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Never Say Die

Christine Todd

In November of my intern year, I had trouble finding the sun. It was dark when I woke up for work, and it was dark when work was done and I headed back home. I’d picked up the service on the cancer ward from an intern named Bob, and Bob had left me six handwritten pages on the subject of Jim Franklin.

And this was the deal: Jim Franklin, thirty-seven years old, had been living on the cancer ward for the last three months. He had a two-foot-high stack of records, and the pity and admiration of nearly every nurse, tech and doctor in the hospital. He’d been diagnosed with Hodgkin’s lymphoma four years earlier, treated with chemotherapy and thought to be cured. A year ago his cancer had recurred, and he’d been failing therapy in what could only be called a spectacular manner ever since.

By November, I had been a doctor for six months. I thought that I’d seen just about everything there was to see, but I had never seen this. Jim weighed ninety pounds, his hair and teeth were falling out, and his legs were covered with oozing sores that were never going to heal. He grew antibiotic-resistant bacteria and esoteric fungi out of his blood every time we cultured it. Most of my day was spent fielding calls from the lab about Jim’s consistently out-of-range test results. My chief resident looked over my shoulder at Jim’s chart one day and had this to say about the status of Jim’s protoplasm: “Incompatible with life.”

But the thing of it was that Jim Franklin did live, and this was most obvious to me in the way he got pissed off every morning when we interrupted his breakfast with more bad news about his body and he would let the oncologists have it.

“You morons tell me every day I have to gain weight! Why don’t you tell me how the goddamn hell you expect me to do that when you interrupt my damn breakfast every time I pick up my damn fork? I thought you retards were supposed to be fucking geniuses and shit. Hell, I’ve met dogs smarter than you pack of vultures. Go ahead, stand around and stare at me like the idiots you are.”

Privately, I sort of enjoyed hearing these morning tirades.

It was no secret that the specialists hated Jim. They couldn’t stand how he wasn’t going to live, but wouldn’t die. Watching these guys have to stand there and politely take it from a man who couldn’t even lift his head off the pillow delighted me. I worked all day every day on Jim, and I got a lot of sympathy from the other doctors for having to do so, but the secret was this: I was glad to.

I never told him, but Jim and I had more in common than he suspected. He was from a small town, as was I. He was far from his family, and his hospital room had become the entirety of his existence. I was new to town, and the hospital felt more familiar to me than my apartment, which I used only for sleep. Neither of us had any friends nearby. We were two lonely planets, set on intersecting orbits.

When I was alone with him in his room, drawing his blood or trying to find a vein for another IV, he would make his apologies to me for his morning tirades. He was old-fashioned enough to believe that you shouldn’t swear in front of a woman.

“Now, you know those are just words–I don’t mean anything by them.”

“No apology necessary.”

“Only thing left that I can do is swear. Look at me.” He showed me his arms, his elbows thicker around than his biceps. “I used be a big guy. Hard to believe!”

“You should get your family to bring in some pictures, so people could see how you were.”

“Nah, my family ain’t coming all the way up here to bring me pictures. The day they brought me up here they knew I wasn’t coming home except in a coffin.” He looked at me out of the corner of his eye, and pointed to himself.

“Piss and vinegar,” he said. “You’re stuck with me, and I’m stuck with you.”

The radiologist felt that Jim Franklin was a waste of X-ray film. One day he threw Jim’s latest chest film on the light box and gestured vaguely at it: “There’s nothing normal about this X-ray.” He meant the eaten-away bone, the big, weak heart, the fluid on the lungs, the huge tumors.

I knew the radiologist meant that the dirty thumbprints of Jim’s cancer were everywhere. But the way in which he said it made me mad. Jim’s X-ray suggested nothing but hopelessness–but every day I walked into his room and saw someone who was still alive. The radiologist didn’t have to deal with that, but I did.

So I pointed to the bones of Jim’s left shoulder.

“It’s normal right there,” I told him.

