By: Parsa Salehi

“I won’t let anything break my spirits. Nothin. With God on my side imma keep on breathin”
-J.C. aka Patient 12

Early on in my internal medicine rotation, I was assigned a patient admitted for constipation. I remember our first encounter with clarity. His eyes, his position in the bed, the stutter in his speech, his 5/5 strength, his complaints, his beliefs—the list goes on. Although there was no way of knowing Patient 12’s fate at the time, I had a feeling dwelling in the deepest corner of my brain that something was off—that somehow the experiences shared with this patient would be different than my interactions with other patients.

Even after a physical exam and history consistent with the attending’s diagnosis of bowel obstruction, something still felt off. J.C. told me that this was just a small obstacle and that he would recover without a problem. He told me about suffering a broken leg years ago in a work accident, and how God gave him the strength to rehabilitate and walk again. I shared with him the story of my recent broken clavicle and how God also helped me recover from the injury. We bonded. He described his sheer will to live and determination to get through this. I assured him we would do everything to help him, and he thanked me. However, something in his eyes told me he doubted some of his own words.

The next day I did a mini-mental exam on him. Person, check. Place, check. Time, check. He even told me the name of the president, Barack Obama…who he proceeded to tell me he knew personally. Obama would send him a personal card every Christmas—sounded plausible, but improbable. He then told me Michelle and the Obama kids visit his house often—sounded like delirium. I could sense the foundation of J.C.’s determination was cracking. His voice trembled as he assured me he would get through this. I noticed he would avoid picking up the calls of his family, who I had never met. When he would pick up, I could hear them pleading on the other end for more information about his prognosis. Silent tears escaped from his eyes as he put the phone down, without hanging up. Again he reiterated his determination, his own strength, and faith in God. I saw something different in his eyes that day—fear. He was scared, questioning his own faith, making empty promises—was he in an existential crisis?
What didn’t make sense to me was why a simple bowel obstruction was stripping a previously strong-willed man of his hope. This was not just delirium. Patient 12 realized the end was near before anyone else in the hospital did. Before the attendings. Before the medical student. Before the nurses. Before the physical therapists. At the time I didn’t truly understand J.C.'s words and behavior. Most of all I did not understand the look in his eyes. In retrospect, I now understand that look. The look in Patient 12’s eyes was the look of a man who knew he was being dragged down by death, but was unprepared to make the journey to the next life—a man pleading for someone to grab his hand and pull him to safety.

That same day imaging showed a mass in J.C’s colon. Colorectal cancer was responsible for his obstruction. He needed surgery. Frankly, I don’t think he understood what was going on when he went under the knife. When he woke up from the anesthesia he was a different person. He was combative. He continually accused the hospital staff of trying to hurt him. Oddly enough, the only person he trusted was me. The day after his surgery he was making a gurgling noise in the back of his throat; he fought off the respiratory therapist trying to suction the fluid. He made the attending physician bleed during cardiac auscultation. He died later that night, after I had already gone home.

I still don’t fully understand why this experience has been so meaningful for me. I have experienced death before. I have seen more traumatic things in the hospital (full code ALS patient, gunshot wound to the head, overdoses, etc.), which should have made Patient 12’s death look relatively benign. What I think impacted me the most was seeing a patient make the transition from life to death so quickly. Moreover, the fact that the patient did not want to die and was not expecting death really affected me. To see a patient go from a relatively common ailment (bowel obstruction), to cancer, to surgery, to death all in a short interval did not afford me—or the patient—enough time to ruminate on the situation and accept death. The look in his eyes and his silent calls for help are etched permanently into my hippocampus.

Perhaps part of it was highlighting for me that death can happen at any time, and that we are not always prepared for it—shattering my previously held conception of death. It’s difficult articulating what I saw in J.C.’s eyes and how it made me feel. All I know is that Patient’s 12’s death reaffirmed something I’ve always known: everyday is a gift, one ought to enjoy life as much as possible, and one should never take health for granted.