We meet because you have an infection,
though I suspect you are most troubled by a different problem in your chart.
“Recent left hemorrhagic stroke, basal ganglia and thalamus,”
not even two weeks ago.
Notable sequelae include
right sided hemiparesis
and expressive > receptive aphasia.
Before I go in, your nurse informs me that you are a doctor.
I think about how I would feel if some young medical student came in
and called me anything but doctor.
I call you doctor. It is difficult to get a history from you.
Partially because you can scarcely speak,
(only the occasional, quiet, raspy word)
and partially because you are confused.
I tell you who you are, and you agree.
When I give you options for where we are,
you indicate that we are in a grocery store,
and I know that you are only half with me.
I see you each morning. I meet your family.
I ask about your baseline before the stroke.
“Walking, talking. She went to the gym. Her hearing has been going.”
“But otherwise, like you and me?”
“Oh yes.” Your husband confirms.
I imagine what it must be like.
Walking, talking, then suddenly unable to do the simplest things,
barely able to even speak.
I now understand why you told me you
“Need Courage.”
The next time I come in, you are feeling better.
You are doing something strange with your finger.
“Writing,” you rasp.
I offer to write the alphabet for you.
I write out all the letters so you don’t have to.
You point to each letter
to spell a word.
“B-R-I-N-G”
It is slow going.
Finding the letters is a challenge for the parts of your brain that are compensating.
“Bring?” I ask.
You nod.
You start again.
I listen to your heart while we try to communicate, multitasking.
You understand. You were a doctor.
You remember what it was like to be a student.
We get three letters into the next word
before I have to go.
“D-E-A”
I let you know that I need to go,
but that I will leave the paper
and a note for your family
so you can talk to them.
You nod and squeeze my hand tight.
I tell my team about
“BRING DEA-”
They ask me what I think it means.
When we return, my suspicions are confirmed.
“Bring Death” your husband says, tears in his eyes.
I had a feeling.
The attending asks if you have been feeling down. You nod.
He acknowledges that you were a doctor, that you know how hard it can be,
after something like what you went through.
He offers a medication to help your mood.
You accept.
Before we go, your husband gives me a hug.
“Thank you. She has been talking all day using this.”
I feel conflicted.
We fixed your infection,
but we cannot fix the broken pathways in your brain.
I say goodbye.
You squeeze my hand and whisper
“Thank you.”
As we gaze into each other’s eyes for the last time,
I feel our profound connection.
My patient and preceptor,
you have taught me more than you know.
