“I will repay you for the years the locusts have eaten...”
I was in the most sullen of moods when the alarm went off at five in the morning. My feet begrudgingly hit the floor to face yet another day at work. Another day of taking care of ungrateful sick folks; smelling their smells and being blamed for things far out of my control. Understaffed. Sleep deprived. Unappreciated.
And that day of all days. Why could I not celebrate that one day with my family? Was that really asking too much? It was Thanksgiving, after all, and my extended family had travelled from out of state to visit and spend the holiday with us. Now, with the hospital patient census soaring through the roof and our lack of adequate staff, the day would be practically over before I ever got home. I knew how it would feel arriving home, dragging myself through the door to meet their smiling faces all the while grieving over the time I had lost. Time that I could not regain.
So, with those thoughts hanging gloomily over my head, I grabbed my coat and, as quietly as I could, stepped out into the cool and dark November morning. I tossed my stethoscope over into the passenger seat of my truck as I turned the ignition and the engine roared faithfully to life. With the press of a button, the garage door squeaked open and I was soon dodging deer on the familiar drive to the hospital.
The sun had still not yet risen as I eased my truck into the deserted parking lot. I crossed the shadowy parking lot and scanned my badge to open the side entrance and stepped out of the brisk air into the warmth of the hospital hallway. Taking a right turn, I retraced my usual steps to the administrative conference room where I always received my newly assigned patients. Opening the door to the room, I was greeted by the fatigued face of my partner who had been the overnight admitting physician.
“Your expression says it all,” I said in greeting as I managed a smile. “Looks like it was a rough night.”
She managed a weary grin in response.
“You know,” she began. “You’d think a hospital would be the absolute last place that people would want to come on the night before Thanksgiving. But, as last night proved, I never cease to be amazed.”
She then fumbled through the neat stack of papers near her right hand until she found the specific sheet she was looking for. Her arm then stretched forward as she handed it to me.
“I wish the number of patients was better, especially on a holiday,” she began. “But, unfortunately it’s not. Everyone is going to have a lot of patients to see today.”
I responded by telling her that it was no less than I expected and that it was not her fault, but truthfully the lengthy list did nothing to elevate my mood.
“If it’s any consolation,” she added as I turned to go. “The last patient that I gave you on your list is a comfort care only patient. End stage cancer. I’m not trying to be morbid, but if you get delayed in getting to see him, you may not get to see him at all.”
I nodded in response and turned once again to leave and begin the day.
The day progressed no better than I had expected. The patients remaining in the hospital over the holiday were understandably melancholy and with so many of the ancillary staff out for the day it was difficult to make much progress with treatment. The nursing staff, as always, tried to make the best of the situation and many of the staff had brought their holiday specialty dishes to work as part of the annual Thanksgiving potluck lunch. On each floor that I visited, I was invited to try many of the dishes as there was always plenty of food, but each time I politely declined. I was empathetic with the suffering of those around me but I could also never quite rid my mind of the thoughts of my family at home without me and I did not want any distractions that would delay me from getting home. It was already going to be late enough.
I had just finished turning down yet another offer to try someone’s grandmother’s famous pecan pie when I realized that I was on the same hospital floor as my comfort care patient. My original intent had been to see him toward the end of the day as there was really very little that I could offer and the nursing staff was always excellent at contacting me if a patient’s symptoms were not controlled. However, I realized that it would be much more efficient just to go ahead and see him while I was on the floor and make sure that there was nothing that he needed. It would also allow me to avoid having to make a special trip back to that floor at the end of my rounds. I quickly grabbed a free computer and logged on before grabbing my stethoscope and placing it around my neck and heading down the hallway.
As I headed down the hallway, I began to think about the man that I would meet in just a few moments. In those situations involving comfort care, all possible medical therapies had been exhausted and the only options left were completely palliative and intended only to provide comfort. Comfort care patients have a way of reminding those who are healthy about the reality of the brevity of life. Any illusion of health is only temporary, as death inevitably comes for us all. Some much sooner than others.
My mind was occupied by these thoughts as my hand reached out for the door handle leading to the patient’s room. The door slowly swung open as I gently knocked on the frame to announce my arrival. As my head peaked around the edge of the door, my eyes begin to adjust to the dimly lit room where my attention focused on the patient lying in bed with the head of the bed elevated. At first, I thought the patient was sleeping but he soon turned to face the door and greeted my entrance with a weak smile.
He was a middle-aged man who was very thin and pale, his skin color evident even in the low light. His cheek bones were very prominent and gave his eyes a sunken appearance. His extremities were mainly skin and bone. A morphine infusion was connected to his IV line to help control his pain. His smile, while genuine, seemed to take great effort to produce. I introduced myself and stepped over to his bed.
“It’s nice to meet you, doc,” he began in a raspy voice. “I appreciate you coming by, but I’m sorry it had to be on Thanksgiving.“
I assured him that I didn’t mind, knowing all the while that I was being hypocritical.
“So, how are you feeling?” I continued.
“You know, today is actually not too bad,” he responded. “Now, I mean no disrespect whatsoever but it sure does improve a fellow’s demeanor to have such pleasant ladies take care of him. I just feel badly that they have to do everything for me these days.”
“Don’t feel badly,” I responded. “It comes with the territory.”
The multiple IV lines hanging from the nearby steel pole suddenly reminded me of the purpose of my visit.
“How is your pain?”
“Well, “ he said motioning to his morphine pump. “As long as my friend here keeps working, I’m fine for the time being.”
