14 August 1996



We're rounding, just me and the chief.  I'm post-call, toasted to the point that I'm crumbling at the edges, leaving bits of carbon char on every surface that I touch or brush by.  The chief looks crisp and fresh, as per usual.  It's okay though; she wasn't on-call. 

Our medical student has taken off for a lecture or something so there we are, just the two of of, wandering up the hallway to catch an elevator.

"We should be called the Grim Reaper service," she says.

I nod and grunt.

"You're Grim, I'm Reaper," she continues, and starts to gesture toward phantom patients in the hallway.  "You're going to die . . . and you, you're going to die also.  As for you over there..."  She pauses as if in thought, interrupting her singsong monologue.  "Well actually, you're going to die too," she declares,  "probably very, very soon."

It's too much.  I collapse backwards against the wall, giggling madly.  As I fumble for the elevator button she adds, "This is depressing as hell isn't it?"

When it finally arrives, voice annunciator clearly proclaiming the wrong floor in cultured tones, I stagger in, holding the door for her.  I leave streaks of char there as well.


We are surgical oncology, and we have lots of dying folks on service.  I get to tell people that they have incurable cancer.  I get to tell their families.

"It is very important for you to understand that the procedure we are proposing is for comfort only.  It will not be curative.  It will not give your father extra weeks or months."

I get to tell them, "I do not expect the pain she is experiencing to resolve completely.  As a general rule, we simply can not make pain go away altogether.  We can, however, reduce it to a tolerable level."  I look at the family levelly, and say, "He is sleepy because of the morphine.  Yes, he will be more awake if we cut it back some, but each decrease in morphine represents an increase in pain.  I don't mind making him sleepy if that's what it takes.  Do you?"


Later that day we're in the o/r.  The intended procedure is excision of an abdominal mass.  I'm suck-boy.  I clutch the suction catheter tightly in my fist, secure in my delusion that I'm actually helping out in the case.  There are suture-sissors close by, on the off-chance someone throws a stitch that needs to have the tails cut.  I feel vaguely guilty because I announced to the student that I would be second assist, meaning that she wouldn't really get to do anything at all.  She's been in the o/r more this month than I have though, and besides, I was there for this patient's initial diagnostic procedure.  All in all, I feel justified.

Our attending is permitting the chief to do most of the work, which in this case represents an incredibly subtle and deft dissection.   She works delicately around an improbably large mass of malignant tissue, and then stops.

"I've gotten it off of the superior mesentaric artery.  I think the vein goes right through it though."

The attending vascillates for a little bit, then agrees.  He goes off to the corner of the o/r to talk to the pathologist on the phone -- we had sent a chunk of tumor off to path so they could take a quick look at it intra-operatively.  While he's away from the table, she lets me reach into the incision to feel the mass and the surrounding structures. 

"There it is, Grim," she says quietly.

"Damn betcha, Reaper," I respond.  "I guess the fact that it surrounds the vein means we're done, huh?"

She nods.  "So is he."



That evening I wander over to my folks' place to skim the funnies and chat with them while they dine.  Mom offers me some really tasty-looking pasta, but I decline, having gorged on some sort of cholesterol nightmare only a couple of hours back.  She rolls her eyes, then grins.  "Your loss, kid..."

My dad observes that it's all the more for them, then asks, "How's work?"

"Work?  Oh - work is good," I say.

I tell them about my night on call, commenting that my pager went off something like fifty times.  Yes, I actually kept track. 

I tell them how kind the junior who supervises me is.  "She could crush me you know, but she doesn't, even when I fuck something up and make extra work for her.  She just comes down and shows me how to do it right, and so next time I do.  She's really very sweet."  I also comment that much to my suprise, I'm actually enjoying working on the surgery service.

"But what about your patients during the day?" my mom asks.

"Ah - it's pretty depressing Mom.  I don't really think you want to hear about it."

"Oh, come on.  It can't be that bad.  Are they really working you that hard?"

"No, it isn't the work itself, I can handle that fine -"

"Well then what about your patients?  I want to hear about them," she interrupts.

I take a deep breath and stare at my beer bottle.  My hand reaches up of it's own will and begins worrying at the label.  "One lady has a tube through her nose to suck thick green junk out of her blocked stomach so she doesn't have to vomit it up.  We're not going to do anything about it because the surgery would probably kill her, and she's going to die in a couple of days anyway.  The oncology team started her on a morphine drip this afternoon to control her intractable pain - she was getting to the point that she didn't recognize her own family members, so they figured what the hell.  Her family is utterly devastated."

I look up at my folks briefly.  "It really is very depressing.  I don't think you want to hear about it."

We chat about local politics for a bit, as if the conversation never happened, then I go off to lose stacks of small change to some of my colleagues in a poker game.