“Do you have any specific worries about him?” I asked.
The interpreter, a young man seated next to me, transformed my English into the musical tones of the Asian language spoken by the little-known agrarians from the mountains.
Before his wife could finish her sentence, her husband, the patient, lifted his head slightly and mumbled a short phrase. His lips hardly moved; I watched the few, wiry whiskers on his wrinkled chin wave as his jaw shifted positions.
An amused smile flashed across her elderly face, the wrinkles on her forehead resembling the even rows of crops she once tilled before she departed from her homeland. Her fingers, still slender and fluid, covered her mouth as she laughed. A single, beautiful ring adorned her left hand; it was a mosaic of muted purple, red, orange, blue, and silver.
The patient, his face tired and old, looked at his wife—was that disdain on his face?
She continued to laugh quietly.
I turned to the interpreter, my perplexed expression clearly asking the question that my lips had yet to ask.
“She said that she’s worried that he’s going to die,” he said, stifling his own smile, “and then he said, ‘She wouldn’t worry even if I was already dead.’”
I cocked an eyebrow at the patient, bypassing the need for translation. His facial features softened and a playful smirk appeared. He then looked at his wife and and smiled.
His wife recognized the affection in his face and her eyes filled with mirth.
Only then did we all start to laugh.
28 Feb 2007 | 4 comments.
A Different Person.
(I originally wrote this in December 2006 for the Medgadget Sci-Fi Contest. I wanted to create a more compelling dénouement, but I was unable to come up with anything more powerful. I’m still not happy with the ending.)
—Post-Op Day 1—
The operation went well. There were no complications and I anticipate that his recovery shall be uneventful.
I still wonder if it was prudent of me to personally operate on him… but then again, I wouldn’t trust anyone else to perform the procedure.
He wasn’t living anymore; he was merely existing. If he had died on the operating table, that would not have been a bad outcome. Witnessing a man wither away from dementia is painful and, honestly, I didn’t want to support a man who looked like my father, but was actually a useless biped whom I did not otherwise recognize.
It’s like he became a different person: an infantile creature who could no longer do anything for himself. It was embarrassing to see him transform into a child.
Sometimes I can’t believe that only a hundred years ago, people actually tried to prolong the lives of these demented people with those pitiful medications that did nothing but make people nauseated and help them draw an accurate clock for a few more months. My father—or anyone else, for that matter—is better off dead than simply existing with little, if any, quality of life.
Dad was (how I want to use the word “is”) a brilliant man. When he was basically forced out of the symphony because of his memory problems, he was devastated. At that time, he had some insight into what was happening. Reminders were everywhere about his declining memory—and how heartbreaking it was for him to witness the deterioration of his talents.
And why couldn’t he be one of those pleasantly demented people? The ones who aren’t as bothered with their deficits, the ones who don’t wander around, talking all night long and reorganizing useless items all day in an effort to “make things right”?
It is completely unfair that this happened to my father. He brought life and joy to so many people with his music—why was he struck with this illness? He had so much to give. His life was robbed from him—except he wasn’t the only one who experienced this loss.
So did the rest of the music world.
—Post-Op Day 3—
My brother called today, asking how Dad is doing. He just started a new job as a curator for the art museum. It’s hard to talk about the procedure without using medical jargon, but I think I explained it well enough. I had to leave some details out so he wouldn’t get angry.
The procedure was initially tested on cats, then ultimately on monkeys. In the past, people thought that the brain was a permanent structure: once mature, it never changed, grew, or had any plasticity. Medical science demonstrated otherwise with Parkinson’s disease. Scientists were able to grow neurons from the substantia nigra in a dish and implant them, along with a solution of neurotrophic factors, into the appropriate nucleus of the basal ganglia. It’s not unlike planting flower seeds with rich fertilizer in suboptimal soil. To everyone’s surprise—remember, everyone thought that the brain would not tolerate such invasive trauma, despite the advances in brain imaging and surgical instrumentation—the neurons easily integrated into the existing neural network and the body did not reject the donor neurons. In animals, at least, the manifestations of Parkinson’s disease eventually melted away within a few months and function returned to normal.
The success has been less consistent with cortical neurons, for reasons that I don’t completely understand. There hasn’t been anything in the literature for neuron implantation to treat dementia (this could feasibly be a cure!). Although most memory seems to be consolidated in the temporal lobes around the hippocampus, Brodman himself delineated disparate and scattered areas of the brain that seemed to contribute to memory. The remarkable thing about implanting these various neurons with neurotrophic factors is that the brain somehow figures out where the neurons should go and seamlessly incorporates them into the appropriate areas. Both original memory and function should gradually return during this process.
So that’s what I told my brother. I grew some brain cells that were associated with the areas of volume loss in Dad’s brain, bored open his skull, and injected the brain-cells-plus-neurotrophic-factor soup into the specific areas.