He snickered, but I was in earnest. And in fact the radiologists never did find anything wrong with his left shoulder, even though I was to order many more X-rays, tempting fate each time. And the intern who took over his case when I left the ward at the end of the month took up where I’d left off and ordered some more, right up until the day after Christmas.

That’s when Jim’s family showed up, packed his things and took him home. He didn’t leave in a coffin, like he’d predicted, but we all knew he was never coming back.

A folder of Jim’s X-rays, labeled “Volume 17,” lay around on a desk on the oncology ward, collecting dust. Late at night, having been called up to the ward to attend to a fever or a headache, residents would page through his films, deep in some sad, sentimental fog. We missed him. I missed him.

So one evening, when no one was looking, I took one of his chest X-rays and cut out the left shoulder. It was a piece of film the size of an index card, and I carried it around in my pocket.

There was, in May of my intern year, a solar eclipse. I was surrounded by charts and deep in thought about a note when a nurse shook my arm, telling me that it was happening, and I was going to miss it. I ran down the stairwell and out onto the pavement outside the ambulance bay.

The sun was bright and strong, and half the residents in the hospital were out there, waiting and fingering their chirping beepers. The buildings of the hospital muscled in around us. The internists all had little three-by-five-inch cards in which they’d poked pinholes. They were ready to safely project the eclipse onto the asphalt in front of them.

To me, that seemed like a lousy way to watch such an exciting thing happen–the wrong time to be so prudent. I considered just squinting straight up at it, the way the surgeons were, chancing blindness. Then I saw the radiologists across the way. They all had X-rays in their hands, and they were holding them up to the summer sky and looking through them. They regarded the sun through a film of sickness and shadow.

In November of my intern year, I had trouble finding the sun. In May, I found myself looking right at it. I took Jim Franklin’s normal shoulder out of my pocket, and I looked up and through.

For a few moments the eclipse was absolutely perfect, earth-silencing, a ring of white in the dim sky.

In those seconds, our little crowd paused in mid-breath, just a little scared. We stood expectant, waiting to feel the warmth of the sun once again and be reassured. And then I heard a bird chirp, and I heard the traffic roar. The sun slipped from behind shadow, and I felt the world resume.

I returned to work, putting Jim’s X-ray back in my pocket, but knowing I’d see the world through his shadow for a long while yet.

About the author:

A general internist specializing in hospital medicine, Christine Todd chairs the department of medical humanities at her alma mater, SIU School of Medicine in Springfield, IL. She obtained her AB in the creative-writing program at the University of Chicago. Her reflection “He Says You Are Finished” appeared in Annals of Internal Medicine this past spring. Her blog is “That I could never choose between being a writer or being a doctor was a source of stress when I was younger, but I now see that the two occupations so overlap as to be almost one and the same. When I chose in college to pursue a degree in English literature while also intending to go to medical school, many people told me that being a writer would make me a much better doctor. Actually, I’ve found that it’s a two-way street: Being a doctor has also made me a much better writer, not just by giving me substrate about which to write but by forcing me to empathize with and reflect on people and situations that are far from anything I could have imagined. I found my residency to be a huge inhale of medical knowledge and all sorts of humanity. Almost twenty years later, I’m still finding insights in my memories of that time. This story, based on an experience that often bubbles up in my mind, is one of my most valuable and cherished.”

Story editor:

Diane Guernsey


26 thoughts on “Never Say Die”

  1. I am currently going through treatment for Stage 1 Breast Cancer. I really appreciated this message for more reasons than one. As I know my prognosis is very different from Jim’s, the anger, sadness and frustration is very real. I appreciate how you put the human touch to this horrible disease. I have experienced many wonderful medical providers through my journey. And for this, I am very thankful.

  2. This is so wonderful! Thank you Dr. Todd for telling Jim Franklin’s story and how he impacted you. Very inspiring.

  3. Ronna L. Edelstein

    As I read this, I felt that the author had the skills and education of a physician but the soul of a poet and writer. I was not surprised, therefore, to read that Christine Todd has a degree in creative writing. I wish all physicians took writing classes–classes that encouraged them to look inward and remember that patients are people, not diseases, and that even patients with a terminal illness deserve a life of respect and dignity. Thank you, Dr. Todd, for such a beautiful story.

