Monday, February 26, 2018

Alone

Over the course of a career you see a lot of patients. I'd guess, based on looking through my charts, roughly 30,000-40,000 to date.

Most, especially the ones from the very beginning, are long forgotten. Sometimes I'll request old hospital records on someone from a place where I did a rotation and am surprised to see a note from a younger version of myself. And I have no recollection of them at all.

But a handful never leave you. Some because you learned a lot from them. Others because of a shared interest you chatted with them about. And a few because they struck a chord that's never gone away.

I was at the tail end of my intern year, doing a mandatory ICU rotation, when they brought him in. I don't remember his name now, mainly because I never knew it then, either.

He was a homeless man, who'd fallen asleep in a trash dumpster. In the dark early morning no one saw him fall into the back of a garbage truck when the container was emptied. With the noise of the engine no one heard his screaming as he was mashed by the machinery. When the truck was emptied a few hours later sanitation employees called 911.

He was still alive - barely - when we got him. Massive blood loss and multi-system trauma. Broken bones, ruptured viscera, missing pieces of limbs. Teams of doctors paraded in & out of the room trying to save him. As an intern I was one of them, but on the periphery of the internal medicine group.

What was left of his clothes had no ID, and he was never conscious. Social workers tried to find family, a name, anything. They combed missing person databases and made endless phone calls all over the country. Nothing really to go on, not even a tattoo. Just a 50-ish white male. Police spoke to other homeless who lived in the area. A few remembered him, but none knew his name or anything about him.

For a week in the never-ending daylight of the ICU an army of doctors, nurses, RT's, lab techs, and others did their best to keep him alive. Although his prognosis was grim, we all thought that, sooner or later, the social workers would turn up a friend, or relative, or find some lead to them. He was, after all, somebody's son. Or brother. Or father. If there was someone out there who might be able to tell us what he'd want, or even who just wanted to say goodbye to him, we'd give them that chance.

But it never happened. Roughly a week after he came in the attending doctors felt there was no hope and nothing further to be done. The machines were turned off one by one and he died quickly. Someone on the trauma service signed a brief death note and reached for the next chart. The body was taken away to an unmarked grave. I couldn't find it today if I tried.

I'm sure somewhere out there is an argument about how much money was spent on his case, and how many vaccines or school lunches or police or teacher salaries it could have paid for. Given how many cases there probably are like his, and multiply by that number... I'm sure it's a lot of dollars. But, while it has some points, that debate didn't occur to me at the time, isn't why I still remember him, and I'll leave it to other blogs to discuss.

Regardless of the circumstances of his life - I admit I'd have ignored him on the street if he'd asked me for change the day before - he died alone. Did he have any living family? Do any of them wonder what happened to him, then or now? Were they sick of whatever issues he had again and again, and had long pushed him out of their minds? Did he have a good childhood or was he always on the streets? Did he serve his country? Was he hoping to die in the dumpster or just looking for a little more shelter than the sidewalk offered that night?

Alone.

25-30 years later I can still see him as they brought him to ICU, the different teams of doctors yelling orders. For a week I'd sometimes sit at the nurses station and stare at him, wondering. Did anyone else working on the case find themselves as bothered as I was? Maybe we just all covered it up, afraid that to admit he was anything but a badly injured homeless guy would be a sign of weakness. I may be the only person today who even remembers him at all.

Alone.

The case still keeps me up at night. Thinking of him, and behind that the abject terror of the thought of someday myself, or my wife, or kids, or other loved ones or friends, being in the same situation. Alone. Impoverished with nothing. Unloved. A life and existence forgotten.

Alone.




28 comments:

Richard Smith Jr said...

An excellent story, I thank you.

Be cautious, you stay on this path you risk becoming an economist. ;-)

Anonymous said...

..not completely forgotten. You've remembered him enough to share his story with us and get us all thinking. Maybe that was his purpose?

Jono said...

Unfortunately, I think there are a lot more "non-persons" out there than any of us would like to admit. At least you remembered him.

brent said...

when you stop caring and stop remembering, that is the time to call it quits and retire.

tbunni said...

There is a passage somewhere in the Bible (don't ask me where, I stopped reading it years ago) that talks about taking care of strangers, and that by doing so, you may be caring for angels unaware. I think Anon 8:23 is correct, this may have been an angel sent to make us think. To make us remember that every single person is a human being who at some point was someone's child, someone's brother or sister, someone's father or mother, uncle or aunt, grandfather or grandmother. The loss of each person is a loss to all of us.

Thank you for reminding us of our humanity.

bobbie said...

I'm with tbunni and Anon 8:23 ~ you remembered him, and so will all of us who have read this story ~

Thank you for sharing from the heart ~

Anonymous said...

