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Of What Remains

The patient was an army surgeon in his youth, you know, the resident dolefully offered as I turned away, her afterthought lingering in the air behind me. Pausing in the doorway of the hospital room, I hovered, wondering whether she expected an answer. I must have been a medical student at the time, sent to draw the blood sample. Enough time has passed that I couldn't tell you the service I was working on or even the name of the hospital; however, if you gave me a number 2 pencil and a glass of courage, I could draw you his every defeated wrinkle. The gray man sat in his bedside chair, more crumpled than hunched. I sensed that he had been positioned there like an artist's wooden mannequin rather than having chosen to sit down. His hospital gown had been carefully draped and fastened around his fleshless ribs. Someone had shaved him this morning, a few crusty blood spots autographing their brushstrokes. The patient looked in the direction of the window, but I don't think he saw the rain or the bleak concrete parking lot beyond. I imagined instead that he was walking an Escher staircase, revisiting the same few window scenes from his memories in perpetuity. I hoped that they were more attractive than the current viewperhaps of a wartime sweetheart. Still composing his romantic history, I knelt before him and singsonged my introduction in his general direction as I organized my blood-taking apparatus on the edge of his bed. I was dancing an unsuccessful paso doble with the fugitive vein when a stern voice, cut crisp from the still air, demanded, Full blood count, urea, and potassium, eh? And what else, miss? I startled; with that small jolt, I caught the elusive vessel and watched in surprise as the vial filled. Too scared to avert my eyes from serendipitous success, I replied to his elbow, Yes, sir. I think we want to see how your kidneys are doing. How are you feeling? I looked up, the task complete. My unanswered question occupied the space between us. I rose from my hunched position, the blood gratefully returning to my prickling calves, and perched for a moment on his bed. He seemed now to be absolutely motionless while the room around us hummed with small movements: the draft from the window purring its breath, the swinging IV tubing trying to find its equilibrium. Then, as we both took a breath in eerie unison, time restarted and he watched the distance, back on the staircase, as if he had never been here in this room with me. I slipped away, dropping his stolen blood in the lab chute and telling no one of his outburst. My shame has grown with the passing years. I should have sought out his family and told themencouraged themthat their grandfather was still there, alive below the swirling currents of misfiring neurons. But I didn't. I selfishly kept his story in my pocket, clutching at it like a worn talisman when I needed hope or relief. When I needed proof that a comatose patient could hear me when I whispered in her ear or could feel when I squeezed her hand. When I could not bear to watch a son feed his agitated mother pure while she clawed at the air. When I told an uncle he should talk to his sedated niece, hovering at the edge of life. Was I comforting them or assuaging my own guilt? Uncertainty eases my self-reproach. Is it better or worse to know that something remains of our past once dementia robs us of our present? In the months before my own father died of ALS, we had already lost him to the frontotemporal dementia that sometimes accompanies this monstrous disease. We consoled ourselves that it was a blessing that he was not aware of the magnitude of his loss. But one evening when we were together around the dining table discussing childhood pets, my fatherpositioned like an artist's mannequin as if he were able to eat with ustremulously spelled out the word goldfish on his communication board in reference to my late marine companion. Decades before, he had buried her in a matchbox under the apple tree and recited our traditional mourner's prayers for her despite my protestations that the toilet was good enough. It had been months since he had spelled out anything. We rejoiced, failing to appreciate how this revelation was a contradiction to our previous consolation; its implications for his continuing suffering; and how it ultimately highlighted the ever-present struggle to reconcile what we want for our patients, and for those left behind. Audio. Michael A. Lacombe, MD,Annals Associate Editor, reads Of What Remains by Athalia Rachel Pyzer, MD, PhD