Where To Look

"Where words are restrained, the eyes often talk a great deal."

I walked into Room 30 to find two eager sets of eyes awaiting me. One set belonged to a young man, late-twenties, muscular and imposing, sitting in a chair in the corner of the room. His eyes were hazel brown, big and inviting, relieved at seeing my entry into their sheltered world. The other set of eyes, darker brown and magnified by her gold-stemmed glasses, belonged to my patient, a woman in her early-sixties. She sat  upright in her treatment cot, knees drawn up to her chest and covered by the thin hospital-issued bed sheet.

Clearly, I had interrupted a conversation between them. Upon my entrance into their treatment room, they gave me the respect and gift of silence, a pause in which I would be able to introduce myself. As many of my fellow coworkers would confirm, this does not often happen. Rather, it is not unusual for us providers to walk into a treatment room only to wait for a patient to finish a cell phone conversation (while holding up an index finger indicating they are almost done), finish the last gulp of a bottle of soda or swallow the crumbled remains of a bag of chips. Worse yet, a patient sometimes will keep on talking to someone else in the room and behave as if we haven't even entered.

I liked this woman and man already.

Extending my hand, I introduced myself first to my patient, Ms. Loretta. "Hello, ma'am, my name is Dr. Jim and I will be taking care of you today." Turning to the man sitting in the corner of the room, I repeated myself. They were both gracious in their return greetings and I learned that the young man was her son, John.

Ms. Lorettta appeared calm, composed, and quiet as she sat in her cot. She was of short stature and delicate frame. She looked tired, her graying hair wiry and thin and a few days beyond its last washing. Her face was wrinkled. Her eyes, broody and intent, watched me closely as I leaned against the wall and asked her question after question regarding her reasons to visit our emergency department. Occasionally, she looked towards her son to supplement her answer, to clarify something she couldn't quite find the right words to describe. Each time her son was successful in filling in the blanks.

She had come to our department with several weeks of increasing abdominal pain. A diagnosis of kidney (renal) cancer several years earlier had led this patient to having several bouts of chemotherapy and the subsequent great news of achieving remission. Her complacent face, after learning her history, spoke to me--the more she shared her new symptoms with me, the more I realized that she had an inherent sense that something bad was happening in her abdomen again.

I did, too.

Her son, sitting in the corner quietly unless spoken to, appeared much more anxious than his mother. Whereas she seemed resigned to some bad news arriving in her near future, he seemed to be using his energy to avoid any possible realizations of something bad occurring. His intimidating square face, thick neck, and inflated muscles--all those hours spent at the gym to make him stronger--would be of no use to his mother in what the fates might dictate to her. He fidgeted with his hands and feet. He occasionally diverted his gaze from his mother and I to the corners of the room. He seemed to want to rewind the hands of time to a few weeks prior when his mother was symptom-free of any pain and he could keep looking to a pollyanna future with his mother being an integral part of it.

Her physical exam was concerning for the abdominal pain she complained of. She had some distension which gave her belly the appearance of holding a helium balloon within it. Her pain was diffuse, all over, and I could make her right upper quadrant be the main source of this pain when I palpated a steady pressure downward toward her liver.

We did the workup--blood and urine testing with IV-contrast CT imaging of her abdomen. Sadly, the CT scan returned showing what the patient and I had feared--the cancer was back. She had multiple metastatic lesions in her liver and the collection of some ascites, fluid build up around the organs within the abdomen.

Sigh.

I walked into Room 30 with a heavy heart. Not only did I feel for this patient and her son, but I closely identified with the heartbreak associated with the news I was about to deliver to them. It was just fourteen short years ago that I had been sitting in a corner chair of a hospital room with my mother as the patient. She had been battling leukemia and, after coming out of remission, had a battery of tests that had led to the moment when her oncologist walked into her hospital room to share the devastating news with her and me--her leukemia was more spiteful than ever and was remaining refractory to all of our attempts to fight it. I remembered the pain I felt. I remembered the complacency of my mother upon hearing the news. She had inherently known and sensed this would be her outcome. I remembered the wishing and hoping that my father and six siblings (who all rotated their visits due to living several hours away) had been with us at that very moment to divide the pain of my mother's news.

Who am I fooling? The pain of such devastating news as this isn't divided among us--the pain multiplies. Then multiplies again. And keeps exponentially growing until we all learn the appropriate ways to diminish the power it holds over us.

Entering the room, then, I wasn't surprised to see Ms. Loretta sitting quietly in her cot with John now sitting at her feet, holding her hands within his massive mitts.

Without my saying a word, Ms. Loretta knew. "It's back, isn't it." It was more of a statement rather than a question. I nodded to her. "Yes," I said, "it's back."

She asked me questions about her tests. How was her blood work? How bad was the CT scan? Did she have much time? Did she have options? John remained quiet, his eyes focused only upon his mother.

I kept answering her questions to the best of my abilities, but refused to answer the "how much time do I have" question. I assured her that we would admit her to the hospital and get the oncology specialists involved immediately to provide some guidance to the questions she was asking.

All the while, as Ms. Loretta and I were talking, I couldn't help but steal glances at her son. He was me. Fourteen years ago. Sitting with his mother. Holding her hands. Processing bad news. Staring at his hero and wishing with all of his heart that he could absorb her hurt.

He sat quietly, his anxious movements calmed with the news that he was desperately hoping to avoid. He continued to grip his mother's hands in his. His eyes remained fixed onto his mother's face. I knew exactly what he was doing--he was etching her image, her heartbreak, her attempts to be strong at this very moment, into a memory that would remain with him until the end of his days.

Eyes watching eyes watching eyes. Her expectant eyes on me. My sympathetic eyes glancing between her and him. His loving eyes on her.

Sometimes, our eyes are rewarded with the beautiful imagery they seek. Sometimes our eyes are the recorders of specific moments of our lives that we may or may not wish to remember, memories of splendor and memories of squalor. Sometimes our eyes are the conduit of the emotions of our heart and soul. Sometimes our eyes are our best friends. And sometimes our eyes are our worst enemies...

As Henry David Thoreau said, "Could a greater miracle take place than for us to look through each other's eyes for an instant?"

In this moment with Ms. Loretta and John, I appreciated the miracle of my memory from fourteen years ago simply by looking through their eyes for but an instant. An instant that I wish I could have protected them from.

Thank you, Ms. Loretta and John, for this instant...for letting me be present in your moment of painful tenderness.