"This is not going to be an easy morning," I thought as I answered my fifth page in the past hour. On call for my internal medicine group during flu season, it seemed as if all of Los Angeles had fevers and congestion and needed my help.
My kids, recognizing that I was no formidable adversary while tethered to the phone, used the opportunity to run rampant through the house, creating havoc in their wake. With conspiratorial smiles, they snuck around silently, and while I was discussing the color of someone's sputum, they were taking all the canned goods out of the pantry.
By the time my husband came home two hours later, I was exhausted from running after them, cleaning their messes. My heart was palpitating; there were band aids stuck to all the walls, Cheerios on the floor, the living room furniture had been entirely rearranged, I was still on the phone with a coughing patient and I had to go to the hospital to see five patients on the floor and one in the ER.
Taking one look at my frazzled expression and the maelstrom that was his house, my husband, in his very calm and reassuring manner, said, "Relax, I'll deal with this."
"RELAX?!?" I glared at him "I have to go."
Just then, Julia, my three-year-old, realizing that I was not very happy, slunk over sheepishly, clambered into my arms and wrapped her arms and legs around me so incredibly tightly.
"I love you," she whispered, burrowing her head into my neck.
"I love you too, but I have to go," I growled, exasperated. "I have patients to see," I said as I pried her off.
The first patient was Mr. Mitchell and the only remarkable thing about my visit with him was that it was completely unremarkable. Three days post-op from a routine surgery, I could tell by his labs, vital signs and chart notes that he was doing well and was scheduled to go home the next day.
I entered his room. A tall, robust man, in his early 60's with graying hair, he sat at the window gazing out with a serene look on his face. I introduced myself and still feeling the stress of the morning asked my litany of questions rather tersely. Was he eating, walking, going to the bathroom? He nodded yes to all of them so I began to examine him. As I listened to his lungs, he saw me looking at the red tulips on the windowsill.
"Oh, my wife brought those over. She can't come to visit me today. We are remodeling our house, but I'll be home tomorrow."
Looking out the window he said wistfully, "Sometimes it is so beautiful it makes my heart ache."
I finished up and was about to leave, when looking out the window he said wistfully, "You know, sometimes it is so beautiful it makes my heart ache."
After the morning I had, I really was not in the mood for sentimentality, but I walked over to the window. He was right -- it was one of those astoundingly clear Southern California winter days, right after a rain. From his 8th floor room he had a panoramic view from the ocean to the snow-capped mountains. It happened to be the one week in February when the jasmine blooms and we could see the purple flowers on the hospital patio.
For the first time that morning I took a deep breath and felt my body relax. I stood there for a few minutes with him and said I would see him tomorrow. I had patients to see.
A few hours later, when I left the hospital, I paused, smelled the fragrant jasmine and was grateful to feel the warm sun on my face.
I didn't think any more about Mr. Mitchell until the next morning at 5:45 a.m. when I got paged with a message from the nurses' station. "We are calling to inform you that Mr. Mitchell expired this morning. Please call us back."
Shocked, I called back. "What? What happened?"
"We don't know. He was sitting up looking out the window until very late, maybe 3 or 4 in the morning," the nurse said, "and when we just went to check on him, he was unresponsive. A code blue was called but he couldn't be revived." Then she gave me his wife's phone number to call.
I was stunned. Statistically, I knew a certain percentage of people, thankfully extremely small, die without warning after surgery -- of blood clots or even heart attacks, but I couldn't believe that the sweet, gentle man I had met the day before was gone. Then I trembled as I realized I was going to have to make the most horrific phone call that Mrs. Mitchell was ever to receive. It was 5:51 on a Monday morning and her life was about to change forever. This was not a responsibility I at all wanted.
Just then, Julia came stumbling down the stairs, rubbing her bleary eyes. She looked up with heavy eyelids and a half smile. In her red flannel nightgown with the black boxer dogs on it, she looked so beautiful it made my heart ache. Figuring I could give Mrs. Mitchell and me a few minutes of reprieve, I gathered her up, wrapping my arms around her so incredibly tightly.
"I love you," I whispered as I nuzzled her soft hair.
I stood holding her, dreading what I was about to do. She started to pry me away from her. She had Sesame Street to watch. I inhaled the sweet scent of her neck one last time and reluctantly put her down.
Then, with tears in my eyes, I took a deep breath, said a silent prayer, and reached for the phone.