The Lonely Walker

They made a regal couple, the elderly man and woman sitting in Room 19. She was the patient, he the supportive husband. She sat in the treatment cot while he sat in a chair pulled near her bedside. Together, they greeted me with their warm smiles as I walked into their room.

They both had full heads of healthy, silvery hair that shimmered from the overhead fluorescent bulbs. Their eyes were intense and watchful, and their crescent lips, framing big, teethy welcoming smiles, stretched like thick, pink rubberbands across their lower faces. He was impeccably dressed in conservative, mid-season wear, including a green layering-sweater. She was in a threadbare hospital gown, clearly confident and stylish despite her outfit.

After introductions and the shake of our hands, I learned that they were both in their early eighties and had been married all of sixty years. Sixty years! Can you believe that? How amazing. I congratulated both of them on achieving such a milestone.

"I know where I'm going," she laughed, looking heavenward, "for putting up with him all of these years." He laughed harder at her words than she did.

This, ultimately, explained the matching walkers that were parked against the counter in Room 19. Who needed matching rings for a 60th anniversary present, anyway? I would think that I, too, would be more practical on my 60th anniversary. I noticed these walkers immediately upon entering the room. His and hers. Identical. Front wheels, back posts with thick rubber stoppers, and a right-sided hand brake on each. Greenish-blue in color. Her's had feminine clothing casually strewn over the front bar.

She was 82, to be exact. "He's a few years older than me," she jokingly added, dismissively nodding toward her husband, "I'll always be his spring chicken." By triage notes, she had presented with a two-week history of worsening abdominal pain "that came in waves," mainly to the right upper quadrant. "But right now," she told me, "it isn't so bad." It seemed to be associated with any intake of food.

She still had her gallbladder and my first three thoughts of the cause of her pain were gallbladder, gallbladder, and gallbladder. Of course, elderly women thoroughly enjoy stumping us in the medical field, so I also entertained other suspected reasons for her pain--an ileus (where the bowels are less efficient in moving air or material forward), a bowel obstruction (where the bowels kink on themselves and prevent any forward passage), referred pain from the heart or lungs, an atypical urine infection, or some form of peptic ulcer disease.

I questioned her further. She had no fever. No change in bowel movements. Some occasional nausea and bloating. Then, I asked her one last question, whose answer raised my suspicions beyond the normal concerns.

"Do you have a cancer history, Mrs. Brown?"

"Actually," she answered reflectively, "I do. I had breast cancer about a year ago." She looked over at her husband and smiled. "Remember those days, dear?" She explained that she had undergone chemotherapy following a right mastectomy.

Oh no, I thought to myself. Add metastatic cancer to that list. Unfortunately, I have seen several cases of elderly patients with a remote history of cancer who had presented with a recurrence of their cancer, abdominal pain being their only complaint. I could only hope Mrs. Brown wouldn't be in that category.

I did my exam on Mrs. Brown. Sure enough, she had significant abdominal pain to her right upper quadrant, but only if I was palpating deep in that area.

I explained my suspicions to her. We would need to test her urine, her blood, perform a chest x-ray, and finally, the most important of all the tests, perform a CT scan of her abdomen. That would effectively rule-out or rule-in my biggest concerns. Because we had just had a stroke patient and a trauma patient before her, I explained her workup may take a few hours time.

"Honey," she said to her husband, "go ahead out to the car and take a nap. I'll be all right in here. Dr. Jim," she added, winking at me, "will take good care of me."

Any other night, I would have worked hard to find an extra cot for Mr. Brown, but this night in the ER was crazy. I knew there were no available beds. "Go on, Mr. Brown," I said, "you have a few hours nap time ahead of you. I'll take good care of your wife."

I left the room and let Mr. and Mrs. Brown have a private moment. Minutes later, I saw Mr. Brown shuffling down our hallway toward the exit sign, guiding his lonely walker along the way.

Slowly, Mrs. Brown's results started to return. Her urine was clean. Her chest x-ray was unremarkable. Her blood work, however, returned with two concerns-a mild drop in her red blood cell and platelet counts and an elevation in three of her liver enzymes.

