Imagination

Yemeng Lu, MS3, Otolaryngology

Mr. Charles is lying there, so still, it? looks like he is just sleeping. My mind drifts off to another world, a more ideal one, perhaps one where Mr. Charles would not be…sleeping…

 

“This is a new patient for you, he’s in room 3” The nurse informs me.

                My first impression of Mr. Charles is that he is a quiet, reserved man. He says very little, even when prompted. He came in for a prescription renewal of his thiazide to manage his hypertension. He is ordinarily managed by another physician who is currently out of the office.

                We talk about his hypertension and his efforts to change his diet and lifestyle. He works as a nurse anesthetist and have trouble finding time to eat regular and balanced meals.

                “I go from surgery to surgery and sometimes don’t end up eating till I get home around 10 at night”, he says.

                “I completely understand, have you tried perhaps eating a larger breakfast before you leave in the morning?”

                “Oh yeah, that’s not a bad idea…”

                I am a bit concerned about his stress level at work, but it’s perhaps unavoidable in his profession. So I continued with the social history. I want to establish good rapport with him in case I see him in the future.

                “Who do you live with at home?”

                “Just the wife and kids. Two. Teenagers…”

                “I see, that can be very difficult….” we both chuckle.

                “Is life at home safe and happy?” It still feels strange to ask a 250 Ib man whether if he feels safe.

                He looks at me for what seemed like a long time and sighs. “I guess they are okay…I suppose…”

                “Does anything trouble you in particular?” I want him to elaborate on his very non-committal answer.

                “Everybody’s got problems. It’s just a normal part of life…you know.” He shrugs.

                “Mr. Charles” I lean in a little closer and meet his eyes, “we can talk more about it if that’s what you would like and I am happy to help if I can”

                “Oh thanks Doc…” he looks down at his tennis shoes. “I just have been feeling so lost lately.”

                “How so?” I wish he would tell me more without me digging for it. Then again, I wouldn’t trust somebody I’ve just met either. Even a physician.

                “It seems like everyone’s unhappy with me, nothing I do is right these days. Especially Mary, my wife.” He stopped, perhaps to see if I was still listening or interested. I nodded.

                “We’ve had problems for a while, but not nearly as bad as recently. I have no idea what to do anymore. I’m just so exhausted. She has actually filed for divorce and already moved out and wants to take the kids... I don’t know what I’m going to do without them....I can’t bear to think about it” he trails off. We talk a bit more about their marital issues and he seemed so depressed and overwhelmed. I ask him if he ever had thoughts of hurting himself or other people. He says he usually just drinks a lot and one time thought about ending it all after he’d had half a bottle of scotch.

                At this point, I think it best to elicit some professional help, maybe a psychiatrist, especially because of the suicidal ideations.

“I often find that it helps people to have someone to talk to, someone to help them figure out their problems and deal with their emotions. Is that something you can do, Mr. Charles?”

                “I don’t think that really will change anything, to be honest. Not much can at this point…”

                “Well, sometimes you don’t know until you have given it a try. I really want to help you through this. And you WILL get through this, with some help. Please let me set you up with a colleague of mine, just to talk.” I almost pleaded…

                “Maybe another time…” he started to pack up his things.

                “Mr. Charles, please just consider it. I’ll have the nurse give you a call to see if you have any time later next week to come in, is that alright?” I pleaded some more…

                “Sure, if I can get out of work…” I walked him to the front desk and sent him home with my card and advised him to call if he needed anything at all.

                I call to follow up a week later and learned that he had gone to see the psychiatrist and had already been to 2 sessions. I finally sigh in relief.

 

“I’m sure the tech has told you a bit about him already, but just some more details. So, we have here a 40 year old male, the body was found in a hotel room this morning by the police. He had an IV bag full of Rocuronium bromide hooked up to him and a mask over his face holding down a bunch of gauzes, that are likely full of some inhalation anesthetics… have y’all learned about anesthetic agents? it’s going to be on STEP 1, you know!” The pathology fellow laughed.

