work out. Man, it is. And Sweetie came back. Despite how hard it was for him, he did.
"Sweetie! You made it!"
"Yeah, Sweetie. I sho did. I had to come see y'all so you wouldn't be disappointed."
"Will you keep on coming to see us?" I asked.
"Yes, ma'am. The young doctor was calling me and everything. And they showed me the message you made me. Coming up here is good for my body getting healthy but it also just feel good to know somebody worrying theyself about you."
I felt my eyes stinging and just rested my chin in my hand.
"I do worry myself about you, sir."
"I know you do. And you know what? That make a difference. It do."
"For more than just you. It makes a difference for me, too."
Honestly? I write this blog to share the human aspects of medicine + teaching + work/life balance with others and myself -- and to honor the public hospital and her patients--but never at the expense of patient privacy or dignity.
Thanks for stopping by! :)
"One writes out of one thing only--one's own experience. Everything depends of how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give."
~ James Baldwin (1924 - 1987)
"Do it for the story." ~ Antoinette Nguyen, MD, MPH
Details, names, time frames, etc. are always changed to protect anonymity. This may or may not be an amalgamation of true,quasi-true, or completely fictional events. But the lessons? They are always real and never, ever fictional. Got that?