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Say 'Aaah' | The Doctor Files

Full Hearts in Failing Bodies


Although good doctors are always compassionate, most good doctors are not, emotionally speaking, sweet. Not so patients. Sometimes as a doctor, I meet patients so genuinely sweet I remember them forever. Is this one of life's secret plans: to connect "head people" and "heart people" so each can help the other? I like to think so.

"Judy," a playful woman in her 20s with a Buster Brown haircut, was one of those sweet patients. Judy was mentally retarded and had chronic kidney failure due to congenitally malformed kidneys. She and I met during my internship in the 1970s.

At that time, dialysis was not yet available to most uremia patients. As a result, Judy's organs bathed in toxic waste and she was slowly dying. Her decline was punctuated by worsening chemical imbalance, leading to nausea, fatigue and waterlogged lungs. Then Judy would be admitted to our hospital and stabilized temporarily--with diuretics, fluid restriction and a diet as tasty as sawdust.


Given the harshness of her treatment, you might expect Judy to resent the hospital--and us, its wardens. Quite the opposite. Once revived, she saw the hospital as a glorious social opportunity. Roaming the wards to visit nurses, implore staff for treats and meet fellow patients, Judy was irresistibly drawn to all people. But her particular passion was interns and residents. For us, she reserved a special greeting.

As we trudged through the halls after long nights on call, blearily scanning charts and croaking orders, Judy would scoot up, fling out her arms and squeeze us tight.

Judy--bless her soul--somehow knew that hugs were just the ticket for a weary grunt. She might not pass a first-grade math test, but emotionally she was brilliant.

I wasn't on duty the night Judy died in the final stages of uremic coma--open-mouthed, glassy-eyed, exuding the unmistakable scent of kidney shutdown. But I like to imagine that, in her lingering twilight, she was hugged.


Then there was "Ron," another blue-ribbon sweetheart. Unlike Judy's case, I shared his illness from beginning to end.

When Ron first came to see me, he was a former executive in his 50s. Emphasis on former. A few months earlier, just shy of a full pension, his boss showed him the door.

Stunned and disheartened, Ron left for Mexico, the country of his in-laws. Although his wife had died of cancer a few years earlier, to Ron, her homeland was still a refuge.

Except this time the refuge added to Ron's Job-like sufferings. While in Mexico, he picked up an intestinal infection. Ron's diarrhea lasted months.


By the time he saw me, Ron was exhausted and gray, a once-chubby man who had lost more than 50 pounds and bore all the hallmarks of advanced malnutrition: dry, lifeless hair, swollen legs, skin that flaked like paint.

Could Ron still be infected, I wondered? Sure enough, his first culture grew salmonella, a germ that--rarely--can inhabit the intestine for years. When the report came back, the next part was easy: I prescribed an antibiotic.

For this ray of hope, Ron was so grateful he mailed me a beautiful card. "Dear Dr. Claire," he wrote, "thank you for saving my life." If only it had been true.

As it turned out, Ron had far more than a simple case of salmonella. His real disease was an immune system gone haywire. Not only were rogue antibodies attacking his intestine, they were also destroying his blood cells. This in turn led to transfusions, a splenectomy and new infections. At the same time he battled microbes, Ron's intestinal and blood disease required immunosuppressive drugs that lowered his defense against infection.

Ron had good spells, true enough. To cheer his doctors, he even exaggerated them. But over the next year, his downhill course was clear. In the last months, he spent more days in the hospital than not. His final inpatient stay was especially poignant, marked by widespread nerve damage, bleeding and another infection that ate away his skin.

But throughout it all, as long as he remained conscious, Ron never failed to thank a nurse or doctor or open his eyes in love when someone came to visit. Despite his body's violent war, his heart stayed sweet.

To those who saw him through his final days, it was a mercy when Ron died. He had suffered a long time. But in his suffering, he also inspired. Hundreds of mourners attended his funeral, each of us privileged to have known an extraordinary man.

Most doctors are not sweet. Sometimes, to do our job, we even bury our feelings. But that doesn't mean we aren't touched and comforted by sweet and gentle patients, especially those beyond our cure. Their sweetness is a gift and an enduring legacy.


Claire Panosian Dunavan is an internist and infectious diseases specialist practicing in Los Angeles. She can be reached at The Doctor Files runs the fourth Monday of every month in Health.

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