by David Williams*

(Written before the Covid crisis.)

I have just learned that a friend and co-worker has entered end-stage heart failure.

He is an aged cardio-thoracic surgeon who left the facility that I work in a week ago. His name is Dr. Joe M. I knew he was ill and knew that he had a cardiac condition but I did not know how advanced it was and is. He must have known. If you have the chops to do heart transplants (“its mostly plumbing…”) you know how badly off you are.

Towards the end of his tenure with us, he arrived early one morning panting and breathing heavily. His hand was on his chest in what is known as Levine’s Sign, ¹ an indicator of cardiac distress.  We looked at each other and in that moment achieved an unspoken understanding. I opined that he was in an advanced stage of heart failure. This also explained his attempts to lose weight and avoid salt.  I had noticed. He looked at me and must have known I was aware of his condition. “What are you looking at,” he asked, though he must have known.

“You’re breathing heavily,” was all I said, but I was thinking far more.  “I was walking and I am out of breath,” he replied.  He was lying and he knew that I knew it. His bedroom was 30 or 40 feet away, in the same building.

I observed the florid complexion, the tripoding and the hand to his chest. I almost went to him with pulse oximeter and stethoscope. I actually took my stethoscope off my neck. I didn’t move and I am glad now that I did not. I spared him that indignity. He knew what was in progress and he knew what I was thinking.

I like Dr. Joe a lot. I had the highest respect for him and for his professional judgment and he reciprocated to a degree that moved me. On many occasions I went to him for a consult and the conversation would go something like this:

“Dr. Joe, I have a patient in Exam Two, I think she needs antibiotics for an inflamed spider bite. It looks to me like early cellulitis…”

I did not finish. He did not even get up or look up.  His eyes remained on the anti-Trump article he was reading. “What do you want to give her?”

“You’re the MD, I am supposed to consult you am I not?”

“Well, what do you want o give her?”

“Well, Cipro I was thinking, maybe Zithro? I don’t think amoxicillin would…”

“You know what you are doing, write what you want for her.” He gave a gesture typical of the man; a gesture that I ascribed to his Sicilian heritage. The gesture was something like “We are done talking.”

On another occasion I stopped by an exam room on my way through the hall. The alleged charge nurse was present on one of the rare occasions that she actually preformed work.  Present was also a young student nurse. The patient was young, male, handsome and shirtless, which may have explained why the charge nurse had gotten up from her desk.  I was supposedly the preceptor for all the student nurses.

 I looked at the patient, a staff member with a lesion on his forearm.  “It’s cellulitis,” I said.  “It’s from a spider bite. He needs some antibiotics.” The charge nurse ignored me and sent for Doctor Joe.  He entered the room and looked at the arm for perhaps ten seconds. He gazed from one woman to the next with an expression astonishment and said: “Why do you send for me? David is here. Do what he says!” The doctor gave a gesture which in Sicily is surely regarded as shorthand for “You are all idiots, I am done with you.” He turned and left without another word; the charge nurse stormed out and the student looked like she wanted to crawl under a table.

On another occasion the same charge nurse approached Joe in the charting area. I was there trying to catch up on charting, the doctor was reading. The nurse asked what antibiotics to order for in-house use. Dr. Joe turned to me and said, “Dave, what do we need? Get what Dave tells you.” The charge nurse glared.

Dr. Joe turned eighty-two a couple of weeks ago but still needed to work in order to “pay for groceries.” His scrub pants were ineptly mended with iron on patches from Walmart (“life was not supposed to be like this…”). He has a resting tremor but I have seen him stitch a man’s eyelid with such dexterity that the patient had no scar.

Dr. Joe called me with the news of his health a couple of hours ago. I had patients waiting and I had to call a young physician to finish up. I have been seeing patients since his call and now have a moment to express some of my feelings. His cardiologist urged him to accept hospice care and he did, although up to that time he was still driving and living independently. “I think my cardiologist may be premature,” he told me. Doctor Joe is hoping to improve enough to visit his 89-year-old brother in New York one last time. I hope he does.

I am sad this afternoon as are many of my co-workers.

Postscript March 2021. 19 months later:  I have been out of touch with Dr. Joe for many reasons: Family, Covid, survival, work, an upgrade to my license, surgery for my wife.   I cannot now reach him.  Emails go unanswered, his phone does not pick up. 

It was inevitable and I am sad. 

I remember a conversation that I had with Joe toward the end of our time working together.  He was for some reason impressed with my considerable education in non-medical fields.  He told me that he just had a birthday conversation with his 89-year-old brother in New York City.  It seems that his brother was terrified of his impending mortality. Maybe. Dr. Joe speaking for himself? I wonder.

To me, this ending is unnecessary and detracts from the piece.

I urged Joe to comfort his brother and words such as the following:

“He has nothing to fear. Only the immature that fear death.  In any event death is inevitable, is it not?

I stood theatrically. “If today is the great getting up morning, I’m ready, I am always ready.  I am aware of the pain it will bring my family and my friends, but there is nothing I can do about that in any event, is there?  Death is nothing to fear, I have been dead before and will be dead again.  I was dead for a really long time and it is no big deal. I was dead through the whole renaissance. Yes, I have memories that I cannot account for and perhaps they are evidence of life beyond this, but I am too cynical to entirely believe even my own evidence.  Your brother has nothing to fear. If I am right, death delivers instantaneous and gratuitous nirvana, a state devout Buddhists struggle for their entire life.  Tell him.”

He smiled but said nothing.

On another occasion, he spoke of the disappointments of his life and how hard it is to find work at his age.  I agreed as I am not exactly an adolescent myself. I told him, “No life is without its disappointments, but no life is without its consolations.”

“I’m still waiting for mine,” he replied.

“Isn’t it true that you told me that you have two sons that you regard as upright and moral individuals?”  He smiled and nodded.

I am afraid my friend now knows the long and short of my suppositions on life after death. I get teary when think of him.  I am teary as I write this. Perhaps I am wrong about the finality of death. Maybe we will meet again on the far side of the stream as some suggest. I hope so. I have a pile of people I want him to meet. I wish him a good journey.

References:

1. Levine’s sign. https://en.wikipedia.org/wiki/Levine%27s_sign

Author Bio: David Williams holds a bachelor’s degree, a master’s degree and an ABD for the doctorate in writing. “No other life experience compares to telling a parent that her son will survive an incident that is generally considered non-survivable.”  He is a licensed EMT and is currently upgrading to Advanced EMT. He once functioned as a provider under the license of a noted cardiac surgeon.   Williams lives in Williamstown, MA and can be reached at davidlwilliams@gmail.com