Night Rounds

When the intensity of the day subsides, the physician and patient reunite. This is when the touch and the voice can work magic even as the tenuous web of life is tightened and strained by the opposing pulls of death and life.

It was that way one night, late, as I walked along the beds on the open ward for a final check. It was the time when the restless susurration of heart valves and the tumult of the inflamed site gave way to introspection. The interval when physician and patient were as equals, joined in confronting a sometimes implacable process that had invaded the sanctity of the soul. This was the best part of my domain; I walked it alone each evening.

The ward was as silent as the tomb it sometimes was. Here the alcoholic, in to revive his liver before going out to pummel it again. Next someone with pneumonia breathing rapidly but not as fast as yesterday. Others with umbilicals moving fluids of various types: replacement, addition, and precaution. All was in order as I turned the corner and came back the other side. Here lay the conundrum. She had a disease known and described in terms of its nomenclature, signs, and symptoms, but not its mechanism. We had knowledge but no wisdom. We treated it with the agents of the day, and she and we slowly lost ground as it took cell after cell to its demise. Cell death now is apoptosis, but this really tells us nothing more. We thought that certain of her cells were dying and we were right. But we were shadow boxing with the devil and could not halt the process.

She was awake, a young woman, lying quietly, knowing she would sleep soon enough. The disease was pulling at her with its hands clenched into her vital places and its face gradually replacing her own. She would never know the joys and pain of family and children. Neither the dross of life nor its sunshine would be hers. She did not understand why this should be. Her failing system caused her to breathe deeply and she appeared to gulp in the darkness, as though pulling it within her would make it a friend. I paused and we began to talk across a chasm. It began as innocuous pleasantries, then more serious questions. Why can you not do more? Why is this happening? The unspoken question: Why to me?

So then I broke my rule and sat on the edge of her bed. A patient’s bed is a refuge and physicians do not violate that. But this was the meeting of two equally confused humans, so I took her hand and we talked about her short life and why it would not grow long. And in the corner, death stood by quietly while attending another, but glancing carefully at her so as not to forget who and where she was. 

Then, on panicked impulse, she reached up suddenly and hugged my neck, pulling my head down alongside her own. She held on fiercely for several long moments, trying to seize some connection with life and health; to get close to another human and free herself from the beast within. It was a desperate attempt to siphon strength from one who had it yet could not give it, and to capture some human solace before the door closed.

I made no movement to pull away and after some moments she let me go. There were tears and trembling on her face, and I knew that in those moments she had accepted the barrier between her bed and the rest of the world. I continued to hold her hand and we sat for a long time without speaking. Then I got up slowly and moved reluctantly down the row of beds, looking at those for whom I could do something. It was the pragmatism of the physician, perhaps, or the need to finally conclude the day. More probably, it was a tacit acknowledgement that neither of us knew exactly how to manage a process that would not be managed. 

The door did close on her after several days. It closed slowly but inexorably and quietly. Death did not storm the castle; he simply infiltrated the corridors of the tissues, locking one exit after another until there was only one. Then she left with him.

This story was published in The Pharos, Spring, 2005, pg 39.