Saying goodbye

My patient was transferred to a rehab facility today, and I didn’t say goodbye.

He was admitted over a week ago, 19 years old, sick, and terrified. I saw the fear in his eyes when the resident told him that we would need to perform a lumbar puncture, that we would need to place a large needle in his spinal canal to drain some cerebrospinal fluid fluid to confirm the diagnosis of Guillain-Barre syndrome, a life-threatening neurologic condition. I held his hand while the resident and the attending performed the procedure. He talked to me about fishing and about his mother’s recipe for teriyaki salmon, and he squeezed my hand each time one of my more senior colleagues pushed the long needle into his back.

I explained the condition to this awkward teenager, to his mother, and to his friend. I told each of them individually that this wasn’t his fault, that his immune system was over-reacting to a cold that he had a few weeks ago and was attacking his nerves, making him weak. I stood at the bedside while the neurologist told him that he would recover, but that before that happened he might need a tube down his throat to help him breathe. I saw him look the neurologist in the eye and ask if he would walk again, and I saw him smile and say that, as long as he would walk again one day, everything else would be ok.

I went in every morning and asked about his weakness, his nausea, his backache. Every day I asked him to focus his energy and show me what strength he could muster. And every day he lay there in bed, more paralyzed than not, and worked harder than any body builder I have ever seen just to wiggle his toes. After the exam, we would talk about science fiction books for a few minutes before I had to move on, and I would reassure him that he was doing well.

I would leave the room and, even though he didn’t know it, I would spend hours doing paperwork and making phone calls to make sure all of his needs were taken care of. He only saw me a few times a day, but taking care of him was the primary focus of my time on the ward. I ran all over the hospital gathering paperwork, calling three different departments and visiting three different offices just to find one form.

After a week, he was getting stronger. I have never been so happy to see someone lift their heel off an inch off the bed. We watched him for a few more days to make sure he kept improving, and today he went to a rehab facility.

I was with this man on the worst day of his life, but I didn’t say goodbye. He taught me more about Guillain-Barre syndrome than any teacher or textbook, but I never said thank you. I will never forget his case, or the lessons that he taught me, but I doubt he will remember me. I was just one of a parade of white coats taking care of him. So why didn’t I say thank you? Why didn’t I say goodbye? Because, according to the rest of my team, that’s not what doctors do.

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