My attention was then diverted to his bedside table where I saw a food tray sitting, apparently completely untouched, with the silverware still unopened. I lifted the plastic lid to reveal a classic Thanksgiving meal, complete with turkey, dressing, and sweet potatoes. Not a bite had been eaten. He looked wistfully at the tray as if remembering a time when such things mattered.
“Appetite not too good?” I inquired.
He shook his head.
“No, I knew that I wasn’t going to eat it even when I ordered it. I’m not hungry, but it just made me feel better having it here, with it being Thanksgiving and all. I guess kind of like Christmas decorations always lift your spirits. But, now that I think about it, I suppose that’s kind of wasteful.”
I told him I understood.
“Is your breathing OK?” I inquired.
“It’s fine for now.”
“Ok. If any thing changes or if there is anything I can do, just let me know. Let me take a quick listen to your heart and lungs here.”
With those words, I removed my stethoscope from around my neck and assisted him with sitting up in bed as he lacked the strength to do so on his own. I pressed my stethoscope over the usual areas of his back and listened to his shallow breaths, all the while noticing the protruding ribs that ran in prominent ridges on either side of his spine. As I did so, I could tell that his attention had been captured by some other distraction.
“Isn’t it amazing just how many of those we get to see?”
With the tips of the stethoscope in my ears, his voice was muffled, but I was nonetheless still able to understand him. However, I wasn’t exactly sure what he was referring to.
“I’m sorry,” I said as I removed the stethoscope from my ears and helped him to ease gently back down on his pillow. “I didn’t catch what you were saying just now.”
Without speaking, he pointed out his room window which was facing westward toward the Blue Ridge Mountains. The evening sun was beginning to set and was already painting the evening sky and the scattered clouds on the horizon with beautiful shades of orange and crimson. The gray shapes of the distant peaks cut sharp silhouettes into the straight line of the horizon as they stretched heavenward. I would have been too distracted to notice had he not redirected my attention.
“I mean, think about it,” he began. “On many if not most evenings we get the privilege of seeing that kind of a masterpiece. Most mornings, too. No two are just alike. And yet, because they happen so frequently, we don’t even notice them. They aren’t even something that we deserve.”
His focus remained outside his room, caught up in that far off place of swirling colors. Without changing his expression, he breathed a profound sentence.
“I made a mess of things, doc.”
I did not know how to respond, but his redirection of my attention to the beauty painted in the evening sky made me forget my previous melancholy. Without speaking, I pulled up a chair and took a seat beside his bed.
“When I was disrespectful to my parents,” he continued. “The sun still faithfully rose. When I stormed out of my parent’s home and left behind the two people on this earth that loved me the most, the evening sky was still painted with the colors that you see outside now. When I found that precious young girl and mistreated her when all she wanted was someone to provide and care for her, the mountain laurel still bloomed. When I loved alcohol more than anything or anyone and would wake up from my drunken stupor, I would still hear the rain falling outside.”
I remained silent and mesmerized.
“And I reaped what I sowed. I deserve what I got. There is no one left to blame.”
His voice began to tremble.
“But for the life of me, I promise you that when I look back, He repaid me with good in return for whatever evil I did. Beauty in exchange for ashes. He blessed me in exchange for the years the locusts ate, even though it was of my own doing.”
My eyes fell to the floor as his words brought to life the wasted years of my own life.
“So you see, doc, I deserve to die alone. There is no one left in my life to push away. But, I can see now that He has been pursuing me my whole life.”
He paused as he drew a deep breath.
“I won’t be lonely much longer.”
There was nothing for me to say. What could I say? He had summed up human existence in his short discourse. No matter the size of a person’s debt, it remained a sum that could never be paid by one’s own merit. But, to be paid back with good in exchange for evil? No greater love existed. Out of respect, I remained silent.
“So, what is your favorite food?” I asked when the time was right.
“I’ve always been a sweets person if you want to know the truth,” he said with a grin.
“Fair enough,” I responded. “What’s your favorite dessert?”
“Well, you are in luck. My mother-in-law is in town and, I have to admit, her pumpkin pie recipe is one of the best. I’ll bring you a piece tomorrow. Even if you can’t eat it.”
He smiled in return.
“Just like decorations at Christmas.”
“Just like decorations at Christmas.“
I finished rounding and drove home in the darkness with a completely different mood than I possessed during my morning drive, and one that could be best described as guilt. I had done nothing but complain. Yet, there he remained in the loneliness of his hospital room, dying, and thankful for one more sunset.
I walked through the door of my home into the warmth of love and family. Gone was the regret of what time I felt had been lost, replaced by thankfulness for the time that I had. I immediately found the pumpkin pie and cut a slice before sealing it in a small plastic container for the next day.
The next morning found me back at the hospital before dawn with renewed purpose. I had been very careful to make sure that the single piece of pumpkin pie remained unscathed in its container. It was the least I could do for someone who had reminded me of what in life was truly eternal.
But, when I arrived at his room, I found it unoccupied with fresh, crisp sheets covering the bed and a recently mopped, spotless floor. Fearing the worst, I found his night nurse, before her presence was required at morning report.
“He passed away around one this morning,” she said respectfully. “He seemed at peace. I think he passed in his sleep.”
I gazed down at the container with the piece of pie. I could think of nothing to say.
“It’s always a comfort to me,” she stated as she searched for something to break the silence. “That maybe patients could learn something from us to comfort them in the end.”
I turned and walked away slowly, mumbling that he had taught me more in fifteen minutes than I could have taught him in a lifetime.