I entered her room to explain her results to her. And also to share that she was now second in line to go over for her CT scan. She was, however, napping. I softly strolled up to her lone walker to check it out more closely. It was spiffy. I've only seen aluminum and black walkers before, and was wondering if this was a custom paint job.

"I never wanted that thing," Mrs. Brown said, my back to her, startling me. I turned around. She had awakened. "Edgar needed one. I was afraid he was going to fall. But you know men...he insisted that he didn't need one. The only way I got him to finally accept using one was if I got one, too."

I nodded. "They sure look nice," I said. "Thank you," she said, "they are identical. We call them "the twins." If I had to use a walker I didn't really need, then at least I was going to pick out a color that suited me."

I smiled before remembering the business at hand. Slowly, I explained to Mrs. Brown what I had meant to explain when I first revisited her room. After finishing, I assured her that I would be back the minute her CT results returned.

An hour later, I walked, heavy-hearted, back into Mrs. Brown's room, accompanied by her nurse. Mr. Brown had returned, his silvery hair now somewhat mussed up from his successful nap. The greenish-blue walkers, side by side again, seemed to present a fortified protective wall. I held her CT report in my hand.

"Good news or bad news?" she asked, as Mr. Brown leaned forward from his seat and grabbed her hand. I looked them both in their eyes.

"Not good," I said. I went on to explain that Mrs. Brown's liver, via CT, appeared abnormal. Not only did she have multiple liver lesions suspicious for metastatic disease, but she also had a solid liver mass that was partially obstructing her small bowels. As I spoke, I appreciated the tightening grip Mr. Brown's hand took to Mrs. Brown's.

We all took a deep exhalation when I finished my explanation. "Well," Mrs. Brown said, "I guess that how she goes, then." She looked over at the two walkers, side-by-side. "I guess I won't be needing that thing much longer, Edgar." Her eyes grew glassy, and I was surprised that she had focused her attention, after such devastating news, on the walker. After spending a few more minutes with them, I stepped out to arrange for Mrs. Brown's admission.

Rare or not, I still strongly believe in the power of prayer, sometimes if even to make me feel a little better about things. I'll admit, though, that there are times when my prayers take on a very different, even bizarre, angle. The night I treated Mrs. Brown, I'm sure, my prayers were along that path. Although, to me, they were quite simple and clear.

I prayed that those walkers would sit side-by-side for another 60 years.

As always, big thanks for reading. To the amazing commenters from my Wednesday post, thank you, thank you. Too kind. Next post will be Monday, May 24. See you then...

Heroes Among Us--Gigi

The world just lost another angel. A hero. An ordinary person with extraordinary kindness and love.

Do you ever stop to think how often through your typical day you pass by an angel or hero and simply don't know? Busy, busy, busy. We have things to do, errands to run, and phone calls to make. We keep strangers at arm's length. And the cost of this hurriedness is simply that we fail to share and learn about one another. Every face we encounter holds a history, a story to be told, and sometimes those stories are remarkable and breathtaking. The unfortunate thing is that we will never know if we don't take the time.

Enter Gigi. Someone who always took the time.

Gigi was an EKG technician at our hospital. Almost nine years ago, as I have touched on previously, my son was diagnosed with a rare malignancy that required him to be on chemotherapy for a year. He failed to stay in remission and had to undergo a second complete year of chemotherapy to achieve remission again. Since then, he has been in remission for five years and is an extremely well-adjusted, bright, athletically-gifted boy who makes my chest swell with pride. Through his experiences, I have learned much about life, about love, about compassion, and especially about embracing the daily moments that hold the simplistic joys that many feel come only with big life-events.

What I was learning at that time in my life, however, Gigi already knew. She was frequently called down to our ER to do EKGs on patients and she could be overheard in conversation with them, asking them frank, sincere questions about their health, their lives. She seemed to really care and enjoy her interactions with each new face.

I didn't really know Gigi, however, until one day when she approached me soon after my son's initial diagnosis.

"How is your son doing?" Her voice had startled me and I looked up from my chart to find this middle-aged woman with a soft perm, intense eyes, and a big smile talking to me.

"Pardon me?" I asked, surprised at her bluntness. Most people either tiptoed around me or asked me directly about my son. I appreciated the latter approach and Gigi did too, obviously.

"Your son. I just found out about him and I'm praying for him and your family I just wanted you to know."

