Thursday October 31, 2019, 11:00 pm: A forty-five-year-old woman named Maria drove her Subaru Forester along a Pennsylvania highway called the Blue Route, about fifteen miles west of Philadelphia. It was raining heavily. She drove more slowly than she ordinarily would, partly due to poor visibility but also because the wind seemed unusually strong. Her hands firmly gripped the vinyl steering wheel at 10:00 and 2:00, so as not to allow the vehicle to be blown about the road.
Maria was just about to switch the car radio to a news station, hoping to hear a weather report, when she saw the funnel cloud headed directly toward her.
Detroit, January 1997
In a haze of sleeplessness, I open the door to the general-surgery call room (aka “the Garage”) just after midnight. I’m one of two third-year medical students on this call team, and if I arrive first, I might be able to avoid the bunks with the most creased sheets and the pillows with head indentations still on them. The entire general-surgery team sleeps in this one room, with its messy bunks for eight and its odor of stale bodies. That is, we sleep during free moments, in rare fits, interrupted by pagers beeping and the door opening with a flash of light and closing with a loud click.
Climbing to an upper bunk, I get beeped: Code 1.
“There’s a transplant happening today,” said Sophie Lee, a resident, glancing at her pager.
It was a Saturday afternoon, and I was a second-year medical student doing a clerkship on the hepatobiliary surgery service (specializing in the liver and bile ducts).
I felt a pang of disappointment: Now I couldn’t go home until after dinner. But there was no use complaining. I followed Sophie to see the transplant recipient, Mr. Franklin.
For months, as I’ve visited Evan as his hospice social worker, he’s been praying to die. In his early nineties, he has been dealing with colorectal cancer for more than four years, and he’s flat tired out. As he sees it, the long days of illness have turned his life into a tedious, meaningless dirge with nothing to look forward to other than its end. He’s done, finished. He often talks about killing himself.
On this visit, though, his depression seems to have lifted. He’s engaged and upbeat–and this sudden about-face arouses my suspicions: Has he decided to do it? Is he planning a way out?
A few months ago my friend Phil gave me a newspaper clipping from the Sunday New York Times on body-focused repetitive behaviors, from nail-biting to hair-pulling to skin picking. I know he gave it to me because he wanted to help me with my own problem. He’s heard me express my frustration about it at the support group for faculty in our family-medicine residency.
I had planned to take care of my dad at the end of his life.
In 2009, Dad retired at seventy-five because of Parkinson’s disease. Over the next couple of years, he lived in his own home. My younger brother Mark, who lived nearby, faced the first difficult milestones brought on by Dad’s declining health. Mark was the one to tell Dad that he could no longer drive. And after Dad moved out, Mark took on the monumental project of cleaning a half-century of detritus from the house Dad left behind.
“I long, as does every human being, to be at home wherever I find myself.” — Maya Angelou
Before starting my dive into medicine, almost four years ago, I was an avid violinist, pianist, disc golfer and novice chef. Each of these activities felt comfortable and familiar–like “home.” But when I began medical school, I somewhat wistfully set them aside to focus on becoming a doctor.
I was young when I met Larry. Well, not that young: I was thirty-one. My medical training–thirteen years in all–was finally over, and I was working as an instructor in the child-neurology clinic at the University of Michigan, Ann Arbor, and caring for kids with epilepsy.
My patient Larry was seventeen. A stocky, dark-haired, nonathletic boy with borderline intellectual disability, he suffered from depression, and my notes mentioned his “pugnacious personality.”