Seizures in young men are common. A few nights of hard drinking and little sleep. Poorly treated epilepsy. Traumatic brain injuries. Withdrawal syndromes. Thirty seconds and I could tell that this guy didn't look like an honest citizen. He was probably off his seizure medications. Or drinking. Or drinking and off his seizure meds. Or maybe they weren't really seizures at all. I had to leave the room to take a call and check on Room 3. I came back and tried to catch him in his words. Was this really a seizure? Loss of bowel or bladder function? Were you awake? Do you remember the seizure? You forgot your meds didn't you?
"I don't know. I don't remember... I just passed out and woke up on the floor with a headache. I had to crawl to the phone and call my neighbors. I live alone." I went to auscultate his chest. I opened his gown, I saw a massive, deep scar on his back. I smiled weakly at his neighbors. It was as if the very hand of god had reached down from the heavens to claim a pound of flesh from his back. It was a deep, eye-shaped crater characteristic of wide-margin excisions performed typically for skin cancers. "Melanoma he said" They found it two years ago and cut it out of my back... As I stood there awe-struck, Room 15, next door began a sort-of howling that could only come from gastroparesis...
"I don't know. I don't remember... I just passed out and woke up on the floor with a headache. I had to crawl to the phone and call my neighbors. I live alone." I went to auscultate his chest. I opened his gown, I saw a massive, deep scar on his back. I smiled weakly at his neighbors. It was as if the very hand of god had reached down from the heavens to claim a pound of flesh from his back. It was a deep, eye-shaped crater characteristic of wide-margin excisions performed typically for skin cancers. "Melanoma he said" They found it two years ago and cut it out of my back... As I stood there awe-struck, Room 15, next door began a sort-of howling that could only come from gastroparesis...
When I came back into the room, the neighbors had stepped out. I remember he talked with a nervous joviality around them. That too, was now gone. He already knew what the return of his seizures meant. In fact, I think he had known for some time...
35 year old... History of melanoma excision 2 years prior with negative margins and negative sentinel nodes. 2 months ago he had some R hand twitching. A CT scan had revealed three small masses in his brain. 15 cycles of outpatient radiation to shrink the tumors. An outpatient MRI had been done 2 days ago and he was sent home to wait on the results. He lives alone. And today, he is carried in by neighbors, after having focal motor seizure. Joking. I opened up the MRI which reveals a brain riddled with disease. He has cerebral edema. I discussed with his oncologist. They advise a referral to hospice. 35 years old...
He told me he already knew. He also suspected that little could be done. He tried to remain composed. Imagine trying to spread cheer as your own life is being extinguished. Lying in an ER stretcher surrounded by people that you can't genuinely call friends... neighbors. He smiled indifferently..."what are you gonna do, right?"... I could see him trying to lighten the atmosphere..for their sakes. Maybe lighten is not the right word but numb... suffusing it with a novocaine to make this easier for us all to accept. After all, the realization of mortality had visited him long ago. The rotting teeth from focused radiation treatments, the patches of alopecia that dotted his scalp, the sallow cast that can only come from the ravages of cancer... He had known for weeks that things were rapidly deteriorating...that he was dying. Struggling to deal with his own plodding death while trying not to become a mire of pity. After all, no one wants to be around someone as they're dying...
Pity, sorrow, and a general melancholy seems to flow from people unconsciously around those marked for death. It stifles the human spirit when you're no longer a person with hopes and dreams. I wanted to call him several days later...What would I say? Maybe share a game of cards or a few minutes of idle chatter. Maybe have lunch. Over the years, doctors have become wary of crossing lines. Of HIPPA. Of impropriety. Of presuming and asking too much. Of human decency and emotion. Too often, we are the "sometimes friends"... willing to share a smile but never call on a rainy day.
35 year old... History of melanoma excision 2 years prior with negative margins and negative sentinel nodes. 2 months ago he had some R hand twitching. A CT scan had revealed three small masses in his brain. 15 cycles of outpatient radiation to shrink the tumors. An outpatient MRI had been done 2 days ago and he was sent home to wait on the results. He lives alone. And today, he is carried in by neighbors, after having focal motor seizure. Joking. I opened up the MRI which reveals a brain riddled with disease. He has cerebral edema. I discussed with his oncologist. They advise a referral to hospice. 35 years old...
He told me he already knew. He also suspected that little could be done. He tried to remain composed. Imagine trying to spread cheer as your own life is being extinguished. Lying in an ER stretcher surrounded by people that you can't genuinely call friends... neighbors. He smiled indifferently..."what are you gonna do, right?"... I could see him trying to lighten the atmosphere..for their sakes. Maybe lighten is not the right word but numb... suffusing it with a novocaine to make this easier for us all to accept. After all, the realization of mortality had visited him long ago. The rotting teeth from focused radiation treatments, the patches of alopecia that dotted his scalp, the sallow cast that can only come from the ravages of cancer... He had known for weeks that things were rapidly deteriorating...that he was dying. Struggling to deal with his own plodding death while trying not to become a mire of pity. After all, no one wants to be around someone as they're dying...
Pity, sorrow, and a general melancholy seems to flow from people unconsciously around those marked for death. It stifles the human spirit when you're no longer a person with hopes and dreams. I wanted to call him several days later...What would I say? Maybe share a game of cards or a few minutes of idle chatter. Maybe have lunch. Over the years, doctors have become wary of crossing lines. Of HIPPA. Of impropriety. Of presuming and asking too much. Of human decency and emotion. Too often, we are the "sometimes friends"... willing to share a smile but never call on a rainy day.
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