Mr. V.

One of my longtime patients, Mr. V. has surgery tomorrow. A soft spoken Puerto Rican man in his late 50s, he has had the proverbial 'nine lives'. Diagnosed with a rare form of sarcoma almost a decade ago, he has had to date four surgeries, radiation twice, chemotherapy three times, outlasted an oncologist or two, and generally trained a whole host of nurses, technicians and doctors on himself by virtue of his disease and, more importantly, his wonderfully insightful personality.

His surgery tomorrow is going to be brutal. For the last couple months, just a year or so from his last round of bone marrow destroying therapy, he started to feel some abdominal discomfort. A CT scan showed some small masses around both his left kidney and his stomach. Having not tolerated his last set of therapy so well, knowing the likelihood of recurrence, somehow having faith in a Creator, his family, his heritage and his slightly overwhelmed oncologist (me), he sat tight. He was feeling great and honestly, there weren't that many options out there. His surgeon wasn't excited about operating again, given the month long recovery required from the last hatchet job.

So, we wait. And wait. I get an email here or there. I'm in Puerto Rico. Now I'm in Florida. Here's a photo of my family. The surgeon and I both pretend it's all kosher. We just sort of do that thing doctors do sometimes, pretend everything is okay, smile and just pray that, despite your disease, the fact that you look so good will buy some "quality of life". So what happens?

Of course, it looks like he's progressing. Weight loss, fatigue, depression. The good times have stopped rolling. The masses are bigger. He's losing blood. Has a blood clot in the leg. Something is bleeding. He's vomiting. His wife looks more haggard than he does, shuffling all over the state trying to take care of him.

So, as I sit by his bedside, I can only imagine what is going through his mind. I can't imagine my face looked too happy. Usually, it's a bit of pep here or there, a joke, some comment on the family, whatever. This time, I'm at a loss. When you see someone continuously for three years, they become more than your patient. Not really a friend or family but something very distinct. Not the impersonal feeling of a brand new patient, but something akin to a comrade in arms. A fellow soldier. Someone you've humped through the bush, the desert, the bullshit for a couple years and now he's hit the goddamn landmine. Most of the time you just have talked shop, but that and the emotions involved are enough to bond you forever. Call it doctor-patient relationship. Whatever you want to call it. It's brutal.

"Why the sad look, Doc?" "You know, I imagine how hard it must be for you doctors to have to talk to sick people all day, one after the next... to try to give hope and comfort to strangers all day, every day. Thank you for taking care of me. My wife thanks you, too." Man, you don't hear that from patients that often... just hits the nail on the head, hits you in such a way that the air is just sucked from your lungs and the tears start to well up.

At that moment, I had to wonder who was the doctor and who was the patient. He'd been sick so long, he'd long since come to grips with his death. He'd found peace with his God and his family and his disease. I was the one who wasn't ready to face my own impotence, my own failings.

I have a terrible feeling deep down about this surgery. It is undoubtedly going to be a lot of tumor. It probably won't be fully resectable. I don't have many options for him for chemotherapy. We've talked in the past about hospice. We've talked about death... he has told me that he is at peace with this. But, as I hit this brick wall of therapuetic ineptitude, I try to think over and over again about the truth, the veracity of Mr. V's words, "Doctor, I know you've tried your best." No, Mr. V., you've tried YOUR best.

Mr. V., I pray your surgery goes well tomorrow. Godspeed. You've always said you loved to being a professor back in the day. That you liked to see the eyes of your students when they finally got it. You've certainly taught me a whole helluva lot about life. I think I might be getting it. Thank you.