I have modified the names of the patients in my stories to protect their identities, and am writing these stories based on my memory alone. These stories are very close to my heart and are not meant to offend anyone. I understand that my view of the medical school experience is one of countless different views, and I am simply stating them.

For those who are used to reading my Lyme blog, please be aware this blog is much more graphic and uses adult language. The graphic nature of some of the stories are not meant for the faint of heart.

Saturday, August 20, 2011


‘twas the night before Christmas, and all through the house, not a creature was stirring. That is, except for me.  I lay on my bed as tears rolled down the sides of my face.  This was a quiet kind of crying.  Not the kind that craves a shoulder, or could be soothed by friends, or should be kissed away.  I was not particularly feeling sad, or lonely.  There was no self pity in these tears.  The pillow that had on so many occasions dutifully collected my tears of grief, on this night before Christmas, was fulfilling its duties for another reason altogether.  On this night, the tears were for the sake of old man Hansen.

Old men are not all the same, but they mainly come in one of three different flavors.  The first flavor, thankfully the rarest, is the all-bitter type.  These are the men that yell at you on the subway for speaking on your cell phone, or corner you in a library and harass you for not sitting properly at the table.  These men must have lived a long life full of disappointments and loss, are angry, and have vowed to make everyone they run into pay for it.  Naturally, these men live to be about five thousand years old to maximize the time they can torment others.  They are beyond reach. 

The second flavor is most favored in old movies.  These are the bitter-sweet men.  You know the story-line; lonely man, snaps at everyone and everything in sight, and walks around with the map of Los Angeles engraved in the form of frowns on his forehead.  Then by some odd chance this man runs into a cute little girl with curly blond hair, and due to some crazy circumstances they must live together in a place isolated from the rest of the world.  After two hours of  boring you to death, the man finally smiles and gives the child a nice hug while tears of joy stream down both of their faces.  These men are more common, and beneath their bitter exterior, there is really someone sweet, and reachable.

The third and commonest old-man flavor is all sweetness.  These are men who have lived a long life, have faced disappointments and grief, but also have loved and been loved.  They have reached old age with a positive attitude, have learned to take life’s ups and downs in good stride, always talk sweetly to children and have a kind smile on their faces.  They always seem to have good stories to tell, and if you keep your heart open, they can reach you. 

Mr. Hansen was all sweetness.

He was in his late sixties or early seventies, altogether too young to die.  He was admitted to our inpatient medicine service in July, transferred from another hospital.  At the other hospital he had been treated for something I forget, but something benign, like a broken toe.  However, as they had run some routine studies on him, they had found tumors everywhere.  Further studies had indicated advanced and highly spread cancer in its late stages.  Of course all they had told him was that he had some “masses” in his body and was being transferred to us for evaluation.  Poor thing, he was brought in by an ambulance, but ended up waiting on the gurney for many hours since we did not have a bed ready for him.  When we finally found him a bed, as soon as he was placed in it, the ceiling above him started collapsing.  We rolled his bed out just as big chunks of ceiling were falling onto where he had been a few seconds before.  I ended up taking his history out in the hallway while we waited for the maintenance men to fix the ceiling.  Despite all of this, he was far from angry and talked with me in high spirits.  He turned out to be a veteran of world war II, a father of three, and grandfather of many.  You’d be amazed at how much you can learn about a person if you just pull up a chair, sit next to them, and listen.

At some point in our conversation he built up enough courage to ask me about these “masses.”  No one had told him what they were.  He had his suspicions, but even as he feared the worst, he was still hopeful for the best.  I thought about pretending not to know anything and deferring his questions to the doctors, but I could tell that he really wanted to know, and was frustrated with everyone bouncing his questions off to someone else.  So I told him.  I held his hand and said that things did not look good.  That the studies had shown these “masses” were all cancer which had spread all over his body.   As I told him all this, I could see all of his hope seeping out of him, and the sweet smiling face of only a few minutes ago was replaced by a sad, terrified face.  He was silent for some time, and then the first words out of his mouth were “How Long –  How long do I have?”  For which I had no answer.

The hospital in which Mr. Hansen was staying is no ordinary hospital.  It is the type of hospital where you – the doctor or medical student – would place your orders in the state-of-the-art computer program.  Pick any order as an example; make it simple, say a blood draw.  You place your order into this geniously designed piece of software knowing that you’ll have to make twelve phone calls, meet five different executives, and get down on your knees and beg seven times before the blood is drawn.  Then comes the challenging part; making sure that the blood actually makes it to the lab before the end of the century (21st century to be precise).  The job of a medical student working in such a hospital is wrought with peril. 

