Fresh out of residency on my first night shift as a hospitalist, I was wide awake and bright-eyed—running on a healthy dose of adrenaline, ready to take on anything. Having tackled admissions, cross-cover and everything in between, I sat perched over my computer by 3 a.m., eager to complete all the night's documentation. In my Zen-like zone, I began typing but was soon jarred by the buzzing of my pager. It was a fretful nurse requesting my immediate presence at a patient's bedside.
Standing outside the patient's room, I quickly glanced at the cross-cover notes. He was a 47-year-old homeless man with AIDS who was admitted for pneumocystis pneumonia, now on hospital day 12. Before I entered, the nurse told me the patient was extremely angry, was demanding to have his oxygen removed, and wanted to leave the hospital against medical advice.
With that information in hand, I eagerly entered the room. I felt confident I could use my compassion, medical knowledge and wit to bring some comfort and calm at this odd hour. When I started to introduce myself, I was interrupted by Mr. P's harsh, sharp voice and cutting eyes, which dissected my every motion as I made my way towards him. I immediately recognized the weathering effect the physical elements had placed upon him—long beard, missing teeth, scattered tattoos—and I was struck by his fighting spirit. I pulled up a chair to listen to his concerns, though I was not a welcome visitor that night.
In the following days, Mr. P's condition began to rapidly deteriorate. He became increasingly hypoxemic, continued to lose weight and—most concerning—the feisty sparkle in his eyes began to dissipate. He initially attempted to protest his body's deteriorating state by refusing to eat and by sprinkling snide remarks into every conversation. Reasoning with him was next to impossible.
One afternoon, as I explained to him the current therapeutic dilemmas and the very real prospect of his mortality, tears rolled down his hollow cheeks. Despite the tough external facade, Mr. P's emotional walls were crumbling and he was starting to open up. There was now room for dialogue and emotional honesty where before there wasn't. As I reached towards him to comfort him, he looked me in the eye and said, “I'm scared.”
Over the weeks of his hospital stay, I had the opportunity to know Mr. P not only as a patient but as a friend, a dreamer, a fighter and a witty, compassionate individual. As the illness experience enveloped him, I witnessed his beautiful metamorphosis to a state of higher insight and peacefulness about his own health.
He made a miraculous recovery. His physical body regained strength, but more surprising was that he seemed overcome with a general sense of peace, contentment and lightness. While he looked forward to getting back to his tent under one of the highway bridges, he was also contemplating taking some classes and considering how he could use this life-altering experience to help others.
Sometimes when I'm driving under various bridges around the city and spot pockets of homeless people, I find myself wondering about Mr. P. I hope the new vista that his mind and body have offered up will give him the strength and courage to embark on many more of life's adventures.