Surprises

I don’t like surprises. It is not astonishing, since in my business, they are almost always of a negative nature. They usually begin with a telephone call at 2 am and an apologetic, breathless nurse on the other end saying something like: “I’m sorry to bother you Dr. Waldron, but…” It all goes down hill from there.

A couple of years after I began practice, I remember one such event.

 

My patient Caesar had been in the hospital for four days and he was going to a nursing home. “Not long term.” I had assured him. He would only stay there long enough to get his strength back and then he would return to his own home.

Caesar was a cantankerous old man who had lived in the community for all of his 76 years. He experienced a small stroke and now had some residual weakness. Not a lot of weakness, but enough to keep him from going straight home.

It was two o’clock in the afternoon on my day off when I received the telephone call. The nurse on the other end was breathless. “Dr. Waldron, Mr. Campbell is not doing very well.” I grimaced internally. That statement could mean almost anything, but it was almost definitely bad. “What’s going on?” I asked.

“He’s breathing much harder and he can’t seem to catch his breath…”

I listened with half my mind, inwardly reviewing his medical problems. When the nurse finished speaking, I gave some orders. I finished by telling the nurse that I would be right in.

The nurse had been right about Caesar. He wasn’t doing very well. His breathing was labored and he was using his chest muscles to assist with every breath. As his labs and imaging results began to come back, the cause became much clearer. He had developed a pulmonary embolism.

A blood clot to the lungs in a young person is bad enough, but in a 76 year old with emphysema it is life threatening. I had the nurses call the family to come in.

Caesar’s only daughter arrived and I went over the situation with her. I asked her is she knew her father’s wishes about being ventilated. She shook her head. “I don’t think he does, but I’m not sure. Have you asked him?”

I hadn’t, so we went together to his bed. Caesar was laboring to breathe, but he was still alert. I explained the situation to him and asked if he wanted to be put on a ventilator. He shook his head no. “You understand that you will probably die if we don’t put you on the machine?” I asked.

Caesar nodded “I don’t… want… machine.” He gasped out.

I wrote orders to make him comfortable and to try to stop the clot, and then stood at the foot of his bed, feeling helpless. This wasn’t supposed to happen. Caesar was supposed to get well and go home. I had promised him as much.

Caesar’s daughter seemed to sense some of my helplessness, for she rose from her chair at Caesar’s bedside, and touched my arm. “It’s OK.” She said simply. “It’s what dad wants.”

She spoke the truth. He had not wanted a ventilator. As I stood there, I realized that I was feeling sorry, not for Caesar, but for myself. It is the nature of young physicians to believe that they can predict and control all in their patient’s lives. I felt distress for not having predicted this embolism and as I realized this, a kind of peace came to my life.

For, I learned what many physicians never learn. I learned that human life is hopelessly complex and that no one can completely understand it. I learned that the most important thing is to follow the patient’s wishes. Most of all, I learned that I am not God. Despite all of my efforts, some things cannot be controlled. There will always be surprises and that will not come as a surprise to me again.