A few months ago, my husband was rushed to the hospital because of chest pains. While they were doing all the tests and what not on him, I mentioned to a nurse all the homeless that were loitering around the hospital grounds. (this is in Seattle) she said that they frequently get people in that need treatment and when they leave all they have on are paper garments the hospital gives them because the clothes they had on when they come in are so filthy and tattered they're thrown away. She was really sad about this and said, 'This is not what I was trained for. " I had no reply for her. But have not forgotten what she said.
So rest assure, Dr. Grumpy, there are others who do remember those that, for whatever reason, society has brushed aside.

A. Marie said...

The parable of the Good Samaritan (which may be the one tbunni is thinking about) is alive and well and living in Doc G's reminiscence. (Luke 10: 25-37 in the New Testament, as per Wikipedia. I know Doc's not a huge NT fan, but...)

CrystalBlue said...

@tbunni: you're thinking of Hebrews 13:2.

As for "money better spent elsewhere", money doesn't go away. It keeps circulating. The effort we spend to help others is what keeps us human.

Anonymous said...

As a trauma surgeon, this really hit me in the feels. I also see a lot of these people, and a few stick out much like yours did. It's a memory we carry forever.

SwanSpirit said...

Mr. K., in Baltimore City Hospitals, dying of colon cancer. He had no one, so the nursing students adopted him. He was polite, charming, and personable.
I had to take 3 buses, at 5:30 AM, to get to my clinicals on time, at 7:30. If you were late, you were locked out and declared absent. 6 absents, you were out of the program. Things were stricter in 1976. One morning, on the bus, I just had this feeling, that Mr.K was gone. When I got to the floor, his bed was empty..
My very first patient ever. I hope he remembers me.

Anonymous said...

Thanks for reminding us, Dr. G. why we thought we should do this.

We were training for ACLS the other day. I'd never gone through the training in my 30 years, but the opportunity came up and I went for it and am now certified. I attended many CODEs on the night shift carrying up the drug box.

There's a part in the AHA class where we go over the time to say goodbye, and the actors were very realistic. While I was thinking of that vignette, I suddenly remembered a patient in CCU, elderly, had been on the unit several days and then the CODE was called, and we were up there a good while. There was no one to call and let them know their loved one was passing on, and in the moment, Faith who was on duty that night, started singing 'Amazing Grace' as the CODE was called. I happen to believe that it was heard in the transition.

I started out 30 year ago with an idea of why I should do this, and 30 years later, I know the people that I am doing this for.

gloria p said...

Thank you, Dr. G. for having a heart and remembering the man with kindness. And thanks for giving others the chance to express their own hearts by sharing your story.

Chloe B said...

He was one month and one day younger than me. I was the young pharmacist responsible for organising chemotherapy for the whole hospital.

I followed his progress over the years, from his initial diagnosis of acute leukaemia, through remission and relapse, second and third line treatment, to eventual palliation.

I don’t remember his name, but I still remember his birthday.

Susan Claire said...

This very thing just happened here in San Diego County. Luckily the person was heard before the compactor engaged. He or she walked off before anyone could be summoned to help.

Anonymous said...

Thank you to you and to all of the commenters - this story is a concrete example of a lot of thoughts that have been bothering me, and the comments help put it into perspective. And now I will remember him, too.

Anonymous said...


Not in the medical profession. (couldn't handle it.) I follow your blog for the humor and the history lessons.
Every now and then you throw in a story like this which shows us that you are not your average a run of the mill yak herder and I don't think you learned this in med school either.
Thank you for being who you are Doctor.
Anon 1024.

Ivan Ilyich said...

I spent some time in ICU as a patient. ICU doctors and nurses see a lot of death, so naturally they become accustomed to it. Otherwise, they couldn't keep doing it. ICU nurses often seem more severe than others, but I'm sure they never stop caring about their patients and remembering the unusual or especially tragic cases.

Anonymous said...

He was scheduled to discharge to the nursing home that day. Totally stable, only stayed one more night due to when the home had an opening. The nursing assistant went into do vitals. We coded him for 30-45 minutes. The only family to call was a great niece.


Then there is a whole parade of my chemo patients.

-a hospital pharmacist

Anonymous said...

Those of us who work/have worked as a front-line health care provider all have one that we will never forget. Mine was a teen-aged girl
put into foster care so that she could receive hemodialysis in a city with tertiary-care hospitals. She was from a rural first nations community. I still remember her accosting me in the mall at the kidney health information booth she was manning, and gently teasing me for not stopping.
She died, in hospital a few months later. All of the renal unit staff and physicians were in tears; she was such a gentle kind sole. What still brings me to tears is the image I hold of her foster mom comforting her birth mother. You see, no one knew her birth mother because all of their interactions were with her foster mom. As the girls' health declined, the foster mom reached out to her birth mom and arranged for her to travel to the city to be with her daughter when she died. But she sat alone on a bench in the renal unit waiting area because no one else knew who she was. Until the foster mom came to comfort her. I came upon them, sitting together, with their arms wrapped around each other, comforting each other in their grief.
Still brings me to tears every time I think of it. Because the birth mom was native and poor and the foster mom was a well-educated and middle-class. And together, they both lost a daughter.
That was over 20 years ago and I will never forget.

