It was deep into a winter Saturday afternoon that Mr. Monson came to the Emergency Room, drunk. Outside, the gray light was fading towards black and rain covered Solano County like a blanket of tears. In the ER, every gurney was filled. Ambulances and police cars were scattered in the parking circle, and the department teemed with busy staff, harried physicians, and worried family members.
Mr. Monson, though, was alone.
After practicing general internal medicine for 25 years, one thing had become clear to me. Well, perhaps more than one, but the pearl I want to share with you is a doozy.
What is this shing little gem, you inquire?
I don’t mean to be the town crier of bleakness, here, but it is increasingly hard to avoid the facts. The longer my tenure in the field of general internal medicine, the more ill and infirm become my panel of patients. The measure of my success as an internist is whether I keep my patients alive to travel further along the deeply-trodden path of aging. And lo, that way is fraught with peril: withering rose bushes whose pretty petals litter the ground but whose thorns remain pointy-sharp, greasy patches guaranteeing skids and mishaps galore, and a deepening twilight which darkens the trail ahead. The better I perform and the more people I send along that road, the further down the path they must trudge.
After close to three decades practicing medicine, I sometimes naively fancy myself an expert on the human condition in general and the aging process in particular. I have certainly borne witness during my years in practice. On my watch, I have shared much with my patients. Tens of thousands of iffice visits. Hundreds of hospitalizations. Thousands of operations. Problem lists growing longer with each passing year. Around 800 deaths.
coda: a passage at the end of a composition that brings it to a formal close
Physicians’ days are filled with codas. These finales to office visits, hospital visits, and procedures can be the most significant, moving, and revelatory moments in our profession of healing. I am continually impressed by the power of the coda for both the patient and the physician, though this power is often unrecognized. The brief, closing moments can cover more ground and unveil more about the patient’s situation than everything that came before. The wise physician pays heed to the coda. It often provides the key to the patient’s real concerns and the true nature of the illness. It can forge or damage the trust between patient and healer.
Yes, each day in the clinic has its frustrations. But it has rewards as well, things on which, when evening comes, I sometimes dwell. I want to share with your some of these small twinkling lights, which I occasionally contemplate late at night.
One thing I like is seeing patients who should be dead.