It is twenty past five on a Thursday afternoon. Dr Wong and I are rounding on my last patient, ninety-year-old Mr Patel.
“Hello, Mister Patel,” says Dr Wong, the fake cheer in her voice too pathetic to fool even a small child. It is her first day on our ward, an emergency locum called in, and she is tired. She is ready to go home, ready to be done with these patients. She was speaking with the surgeon on call about a pool and margaritas only a few minutes ago. “How are you today? How’s your pain?”
“I’m terrible, thanks for asking,” says Mr Patel, folding the newspaper he was reading neatly in his lap. “I’m sick of this place. Takes forever to get anything done. And you doctors come around here at your own convenience. I ask and ask, but no one comes. I want to know what’s going on. I’ve been in here long enough. I want some answers. I’m like a goddam prisoner here, and I’m real sick of you doctors not telling me anything.” Mr Patel is using the same rant he’s used for the past week, even though I’ve addressed everything twice today alone. Perhaps he thinks that Dr Wong might give him more answers, an idea not completely unfounded. She is the doctor, after all. But Dr Wong stiffens, as if Mr Patel’s words are personally insulting. “I’m sorry, sir,” she says. I can hear her teeth gritting from across the room, where I stand. “But doctors are very busy people, and I’m sorry if you don’t realise that you’re not the only patient on this floor. Or this hospital.”
I don’t know who is more taken aback by this outburst, Mr Patel or me. Mr Patel has been here for over one month without diagnosis or treatment with any curative intent. His CT scan alone was delayed four times over the past twelve days. To me, Mr Patel has every right to be upset. His situation is a mixture of bad luck, failed communication, and, yes, blatant incompetence on several staff members’ parts. But, as upset as he is, Mr Patel’s family is even angrier. I have met all four of his sons, two of his three daughters, two daughter-in-laws, five grandchildren, a brother, a neighbour, and, of course, his ever-present wife, with her elaborate embroidery she works on by the window.
But Dr Wong doesn’t know this. All she sees is a wrinkly old man who reeks of faeces and stale urine standing between her and her pool and margaritas. Dr Wong is tired. She is worn-down. Her empathy metre has run out years ago. I make excuses for her as her mouth opens, spilling words out. “Your CT scan results came back,” she says, her voice devoid of emotion, her eyes bored. “They show that you’ve got lung cancer, spread to the liver, brain, and most of the bones. There’s some thick parts around the bladder, too. Not sure what that is, but no use in looking, really. You’ll be dead before we can get the test results back. Nothing we can do. You’d better call in any family from out of town,” Dr Wong nods to the corner, acknowledging Mr Patel’s wife for the first time. “Won’t be long, now.”
With those words, Dr Wong turned on her heels, and left the room. “Hey, kid, consult palliative care,” she calls to me. “There’s probably no point in a hospice referral, but we’d better put it in to make the admin happy. Palliative closes at three-thirty, so get to it.”
Mr Patel’s wife is crying. Her eyes are big, red, and puffy, and her embroidery has been discarded on the floor. I place a hand on her shoulder, searching for words of comfort, kindness, anything to ease the blow they have just been given. But Dr Wong’s screeching voice is calling me outside the room, a pulsing distraction, and I can only squeeze her shoulder before running outside, grabbing the ringing telephone from the outstretched hand to speak with the palliative care nurse. Dr Wong interrupts every few seconds before grabbing the phone back. “Stupid girl,” she says. “Can’t you even do a simple consult? Brad,” she says to the phone. “The man’s dying. Room 32. Scopolamine, hydromorph, do what you have to do. Sure, the kid’ll do a hospice referral, but he’s circling the drain. Yep. Yep, he’s not leaving this place.”
Fifty-two years ago, Mr Patel quit his job as a mechanic to open the first of a successful chain of daycares, of which he was still the honorary president. He had spent a good half-hour this morning describing the details to me, noting that many of his former charges had gone on to become politicians, teachers, lawyers, doctors, artists. His eyes glimmered with hope and energy when he spoke about the children. “Every child is a new world,” he told me. “It only takes one person to change the world. For better or for worse, well, that remains to be seen. But when you’re in a room full of thirty children…think of all the things that those thirty could do to make this world a better place!”
But, the next morning, when I go to see Mr Patel, he is Cheynes-Stoking on the bed. His breaths are ragged, uneven and laboured. His eyes are wide, but unseeing. There is family gathered around the bed: his wife, two sons, two daughter-in-laws, and a little girl. I take Mr Patel’s hand, and squeeze it. There is a feeble response, but it is so weak I am not sure if I have imagined it.
I want to ask what happened, what’s happening, but I’m not sure how. The words have died in my throat, and my tongue is useless. But Mrs Patel spares me the agony of standing in silence. “He went down overnight,” she says, the ever-present embroidery now strangely missing. “Didn’t eat supper, didn’t sleep, just…this.”
“Oh,” I say. I need to say something. I have to say something. Some word of comfort, some solace, some support. But years and years of training fly out the window, and I squeeze Mr Patel’s hand, only to get no response this time.
“So,” says Mrs Patel, “I guess we just wait? For the hospice bed?” Mr Patel is circling the drain, medical lingo for ‘actively dying’. But there is no need to reiterate what we both know, so I just say, “Yes. Yes, I think that’s the plan. I put the request in yesterday.”
Mrs Patel nods, her expression as blank as I feel. “We’ll be around all day,” I say, citing Dr Wong’s presence as if she might be some sort of assistance or comfort. “Just call if you need anything.”
Mr Patel dies several hours later. I’m in the room when Dr Wong pronounces him, not bothering to listen to his heart or check reflexes. There’s really no need to; Mr Patel’s mouth is open, eyes wide, body stiff and still, even in this early hour. The death certificate says ‘metastatic lung cancer’, but I know better. Mr Patel declined more quickly in twelve hours than in the past four weeks I had known him. He died of a broken heart, of lost hope, of crushed dreams. I want to blame Dr Wong. I am furious that she was so matter-of-fact, so unkind.
But she is human. How many patients has she seen die? You can’t feel for everyone. If you do, you’ll get worn out. Either way, you’ll end up like Dr Wong, a bright-eyed medical student hidden beneath the stony, cold-edged, uncaring exterior. I wonder if she realises that anyone could take offense to her behaviour.
There is a complaint filed against Dr Wong, but it is brushed off as the last resort of a grieving family to make some sense of their loved one’s passing. I receive a new patient, a Mrs Rebecca O’Leary in with pancreatitis. She has two children and five dogs. She is sent home after five days, and I move on. I see more patients. Some of them go home. Some of them don’t. A kinder, younger physician calls them ‘celestial discharges’. But I’m not used to it. Not here, not yet. Will I ever be? I’m not sure. I hope not, because, if I do, I will have become just like Dr Wong herself.
And still, with every dying patient I see, my tongue still freezes, and I feel my heart freeze still. But, really, what can you say, when a patient of yours is circling the drain?