                I finally snap back to reality. I am standing in the ME’s office on the 11th floor of Brinkhous-Bullitt observing an autopsy. “Yeah, we don’t remember too much of it though” one of my fellow classmates responded.

                “Well, as a nurse anesthetist, I’m sure this guy really knew his stuff. We’re going to need to send a lot of these chemicals down to toxicology to get analyzed. The police will probably want to know what kind of compound he used. Most likely a suicide, since he left a note about troubles with wife, but we can’t rule out homicide yet…” the fellow continues to slice into the liver, “bread loaf” style, he called it.

                The autopsy assistant, Peggy, is now starting to work on the head. I am staring at the bloody lung sections and trying as hard as I can to not let the smell get to me. It’s a lot different from the cadaver labs. Fresh blood had this disgustingly sweet and fruity smell to it. I tried to breathe through my mouth. Last thing I want is to throw up, especially when the observing police officers on the other side of the glass window have already taken bets on which one of us med students will faint first. I’ve been standing here for close to an hour and I am still in a state of shock.

                Mr. Charles’s body lays 2 feet away from me. His chest and abdominal cavity have already been emptied. His face still looks so much alive. I didn’t know what to make of this horrifying image, so I shifted my gaze to the tattoo on his chest. It seems like it’s in Russian and it looked like a poem.

                Peggy is now peeling back the scalp. It made noises like peeling apart Velcro. I look down at his hand instead. He’s still wearing his wedding ring! Does that mean he still loves his wife? Or he just forgot to take it off. I had a strange overwhelming urge to hold his hand. It looks slightly cyanotic but still retains most of its color. These are hands that held his kids, if he had any, hands that touched his loved ones and worked as a skilled nurse helping people in their more vulnerable times. They were once warm. Maybe he would feel better if somebody held his hand right now. I start to be disturbed by my strange thoughts.

My attention quickly shifts as the brain is slowly being removed from the cranial cavity and Peggy is teaching us all the cranial nerves. It’s pretty amazing to see the optic chiasm and all the nerves attached to the brain. She then shows us the coolest thing yet – breaking the bone overlying the sella turcica to see the pituitary. Such a small organ with a whole category of diseases attributed to it. It looks like a tiny garbanzo bean. We each hold the brain to feel its weight and texture. I wonder if a lifetime of memories is stored in his hippocampus and if his personality is sitting in the frontal cortex. I can’t seem to see it at all in the brain that I’m holding. 

                We step back as Peggy carries the brain over to the pathology fellow. I almost trip over the pile of clothe on the floor that Mr. Charles once wore. It’s a really nice Lacoste polo shirt, I wonder if his wife bought that for him, perhaps before they started fighting. I suppose he also wanted to look his best when he went, I think to myself.

                The fellow starts to teach us the anatomy of the heart. I have given cardiology a lot thought as a future career, so I nudge a bit closer to get a better view. You can see every coronary artery, all the valves, and the dark striated muscle on each of the slices. “The heart is slightly enlarged, especially the left ventricle. He probably had hypertension. His coronaries are relatively clean though, pretty impressive for a big 40 year old guy. I’m probably not so lucky on the other hand” the fellow said. Who is the lucky one here anyways?

I held the heart slices and thought to myself - the heart is truly an amazing organ. “You probably won’t see any signs of COD on the heart since he mostly likely died of respiratory depression from muscle failure” the fellow said, “the lung on the other hand is very congested looking”. He picks up the right lung and plops it on the cutting board and spread it apart. It reminded me of the butcher shop that was down the street from where I grew up.  Honestly, from the looks of it, not much is different…

I’ve never shook this man’s hand or looked at him in the eyes, but I’ve held his heart. I couldn’t comprehend the meaning of it and my mind drifted to another place replaying the same scenes over and over again, “he’s waiting for you in room 3…”