He bought it.
What I didn’t tell him, though, is where I got the brain cells from. I didn’t know if Dad had even a few months to live, given his condition, and I wanted to hasten his recovery and get him back to his former self. It would have taken too long to grow all the different cell lines for the various areas of the brain.
I got the tissue from the buskers downtown. Though some of them have aptitude in music, it’s marginal. They’re useless. They spend their days playing mediocre music on a corner and people don’t pay attention to them. No one will notice that they’re gone. It’s a fair sacrifice, I think; their unknown, yet plentiful, brain tissue as a donation to promote longevity in my father, a man who has composed numerous pieces and has been called the reincarnated John Williams.
I find it oddly satisfying that my hands that took life away are the same hands that will hopefully allow my father to live fully again.
Maybe I’ll tell my brother about this small detail in the future.
—Post-Op Day 4—
We took Dad off of the ventilator last night and he’s now awake. He looks well. He recognized my face and, with that post-ventilator scratchiness in his voice, said my name and smiled.
I almost cried. Just a month ago, he had no idea that I was his child.
He’s still understandably tired, so I’ll save the testing for later.
I wish the time would pass faster. Given that the neurons he received were mature, I’m guessing that he should regain all of his prior function in about two weeks. He’ll have no problems fastening his own buttons, shaving his face, or walking around the city.
And then he’ll effortlessly write glorious music.
I want him back now, not in two weeks.
—Post-Op Day 12—
I took Dad home today. He looks great. He’s walking, talking, and eating. His head wound is healing nicely, there is still no evidence that his body is rejecting the neurons, and his head scans show that the cells have migrated to the appropriate locations and integrated themselves fairly well into his brain tissue. This is fantastic and I couldn’t wish for a better result.
I think we’ll go through neuropsychological testing soon. Give Dad a chance to reorient himself to my house—though, so far, it doesn’t look like he’s having any problems. He even recognized the music box in the study. He gave that to me when I was ten years old. There was a time when I was the only one who remembered and recognized the gift.
—Post-Op 13—
Dad sat through the five-hour battery of tests today and—would you believe it?—his cognitive function has significantly improved! His visuospatial skills are essentially normal and his semantic and categorical memory functions are the best I have ever seen them. His language skills are still lagging a bit, but are improved compared to a month ago. He no longer has any problems with attention.
It’s been several years since he’s looked this healthy. I think we all first noticed the onset of his dementia about seven years ago. His function rapidly declined about three years back. It was amazing to watch him talk and take these tests with ease; it’s like he’s received the priceless gifts of time and youth.
He really is a different person now—he is becoming who he once was: a great man.
—Post-Op Day 15—
Dad has taken a strange liking to steak. He was a vegetarian for many years. It’s not that he abhorred cattle cloning and farming practices; he just never liked beef. I can’t remember him ever eating a steak in the past.
That being said, it was nice to grill up a couple of steaks tonight for dinner. It’s wonderful to have him back in my life again. He’s not a demented old man anymore; he’s my dad.
—Post-Op Day 19—
Dad sat in front of the piano today and tapped on the keys. The last time he touched the piano was about five years ago. As the dementia consumed his brain, he lost both interest and skill in music.
“I vaguely remember playing this thing,” he said, “but I can’t for the life of me remember what I used to do with this. Did I really write music?”
I asked him to relax; I don’t want him to feel too much pressure right now. But, he had difficulties creating melodies and when he reviewed his past music, he couldn’t even read bass clef–which is appalling. He was known for writing moving bass lines that would carry the spirit to places only imagined.
I don’t get it. We’re nearly three weeks out from the procedure. Maybe I’m just impatient. Maybe the synapses have yet to coalesce but, with a little time, his skills will return.
I’ve already got this much of him back. I should be grateful. But I want all of him back. And soon.
—Post-Op Day 21—
Dad told me today about memories of his childhood in Utah and wondered where his two sisters now live. He then asked me where I had put his guitar and harmonica.
He ran his fingers over the photograph of Mom.
“She looks familiar,” he said, “have I ever met her?”
After taking a shower, he curiously asked me if I had also removed the tattoo from his shoulder during the operation.
He was born and raised in Vermont. He doesn’t have any siblings. He’s a pianist. He was married for over thirty years. And he never had any tattoos.
Who is this man?
One of the buskers was a guitar player who was wearing a Utah Jazz cap when I took him.
I don’t even want to think about what this means.
My dad is not demented anymore, but he’s not my dad.
He really is a different person now.
26 Feb 2007 | 6 comments.
Precision.
“He was a nice guy,” I simply said.
“He is not a nice guy!” he sharply replied. A half smile was on his face; I wasn’t sure which way his point would turn. “He is absolutely not a nice guy! Do not make that mistake; he is absolutely not a nice guy!”
