Seeing patients on Sunday
My first patient this morning is watching the Fox Pre-Game Show. He stares intently at the screen when I walk in the room. I pop my stethoscope out of my pocket and listen to his heart. His breathing is shallow and doesn't change as I impinge on the show. He can't see the screen with me in the way, but this doesn't seem to bother him. I lift off his sheets and press my warm hands on his stomach. The feeding tube site looks well-healed. Not a flinch. His expression remains unchanged. My nurse walks into the room. Are you ready for me yet, he asks. Yes, and then we roll the patient onto his side. The sore looks to be improving. His eyes are glazed, and remain fixed to Terry Bradshaw, our analyst de jour. He's telling us he thinks the Cowboys will win today. I imagine so, the nurse pipes in. We laugh as we roll him back. I ask him, what do you think? The patient stares blankly at the screen. As we roll him back, my nurse hits a button and Bradshaw is replaced by a rerun of Oprah talking about abandoned children. The patient continues to watch, passive, mute. In my house, that sort of heresy would have cost you, I laugh as I change the station back. He never speaks a word. It's as if he can see right through all of us, this eighty-seven year-old man with Alzheimer's. His heart is a ticking time-bomb, rattled by years of smoking and coronary artery disease. His back is covered with this sore, which has eaten into his bone above the sacrum. He feels no pain. He sees and hears nothing. Often, I wonder if he knows any of us are there at all. On Sundays, I return from rounds in the hospital to my family and some Cowboy football. His family rarely sees him anymore, resigned to this notion that he doesn't know they are there. I'm a football fan. You change that channel to Oprah, and I'll have your hide. Dementia has taken this man and turned him into a shadow. I pray that for him, every day is Football Sunday, that he does not see what has become of him. I pray that he does not understand for one iota of a moment that the infection in his sacrum is spreading. I hope he feels no pain. I pray that he understands that we have done our best for him, and that now, near the midnight of his life, there is no more, except comfort. I pray that he does not hold this against us, that we, his physicians, nurses, even his family, have all but given up on his condition. I pray that we can ease his suffering. And, as I walk out of his room, I pray that the Cowboys win today.