Medicine as a calling

I have been thinking recently of a special patient whom I cared for during my residency. It has been 13 years since this happened, but I remember it as if it were yesterday.

I was the intern on the pediatric inpatient ward rotation during February and March at a military clinic and hospital in the Pacific Northwest that served as a referral center for military dependents from bases in several states. I was finishing my third inpatient month in a row and feeling the effects of frequent overnight calls (before the 80-hour workweek) as well as seasonal affective disorder from 100 consecutive days of overcast skies and rain. I finally had a day off and I was looking forward to lying around my apartment, catching up on opening my mail, paying bills in my pajamas, and taking a long nap. I needed a mental break from work, even if just for one day.

Around midday, my senior resident phoned me. She told me that our patient Anthony was asking for me to come in to be with him that day. I had known Anthony for more than a year. He was a 16-year-old boy with a tumor growing along his thoracic spine who had done chemo and radiation numerous times and had contemplated surgical excision. He was not given a good prognosis because of the extent of local spread of his tumor and the potential for paralysis from surgery or from more recent growth along the thoracic nerve outlets along his spine. Some neurosurgeons felt that the tumor was inoperable.

Anthony was becoming weaker and noting shortness of breath and paresthesia in his legs, trunk, and arms. He had a great family, a sweet girlfriend, and many friends who spent countless hours in his room sitting up at night with him on my many on-call nights. We talked about all kinds of things-how he felt about his tumor and treatments, his plans for the future, his fears. He had recently decided, after much discussion with his oncologist, neurosurgeon, and family, that he was not going to live paralyzed. He elected to have palliative care and enjoy what time he had left.

On this weekend, Anthony had a sense that the end was near. My senior resident explained that he didn't feel he had much time and he wanted to see me. At first, I just couldn't believe that I was going to get dressed and go back to the hospital. Yet I decided to go, and I spent the afternoon sitting with Anthony, his family, and his girlfriend. I fell asleep sitting up in the chair at one point. I don't think I fully appreciated what was going on with him, but he hugged me hard and thanked me for everything I had done to help him during his illness. I said good night and went home, falling into a very deep sleep as soon as I lay down.

I remember waking up around 4:30