Dear Sir:

I’ve thought about you recently. I’m not sure what prompted this lately, though I have noticed that I think about you every six to nine months.

I’m pretty sure that you’re dead now. There’s no way I can know this with any certainty, though I at least know that you have not died in the hospital. (I confess that I had looked up your hospital records several times within that first year after we met. I no longer do this because I don’t remember your first name, though I do remember your last name. That is how I addressed you.)

I was an intern and you were my patient. You had HIV. We met in the ER. If I recall correctly—the details are hazy now—it was an unceremonious greeting. You were too confused and what you said made little, if any, sense.

In fact, I hold only three snapshots of you in my head:

1. The image of your brain. The greyscale image revealed a large tumor there. That mass explained just about everything about your clinical presentation: Your thick speech, difficulties with walking, and headaches.
2. You nearly falling to the floor. I had walked into the room and you were staggering about, your hospital gown hanging wide open and your arms flailing as you teetered towards the bed. Lucky for us both, you regained most of your balance when you grasped my hand.
3. You sitting on your bed. You invited me to sit down next to you.

Though I remember you for many reasons—the heartbreaking condition of your health, your attractive face (you weren’t handsome, though there was something about your dark eyes and uneven smile that was appealing), the way you shouted at all of us—the primary reason I recall now is that you taught me the importance of being present and genuine with patients.

You were sitting on your bed. I couldn’t understand the words leaving your mouth; the tumor was affecting the nerves that power the tongue and throat.

“I’m sorry—can you say that again?” I asked.

You repeated yourself.

“I’m sorry—I still don’t understand what you’re saying,” I said.

“I AM TIRED! TIRED! I JUST WANT TO REST!” you shouted, waving your arms around.

I recoiled, took a few steps back, and blurted, “I feel scared when you shout at me. Are you angry with me?”

You looked surprised, maybe a little hurt. You shook your head before mumbling, “No… no.”

And then you extended your hand. It was trembling.

At that moment, I felt shame: Did I make a poor assumption in believing that you were angry with me? Should I have kept my fears to myself? What was I hoping to accomplish with my remark? Was I alienating you?

Should I not have made the obvious explicit?

How I wished I could have taken those words back.

I instead took your hand. Your arm gently—though jerkily—pulled me to the bed. Implicit in your gesture was an invitation to sit down. So I did.

And we sat there. You held my hand while it continued to twitch and tremble. We may have had a conversation; I can’t remember. If we did, the content of the conversation was of little consequence, primarily because I still had problems understanding your thick speech.

I can’t know for sure what it is that you wanted to communicate to me. In my mind, I interpreted it as a sort of apology. Maybe you just wanted company. Maybe you were bored.

What you did not do, though, was punish me for my honest reaction.

Shortly thereafter, I rose from the bed and tried to remove my hand from yours. You would not release it.

“I have to go,” I said. “I have to see other patients.”

You mumbled something incoherent, though the expression on your face clearly communicated disapproval. Your fingers popped open and I was free.

The attending had told me later that your prognosis was extremely poor—maybe six months at most. In my selfishness, I didn’t want you to die—we had just met. You seemed like a nice guy. I wanted to see you in the future as a healthy, functional, nice guy.

And that’s why I checked your medical record thereafter.

I will never know if I ever crossed your mind after you left the hospital, though I highly doubt it. I was just one person in a long, white coat out of the dozens who you saw during your time in the hospital. You had other people in your life who reminded you of your days as a healthy young man and good friend, not as a patient with HIV who had a brain tumor.

Some people insist that doctors don’t think about their patients outside of work, or that they don’t care about what happens to them.

That you still remain in my memory and continue to affect the way I interact with patients is evidence otherwise.

Thank you,
Maria