It was clear that he was not jesting.
“He’s a man who puts himself or others in danger when he does not get what he wants. He purposely harms himself to shift the dynamic in his favor. He molests children and preys upon those that cannot defend themselves. He causes more trouble for himself and everyone else by neglecting to register as a sex offender. He doesn’t have any second thoughts about hurting those around him to protect his own interests. He is not a nice guy.”
I actually knew all of this—I somehow hadn’t put it all together like that.
“Let me rephrase that,” I said sheepishly. “He was polite and well-mannered for the twenty minutes I interacted with him.”
25 Feb 2007 | 5 comments.
Resident Influences.
“I love surgery,” he said, a relaxed smile on his face. Our footfalls in the concrete and steel stairwell sounded like an uncoordinated horse galloping across an asphalt field—I was having a hard time keeping up with him.
“What do you like about it?” I asked, running my fingers lightly along the handrail. I felt the cuffs of my scrub pants occasionally catch on the heels of my clogs as we continued our descent.
“I love the operating room—I love the anatomy, the opportunity to see everything, the ability to fix stuff,” he explained. “It’s a great, great field.”
His enthusiasm was infectious—he never complained about floor work, the stuff that was preventing him from entering and enjoying the magic of the operating room. He greeted patients warmly, spoke slowly, and smiled—even when there wasn’t time to do so.
He told jokes and laughed at himself despite juggling a roster of close to twenty patients. With or without coffee (though usually with).
“Okay,” he murmured, focusing his tired eyes, supported only by the darkening bags underneath, on me. “The attending will probably ask you about the output from the two drains and whether they were serous or bloody. You’ll do great.”
Like the other surgery residents, he looked bored while I presented my patient to the attending surgeon. He, however, consistently prepped me prior to rounds and anticipated the questions:
“So, Doctor Maria,” the attending gruffly asked, “what much did the JP drain put out?”
“About twenty cc’s,” I answered with a confidence that I did not feel.
(”Remember to keep your answers short—surgeons never think they have time,” he had advised me.)
“Serous?”
“Sero-sanguinous,” I said. The attending grunted his approval and moved onto the next patient.
Across the circle, the surgery intern nodded and winked at me in congratulations.
Tom always made time to toss a teaching point at me as I trailed him around the hospital as his medical student. He introduced me to a variety of wounds, provided instruction in basic wound dressing techniques, and made every effort to make me look good during rounds. He actually read my notes (”they need to be shorter”), ran through algorithms with me prior to their use (”remember: airway, breathing, then circulation, okay?”), and bore no shame in telling me about the leather pants he wore to go dancing after working thirteen consecutive days.
“Do you have any questions about what you just saw?” she asked me, pulling the mask off of her face.
“No… not yet,” I answered, peeling the gloves from my fingers.
She tossed her long hair away from her face and smiled. “It’s pretty amazing, huh?”
“Yeah,” I said, still recovering from the geyser of fluid that had spurted from the woman’s belly when she made the incision. I never knew that there was so much water involved.
“C-sections are fun,” she said. “They’re generally straight forward and, at the end, you get to pull a baby out! It’s a happy time.”
The night was busy; there were several births, one of which was complicated and ultimately resulted in a stillborn baby.
Irritable and bitter, the chief resident yelled at the OB-GYN intern in front of the entire team on the post-call morning. Looking cooly in the eyes of the chief, the intern said nothing and held her head up without shame. I, along with the rest of the medical students, trembled—both from fear of the volatile chief and lack of sleep.
“I’m sorry she yelled at you,” I said after rounds. The intern had not done anything wrong and there certainly wasn’t any reason for anyone to yell at any time during rounds.
“Oh, that’s okay,” the intern said, a tired smile on her face. “Sometimes people get totally stressed out. Now are you okay? Have you had a chance to eat yet? Are your notes done so we can get you out of here?”
Even on post-call mornings, she offered a few teaching points during rounds as we wandered about the ward. She insisted that I squeeze past her in the operating room to have front row seats to watch how and where the surgeons made their cuts; she then made excited eyes at me.
She actually read my notes and her addendums, in that neat and curvy penmanship, always started with, “Read and agree with excellent/outstanding/fantastic MS-3 note.”
“Do you have any questions before I send you home?” she asked. She never kept me in the hospital for longer than necessary and always made sure I was around for interesting events.
If Christine was ever anxious, she hid it well. Her manner was gentle, her smile was bright, and her enthusiasm for teaching was refreshing. She consistently made time for her patients and medical students and never transferred the angst she received from her superiors onto us.