To add to the excitement, the floor on which our team room was located had a very special head nurse.  One of the routine daily duties of this nurse was to pop into our room at any hour and make life miserable for us.  She did not discriminate between the residents and the students and derived much pleasure from yelling at the whole lot of us.  Some mornings I could tell she had just flown into her office through the window, since in her eagerness to start her day by ruining ours, she would forget to stash away her broomstick and pointed hat and would run into our room still fully clothed as the wicked witch she was, waving her broomstick in the air and cackling as she worked up a storm!  Sometimes when I was the only unfortunate one in the room during her attack, I would wait until her storm was over, and then have a good cry after she was gone.  At other times, when the whole team was there, we would wait for her to leave and then laugh at her craziness.  Although we did stifle our laughs to make sure that her little spy gnomes hiding in our drawers would not report our bad behavior to her.  During our service there a couple of the medical students on our floor “dropped out” of the medical school altogether.  Or at least that’s the explanation the administration gave us.  I think that’s just a cover up story though.  The more logical explanation would be that the head nurse ate them.  She must have been made head nurse as a strategy to keep her away from patients, for the safety of the patients of course.  Once she had a field day with me over something I’d done for Mr. Hansen.

Mr. Hansen needed many studies and procedures done while he was with us.  I’m not exactly sure why since there really was not much we could do for him.  Maybe we did all those tests for our own sakes, just so we felt like we were doing something.  So that we wouldn’t feel so incompetent, so utterly impotent, in the face of death. For whatever reason, all these studies were ordered.  CAT scans, MRIs, X-rays, and any other imaging study that has been created in medicine to date.  As a general rule, studies ordered in this hospital were never actually carried out.  There was never anyone available to transport the patient to the location of the study at their given appointment time.  Later on in the service I learned to transport the patients myself, and to flip off anyone that tried to stop me.  But at that time I was still new and rather civilized, so the transportation of Mr. Hansen posed a real problem for me.

I devised a plan to overcome the hurdle of transportation by asking Mr. Hansen’s family members to take him, as I had met them all by that time and felt very comfortable with them, and they in return trusted me.  We planned everything with the family the day before.  The study was scheduled for eight in the morning, and a son was to come in at a half passed seven and take the patient down with the wheelchair I had left there the night before.  The way we schemed and plotted, all whispering and looking around, wary of listening ears, you’d think we were plotting an assassination! 

On the morning of the appointment I came in confident that my patient would receive the care that he needed with the help of his son.  Around 7:30 in the morning, as we were all working in our team room, we heard a loud screech and a sound of laughter that chilled us to the bone.  We could deduce from the sounds that the head nurse was about to claim a new sacrifice.  We waited in utter dread to find out who the intended victim was.  And she walked into our room, red in the face, breathing hard, poised for the kill. 

“Which one of you arranged the transportation of Mr. Hansen with his son?” she asked, as she scanned our horror-struck faces. 

I felt my heart sink down into my shoes, and I knew – I was on the menu as the fresh catch of the day.  She ripped me to pieces, and took her time in doing so.  She yelled and screamed, waved her arms in the air, insulted me and all my ancestors, and when she was all out of steam, she left the room and sent in her pupil witches-in-training to abuse me.  To this day, if I do a half-assed job at everything I do, it’s because she bit off the other half. 

What she had not planned on, however, was that this experience only brought me closer to Mr. Hansen and his family.  They were very concerned about the trouble they had gotten me into.  It turned out that the son had shown up in the morning, only to find the wheelchair I had left next to his father had disappeared, so he had to ask for one.  Instead of getting a wheelchair, he had received a full interrogation by the head nurse.  He had tried to cover for me, but she has her ways of making people talk.  He had finally cracked under her pressure and sold me out. 

Mr. Hansen was eventually transported for his study and many other ones, and I went with him to all of them.  During his stay, I spent time with him and his family, and made sure that his questions were answered and his needs were met.  He tried asking his famous “how long” question from all of the doctors, and never got a clear answer – there is no clear answer.  They told him that the tumor had started in his lungs and then spread to his brain, his liver, and his kidneys; that there was no hope of an operation.  That he didn’t have much time; maybe enough to get his affairs in order and say his good-byes.  They told him all this as his eight year old granddaughter was sitting next to his bed, staring at the floor and pretending to be invisible, in perfect compliance with the doctors who had pretended not to see her.  I repeatedly heard Mr. Hansen say to the doctors “Well, I’ll be happy if I make it ‘till Christmas.”

I had forgotten about Mr. Hansen.  So many different patients to see, exams to take, homework to do, assignments to finish, and hoops to jump through before you can call yourself a doctor.  But on the night before Christmas, as I lay in bed in those sleepless hours when I can no longer ignore all the emotions I had suppressed, I found myself wondering if Mr. Hansen had indeed made it ‘till Christmas.  That’s how I found my tears flowing into my pillow.  I was hoping he had made it, that’s all.