Mage said...

Not forgotten. You remembered.
I have one homeless man I won't forget. Young, blond, full of happiness. I often would take him a hamburger for dinner. He got an infection in one foot, and when they let him out, he returned to his doorway. He lasted about two years. I remember his good cheer,. He refused to go to a shelter, he didn't want help, and he always smiled.

Packer said...

As a young man I would ride the tubes into Manhattan in the company of my father, we would walk from the Christopher Street station to our respective workplaces. Christopher Street was the home of the Stonewall Inn and was no where as gentile as it is today. On the Streets in that area were many young homeless men, they were Gay and had been displaced from their homes because of it. Kicked out, disowned. My father who was a hard man, would always have a heavy pocket of change that he would dole out on our way down the street. I thought about that for years, here was a guy that sometimes put in 80 hours a week to feed his 9 children and yet he would always have some spare change . Once I asked him why he did that. He simply said, There but for the Grace. I follow he lead to this day and when my children asked why, I repeat There but for the Grace. Thank you for defining humanity.

clairesmum said...

Thanks, Dr Ibee. I have cared for some patients and clients with immeasurably sad life stories and circumstances. It is always possible to choose to be kind, even if only for a few moments or an hour. A smile to someone who on the sidewalk alone, giving a cup of coffee or a small gift card to local fast food places, a conversation face to face with some eye contact and a willing offer of your hand to shake..all of these have dignity in them, and can give a person a little bit of hope, a bit of connection to other people, and maybe a reason to try again to trust, or care for yourself, or to reach out for help and accept it when it is offered.

Knew of a family that had lost 2 uncles to alcoholism, and almost the last surviving uncle - serious alcoholic who passed out drunk into a large snowbank in a blizzard...came to as the dump truck turned into the park where the all the snow would be dumped into the harbor. Luckily someone heard him scream, and stopped the truck. Never took another drink. Family did not even know he was back in town until the ER called his sister. He knew a second chance when he got one. 22 years longer, sober, and often as happy go lucky as a kid. Never a bad word about anybody.
you never know if you are the person to spark hope..or hear the call for help...
be present and be kind when you can..

Anonymous said...

As a neurologist (pedi) my least favorite part of the job is getting consulted for prognosis or a brain death exam. Often we are asked to express to a family ust how little hope there is of a meaningful recovery. I am also so exhausted and infurated by abusive head traumas. Unrelated to those my toughest paitent so far was a young child who suffered an internal decapitation (rear facing car seats till 4 are a good idea). The mother really really wanted us to declare brain death but I couldn't; there were pupils. She couldn't bring herself to withdraw care. While I generally really dislike having to force the withdrawl of care this was one instance where I wish I could have been the "bad guy" and take the burden off of her as she even hinted that is what she wanted.

Stark Radio said...

Oh, Dr Grumpy.... that's a very sad story , beautifully and evocatively told. Thank you for sharing it with us. That poor man. Thank you for trying, and caring.

Migraineur said...

I've got one, a cystic fibrosis (cf) patient. Nearly young enough to be my child, which is how he first stick in my head. Always polite! At four AM, I'm waking him to do treatments, and he apologizes for 'making' work for me. I told him don't ever apologize for that. We're here all night anyways, and you're polite, and smart enough to never refuse treatment, which many cf pts do. I told him we will always help him, and gladly. I was off for my MIL's funeral, but he was declining, and went on continuous non-intubated ventilation (smart enough to sign papers to refuse intubation and resuscitation earlier on). He was fine during the week I was out. It's for years later, and him apologizing is still clear as a recording. I'll never forget him, which is one of the best tributes there is.

Anonymous said...

I’ve read your blog for years. Non medical but appreciate everything you write. This one really got to me. Thank you for sharing his story. You remember him, and that matters.

Donna P. RN said...

My eldest brother was bipolar and homeless. We looked for him for years...I'd go to homeless shelters and my sister would play sleuth on the internet. We found him one day with a head injury and missing part of a leg in a hole in the wall nursing home. He had been there for 7 years unbeknownst to us. We moved him to a better nursing home and visited 3-4 times a week for the next 2 years before he passed away. I always wondered what the nursing home staff thought of his family, why we didn't come in. He was sitting right there in his wheelchair while we were totally clueless looking for him. I'm glad we had our time with him but sad we didn't get there sooner.

 
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