ID : 63 year-old female. Retired pediatric rheumatologist.
Chronic hepatic cirrhosis associated with long history of alcoholism.
Presents with ascites. Lives alone.
Dr. Reddy is here because her belly is full of fluid. Her liver, fatigued by the wear and tear of decades of whiskey sours, can no longer produce enough albumin, the blood protein which usually keeps water where it belongs. When I first meet her, I see she looks just like she is supposed to look, according to our textbooks : yellow skin and eyes, bloated abdomen.
“Hello, Dr. Reddy. My name is Miriam Korn,” I say as I approach her bedside. “I’m a third-year medical student.” I look down at the geography of her face: wrinkles, pale withered lips, folds of grey skin. “How are you?”
Her eyes look up, squint and smile through a golden haze. “I’m okay,” she replies, glancing at her bulging belly. She knows she is textbook material.
We chat for a while. She worked for 33 years as a pediatric rheumatologist in New York City. She loved it. “Medicine is a great profession,” she says. “You are so lucky.” She answers all of my questions: four to six drinks a night for over forty years. Didn’t “get in the way” until the past five years, after she retired.
She tells me about her travels throughout the United States and Europe. There isn’t much to say about her family, she says. Her only living relative is her sister, who has been her sole visitor during her hospital stay. On the night table between us, there is a photo of two collies surrounding a robust-looking woman, atop a mountain. “That’s Chloe and Sasha, with my sister,” she comments, after noticing my interest, “We were in Yellowstone Park.” Her eyes shut for a moment. The corners of her shriveled mouth turn upward.
Later, I reenter with the team. Dr. Hashem, the liver specialist, clad in a pinstripe suit and silk tie, leads us into the room. I like him. He is proud of the framed Hippocratic Oath that adorns his office wall. “Good morning, Dr. Reddy,” he says as he reaches towards her. “How are you feeling today?” He touches her shoulder. “I’m Dr. Hashem. I think you’ve met Dr. Korn.” Doctor Korn?
The Gastroenterology fellow, Dr. Usala, steps forward with his stethoscope and listens to, taps then pokes her abdomen “We’ll probably have to take some fluid off. It’ll help you breathe more easily,” he says. He steps away from the bedside. “We still need the biopsy results,” he adds. Dr. Reddy nods as our team exits.
We huddle together outside her doorway. I report that the liver biopsy results have not yet returned. This is not acceptable, says Dr. Usala.
Suddenly we are all dashing out of the ward, then racing through secret passageways, with our coats flying behind us, like capes. We slow down as we approach a sign marked “Pathology”, marking our destination. We follow the arrow pointing left, through the glass doors, and proceed towards an open doorway.
As we gather just inside the threshold, a man sitting at his desk swings around and welcomes us. He invites us to sit down. We each find a seat, except Dr. Usala, who remains standing.
There is some chatting about vacation plans until Dr. Usala asks The Question. “Have you taken a look at Reddy’s biopsy?”
“Oh yes!” replies the pathologist, as he motions us toward the microscopes. I look through the eyepiece at some purple blobs. “See the white cells?” he asks. No. “Acute on chronic hepatitis. Doesn’t look good.”
Dr. Hashem leans away from his microscope to allow Dr. Usala to take a look. They nod in unison and look up. Then back we go, through the labyrinth, to Unit Six.
Dr. Reddy is discharged after a week of lactulose, which soaked up the ammonia in her blood, and a peritoneal tap, that sucked out some fluid from her abdomen. I’m glad she is better, for her sake and mine. I’m tired of her talk about the glory of the medical profession, and I feel guilty that I pity her. I wish I liked her.
A month later, during my next rotation, I’m back on Six West to meet a patient who is being transferred to my ward. On the board behind the nurse’s station, I notice Dr. Reddy’s name. “What happened?” I ask one of the nurses.
Her explanation is not unexpected. Dr. Reddy had returned home, started drinking again, and was brought back to the ER in an ambulance a few days ago. Liver failure.
I walk into her room, planning to say hello and bring good wishes, and find a blanket-covered mound of flesh on her bed. Her bloated face has sealed her eyes shut. The rhythmic rise and fall of her giant girth is the only sign of life. A long breath escapes me as I absorb the scene. Was she inside this sleeping elephant? I turn and exit.
“What’s going on?” I ask the intern at the door. “Her ammonia and LFT’s are really high,” she replies. “Pretty bad. Might not make it to the end of the week. Her sister agreed to DNR . ”
Over the next few days, I glance into Dr. Reddy’s room every now and then as my team works on a case nearby. There never seems to be a change in her condition. She looks like a beached whale on a gurney, in a lonely, stark, hospital chamber.
One day, my peek reveals an empty, freshly-made bed. I pause. Had her sister come to hold her hand? Who would take care of her dogs?
I recall Mr. Goshen’s * family sobbing by his bedside and remember the flow of physicians inquiring about his condition both before, and after, his death. And I think about the newspaper article that celebrating his life and lamenting his demise…