She was a stranger and yet, looking into her eyes, she was my immediate friend. I couldn't break my gaze with her. I knew that she got me, that she understood. She looked beyond my face and forced smile to see the hurt and anxiety that I was carrying.

"I'm Gigi," she said, holding out her hand. I took it and introduced myself. And she really did want to know about my son. How was he was doing? What medicine he was on? How was he adjusting to having a mediport? She genuinely cared and her thoughtful questions reflected that caring.

After a few minutes of conversation, she had to go do a stat EKG and I had to return to my patients. But before we parted, she asked "Can I have a hug?" A hug from Gigi, I learned that day, held more compassion that a hundred Hallmark cards. It was genuine and heartfelt--not just a quick expected pat on the back.

Through the years since, we learned much about one another's family, yet every time I saw Gigi, her first question to me would be about my son. "How's that boy doing?" His return to good health brought many authentic smiles to her face.

About a year ago, in the midst of a crazy shift, Gigi approached me with some worry on her face.

"Doc," she said, never once calling me anything else despite my urging to use my first name, "I'm really worried." She proceeded to explain that she had some abdominal bloating and intermittent pains for months but was afraid to approach her doctor. She felt it would be bad news and didn't want to face it or ruin her husband's recent retirement.

"Gigi," I said, "let's get you in a room. I want to do an exam and run some tests."

"Oh, no," she said in true Gigi fashion, "I'm off tomorrow and these patients need you today. Let me come in tomorrow to see you and I'll bring my husband along. I'll do whatever you say, but tomorrow, okay?"

Of course, Gigi. The next day, as I knew she would, she did come in with her husband. He was just as I pictured Gigi's husband to be--kind, considerate, supportive, and worried. Gigi and I had never taken our friendship beyond the hospital's walls and it was my pleasure to match her husband's face to her loving stories about him.

Unfortunately, Gigi's workup did reveal some serious findings. She had cancer. Cancer that had aggressively spread beyond its primary site.

With this news, I approached her room with a heavy heart. And knowing me as well as she did, she knew the minute I walked in the room that I held heart-breaking news.

"Just tell me, Doc. Don't sugarcoat anything."

I pulled up my chair, grasped her hand, and explained all her results very thoroughly. She cried, her husband cried, and I cried. It simply wasn't fair. Hardworking, decent, compassionate, loving--none of these traits had protected Gigi from something bad. It was her right, I felt, to only have good things occur in her life. I was really affected by her results and through the rest of my shift, I heavily relied on my Naphcon A eye-drops. It was now my turn to pray for her and her family. We admitted Gigi to continue her workup of identifying her type of cancer, its location, and its staging.

Remarkably, my son and Gigi had never met and, encouraged by my wife and I, all three of our kids made Gigi get-well posters. The next day, Cole and I hand-delivered the posters to her. She was in her hospital bed, her husband sitting in the corner, when Cole and I arrived. We knocked and walked through her room door. After looking up at us, Gigi immediately reached out her hands for Cole, who instinctively walked to her bed and sat down beside her. Gigi wrapped him in her arms and my lucky son received the same exact hug that I had received nine years earlier. If it was possible, his hug was even more magnificent than mine had been.

Through her battle, Gigi never once lost her faith or let her beautiful spirit waver. We shared hospital visits, phone calls, and cards, which never seemed to be enough to satisfy this sender's aching soul. She was, as you would expect and hope, surrounded by loving family and friends throughout her ordeal. She braved multiple rounds of chemotherapy and radiation and, despite her body's failings at times, pushed forward in attempts to beat off her disease. "I'm not doing this for me," she said, "I'm doing this for my family."

Sadly, though, Gigi passed away before the holiday season began.

Gigi was never defined by fame or fortune, but rather by compassion, kindness, and love. She embraced humanity wholeheartedly and clearly enjoyed touching the lives of others. If she hadn't taken the time with me nine years prior, reaching out to me in a dark moment of my life, I would have missed having an angel here on earth as my friend.

Gigi, I thank you for taking the time.

As always, thank you for reading. We all have a Gigi or two in our lives, hopefully more--if you want to share a little about your Gigi, feel free to in the comments. Next post will be Wednesday, January 13.