None of the psychiatry residents I worked with as a medical student influenced me, for better or for worse, to become the resident that I am today. In fact, the only two psychiatry residents that I can recall from that time are The Man from the Banana Republic Catalog and The Woman Who Didn’t Intervene When a Manic Patient Wanted to Have Sex with Me. The former was this impeccably dressed man who wore crisp, white dress shirts, bold, colorful neckties, loose slacks, and shiny shoes. His goatee was neatly trimmed and chic eyeglasses framed his eyes. Everyone stared at him when he walked past—almost as if he was too beautiful to be a doctor. I can understand why the latter didn’t interrupt my interview with the hypersexual manic patient, but I wish she did—at the time, I didn’t know what to do (it was the first manic patient I had ever seen). I had hoped that speechlessness had sufficiently signaled my discombobulation. It apparently did not.
And that’s why I jump in and swiftly redirect any patients—manic or not—who solicit my medical students for sex. I hope they’ll do the same for their medical students in the future.
23 Feb 2007 | 4 comments.
The Psychotic Man and The Machine.
Three times a week, they make me lay down so the machine can take my blood. Everyone can see my blood traveling through the clear tubes that twist and turn through pulleys, travel in and out of hidden slots, and end in large vials, where my blood is no longer red; it’s a foamy pink, like bubble gum soda.
The machine takes my blood because I am guilty. I did something wrong and everyone wants to kill me. Instead of killing me, though, they make me lay down so the machine can take my blood.
I have to lay down for about five hours at a time. I worry that the machine is really stealing all of my blood from me. They tell me that the machine returns all of my blood to my body and just takes away the water and toxins, but I think the machine takes my blood, too. I always weigh a lot less after the machine is done; that can’t be all water. They must take a little bit of blood each time.
They won’t kill me immediately. They have to do it slowly. So they take a little bit of blood each time. Maybe it’s only a drop, maybe it’s a teaspoon, maybe it’s a cup. Maybe they’re cooking something and they need my blood to do it.
But I deserve this because I am guilty. I deserve to die a slow death.
I get really sleepy when I am attached to the machine. I have a really large vein on my arm. It’s the sign of guilt. The doctors put it there—they know I am guilty and they put it there so everyone can know that I did something wrong. The vein looks like a big, ugly slug. It’s like the big, ugly sin I have. I wear my sin of my sleeve.
The big, ugly slug buzzes. It’s really weird. If you put your hand on it, you can feel it buzz. I think that the vein buzzes because it is sending out a radio message to tell everyone that I am guilty. Maybe the doctors planted a vibrating computer chip in there when they put in the large vein. When I put my hand over it to block the radio waves, it feels weird, so I take my hand away. I worry that the people around me will kill me if they pick up the radio frequency. I am surprised that people don’t drive up to me in their cars and beat me.
I’ve tried to find my vein on the radio, but I can’t find it yet. The station is probably blocked in the four radios I own. The doctors, the government, and the radio manufacturers are all in it together.
The nurses put two needles into my large vein to attach me to the machine that takes all of my blood. The nurses tell me that I need to do this three times a week because my kidneys don’t work. My kidneys used to work, though. I don’t know why they don’t work anymore. My doctor doesn’t really know, either. At least he’s not telling me. Probably because he knows about my sin and knows I deserve punishment.
I think the machine puts medicine into my body while it takes my blood out. This must be why I get so sleepy; it’s the medicine that the machine is feeding me. There are so many tubes swirling in and out of that big machine; one of the vials must be putting sleep medicine in there. Maybe it’s the vial where my blood turns pink, like cotton candy. If I get sleepy each time I am attached to the machine, then when they finally take all of my blood away, I won’t notice. I will be sleeping and then I will be dead. Maybe I will look like a popped balloon because all of my blood will be in the machine and I will only have bones and skin.
Then they will feed my bones and skin to the dogs to finish my punishment. They dogs will eat my body and spit it out because it will taste like sin and guilt.
My mom tells me I have to let the machine take my blood because if I don’t, I will die. Sometimes I wonder if my mom is in with the doctors and government and the radio manufacturers. Maybe she’s trying to make me die faster. No one wants their child to be a guilty sinner. She doesn’t know about my sin, not unless her radio has picked up the buzzing from my large vein. We don’t talk about it. She just picks me up every Monday, Wednesday, and Friday and takes me to the clinic where all the blood sucking machines are.
I wonder what sins the other people committed. There are usually a few people at the clinic when I am there and the machines are taking their blood, too. They never talk to me. That’s because my sin is bigger than their sins and so I must die first. They know this, so they don’t talk to me. That’s part of my punishment, too.
Guilt is a lonely thing. And the machine that takes my blood can’t wash it away, like the blood of Jesus Christ, except he was perfect and I am sinner and I deserve to die.
(Read more hemodialysis, a procedure used in people with end-stage renal failure, here.)
21 Feb 2007 | 2 comments.