Tough

I prepare for clinic like preparing for the start of a race- my body sets off into a sympathetic rush... my pulse increases, my eyes dilate, my digestion halts. I am ready for anything, bring it on. I will be fast, efficient, wise, compassionate. I will be it all. I am your provider. I will try my best to help you.

Patient number one- not doing well. very symptomatic. very anxious. medication side effects. examine. talk. revise. make changes. encourage, infuse hope. staff. exit.

Patient number two- doing okay. smooth easy visit. encourage, life changes, exercise, diet, laugh together. on their way.

Patient three- not doing well.
not doing well at all.
And then on some days it is halted - without warning. I read his chart- Severe Aortic Stenosis. Not a surgical candidate. No hope. No cure....

Oh my stomach tightens. I leave the room. I staff with our attending. "Talk to him about the natural history of AS, tell him what to expect, prepare him."

I summon all my education, all my faith, I pray.
I sit down again, and look him in the eyes. Stare into his sweet grandfather like face.

We need to talk about your heart. I am so sorry, but I do not have very good news today. There is no cure. The surgeons who saw you decided it is not safe for you to undergo the surgery which would fix this problem. There is no good answer for us to give. We can treat you with medicine to help you feel better, but there is no guarantee that it will help. This stenotic valve has put a lot of stress on your heart, and you are in heart failure. Eventually you may need to come into the hospital for treatment, you may never leave the hospital. There is a possibility that you may never start to feel better.

I am so sorry. I am so so sorry.

(tears well in his eyes) (I grab his hand) (tears well in my eyes)

I am so sorry.


I hug him. My heart hurts.
I hope I did this okay. Did I say things right? Does he understand?
I hope he will be okay on the drive home. He is alone today.
I hope I can see him again.
I hope he defies all the odds, and proves us all wrong.