  4. I could relate so much to your beautiful story. I also have strong memories from my intern year about the patients I got to know. Every story left an impression back then. It’s a struggle to maintain that sensitivity over the years and I think writing helps us do just that.

  5. How many of us become writers or, as me, writers from birth. I am a screen-writer and novelist. Medicine is the ultimate story, isn’t it? We see people in their final common denominators…thus reducing us, physicians, to …what? I write about that experience, the effect of medicine on the doctor…me. Get Kaleidoscope on Amazon and look for Medicine Man, my new story, about my descent into cocaine use and destroying everyone and everything around me and my career…and the return.

  6. Dr.Todd’s depth & elegance validates my devotion to physician-writers. Thank you for sharing Jim Franklin with us. His life mattered…and now it will always, to so many.

    PS Christine, I just visited your blog page. Wanted to subscribe but see there’s no mechanism to do so (unless I missed it). Please advise if there’s a way. Thanks very much..

    1. Janice, thank you so much for your comments. I added a follow by email gadget to my blog, so you can sign up and get an email when there is something new!

  7. Dr. Todd, that was a powerful story. I admire your dedication to your patient. I have had the experience of trying to summon up the strength to round on someone for whom I have little to offer in treatment. You remind me that we are all therapeutic instruments and that kindness is a treatment which is always appropriate, even necessary in some cases. Your patients are fortunate to have you.

  8. Thank you for this incredibly inspiring story. Your story will stay with me for a long time. It was difficult to write this comment through tears.e

  9. Christine,
    Your beautifully written story has revived my soul with the memory of a time when healthcare was truly about our shared humanity. A sincere thank you.

  10. Although I like reading most of the narratives in this journal, this one moved me more than any in a long time. She captures the spirit of this dying man and writes about him beautifully, i can still picure that clipped Xray of his shoulder in her pocket, the memory of both him and that amazing eclipse glowing through it,

  11. Beautifully written. It evokes for me a time past when medical training – and indeed lives in health care for many – were all consuming. That’s how I trained too. That was my life, not just a job. It was all consuming and very satisfying – but probably not always that healthy. I wonder were you also holding on to a part of your own health as you preserved Jim’s normal shoulder? thanks.

  12. “his elbows thicker than his biceps,” is the most beautiful and evocative phrase I’ve read all week, and I read a lot.
    My God, woman! Now I’m going to go back and read the rest. But first, will you be at AAMC in Seattle in November? if yes, we should connect. I also write, sometimes about medicine, but never non-fiction.

  13. Hi Christine,
    Your writing is excellent and you must be a special doc too. I also share your two worlds. My BA in English Lit and Creative Writing – with an emphasis on poetry – has combined very well with my MD. I don’t meet many fellow travelers and it’s nice to find you are out there. Thanks for submitting your work to Pulse. .

  14. Thank you so much for writing this, Christine. You have captured truth using the perfect image. To me there is nothing more mysterious and mystical than the human body and its will to survive. I recareered as a Hospice RN after being a professional librarian for 20 years. Thanks again.

  15. Dear Christine,
    This is written through the tears – hope you take that as the compliment I meant it to be. I’ve read and experienced a lot of doctor’s behaviors and thoughts and feelings over a 35+ year career as a nurse, and through a lot of reading too. Thanks for a beautiful story, and for reminding me of my favorite doctor/writer (or is that really writer/doctor?) Richard Selzer. I assume that you know him, and if by some miracle you don’t, I believe that you’ll like him.
    Thanks again,

  16. Nicely told. My opinion, and my opinion only you understand, but more would -be writers ought to be about something other than being a writer. My God, be a doctor or a salesman or even a mud wrestler, but not just a writer. What an empty ambition to possess, becoming a writer. The occupation has been grossly oversold in our world. Too damn many poets ,I say, and too few grade school teachers.
    Again, a good piece by a good writer with something to say. Kind of rare.

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