When I first met Florence in the ER, she'd already been dying for some time.
I was a third-year medical student doing my internal-medicine clerkship. Florence was a soft-spoken, tired woman in her sixties. To her, I was yet another face asking all the same questions, but she didn't mind telling her story again--although she did stop in the middle to tell me, "You have beautiful eyes." I paused to smile, then continued taking my history.
Florence was very overweight, diabetic, a mother to children who were somewhere far away, and a wife to a quiet, slender man with bags under his eyes. She and her husband both seemed less worried than I'd expected.
Only a month prior, Florence's nagging cough had revealed itself to be a cancer that had taken up half of her chest and part of her brain. She'd never smoked a cigarette in her life.
She'd been briefly admitted to the hospital and then released. After she'd been home for two weeks, her husband had been awakened early one morning by their bed's shaking: Florence was having a seizure. This time, we'd admitted her so that we could figure out whether she was seizing because she was taking too much insulin for her diabetes or because her brain simply couldn't bear the amount of tumor growing inside it.
Her first admission, in which she'd been transformed from a seemingly healthy diabetic to a stage-four cancer patient, had also started with a seizure. Now she wasn't eating as much as before--she and her husband jokingly blamed his cooking; that had been something she used to do--but she was still taking insulin at her old doses, which drove her blood sugars to seizure-inducing lows.
Easter was just around the corner. I told her I was sorry that she wouldn't be home for the holiday, but she just smiled and said, "I'm a Jehovah's Witness. It's just another day." She did often ask about her worsening anemia, knowing that if we needed to offer her a life-saving blood transfusion, she would have to refuse it.
Florence had other health issues: An infection had taken root deep in her lungs, commingling with the tumor, and it wasn't going to get better. Yet she was always warm and optimistic; when pressed, she would only complain about the nagging cough. Even though all she could bring up was spit, she kept trying to produce sputum and phlegm for the bacterial cultures that we'd ordered. To please us, she began to eat everything in sight: "I know I need my strength for the chemotherapy."
She believed that God would get her through this illness. I believed equally strongly that he would not, so during our visits I held her hand instead. It was easier than telling her the truth.
She believed that God would get her through this illness.
I believed equally strongly that he would not...
Between morning report, my rounds, team rounds, noon conference, note-writing, miscellaneous tasks, phone calls, faxes, presentations, lectures, studying for my exams and trying to get the work done and go home as soon as possible, I didn't seem to find much time for patient care. Everything else, including myself, got in the way. Even a medical student going through the motions of being a physician can be pressed for time, and after a few months I was already emulating the real deal--aping the busy intern.
Every morning, making my rounds, I'd visit Florence for a few minutes. I'd ask her the same questions and listen to the coarse sounds caused by the mucus plugging her lungs. Often, I would stop by again in the afternoon to see if any of our various ineffectual cough treatments might, through sheer persistence, have had any effect.
Every time I showed up, Florence would say "God bless you," holding my hand in both of hers. When I was getting ready to leave, she'd say, "Thank you for your kindness. Thank you for everything."
Hearing this, and knowing that I was doing the least I could do, I began to feel guilty. In the safety of the team room, Florence's intern and I took turns saying, "Gosh, Florence is the sweetest."
One night when our team was on call, I stopped by after I'd finished my last admission note. It was close to nine.
Florence smiled a painfully bright smile when I entered her room, then fixed me with a concerned look.
"They work you young doctors too hard. You're here almost as much as I am," she said.
"I'm not a doctor yet," I almost said; it was something I found myself saying often that year.
"You're here far more than I am, and I'm not dying," I almost said.
"I'm really glad you ate your whole dinner tonight--even the shake! That's excellent," I said instead.
Then I left, thinking it sad that a dying woman probably spent more time worrying about me than I spent worrying about her...that in some parallel universe it could be I who was somehow deserving of pity, even though it was she who would soon pass on.
About the author:
Ben White is a transitional-year intern at John Peter Smith Hospital in Forth Worth, Texas, after which he will begin his residency in diagnostic radiology at UT Southwestern this year. When work is done, he edits Nanoism, a site dedicated to extremely brief stories. His writing, an interest which developed while studying neurobiology at Harvard, can be found in journals and anthologies online and in print. "Honesty and perspective are a powerful lens. I find that writing nonfiction, especially about medicine, can be a uniquely troubling--but ultimately rewarding--exercise."