Paul

 One of my patients died today. That in itself is not an unusual event as my patients live an average of 2.8 years from the time I start seeing them. They are living in a nursing home after all. I was not on call  today but felt compelled to check my voice messages this evening. I had seven messages waiting for me, number four was the hard one to listen too. It had happened Paul had died.

Of course Paul is not his real name but I chose it because this patient suffered the torments of the damned while in the flesh and never once complained to me or anyone else. Paul was an Multiple Sclerosis patient. He was first afflicted when he was 29 years old. He was a happy healthy young man full of promise and life and MS came crashing into his universe.

He had been attending Electrician school and was due to graduate in about three weeks when he had his first episode. It would come to pass that he would never return to school. His loving sister informed me that once the MS had him by the throat it would never let go. He rapidly deteriorated and found he could not take care of himself.  He went from fully functional to living in a nursing home in less than 2 ½ years but the highlight lowlight of his disease was that MS robbed him of his memory. Though perhaps it was a blessing in disguise.

I once asked him if his sister had come to visit and his reply implied that there was maybe a higher mental functioning than we all assumed. He told me "I would not remember if she had visited."

As time passed Paul became worse. The disease seemed to stop advancing when he was able to move only his left arm. When staff entered the room he would wave his left arm in a greeting and state "I love you with all my heart." This became his catch phrase. He never complained, he never said he was unhappy or in pain. He could answer simple questions and tell you how he felt but never once did he complain.

He had a suprapubic cath from the Neurogenic Bladder caused by the MS. Eventually his penis was split like an over-ripe tomato but his only answer to the pain was "ouch."

Several years passed and one night the aids left him lay on his catheter tube. By morning he had a stage 4 tunneling ulcer eating at his hip. We instituted a wound vacuum to help with the healing but he continued to breakdown. It was not long before his other hip and coccyx broke open and I began to get very concerned. As long as he was on the wound vacuum infection seemed to be held at bay. I sent him to the wound clinic where they promptly admitted him and stopped the wound vacuum therapy. Ten days later he returned to the facility with orders for two horribly expensive antibiotics. I spoke with the PCP who set stop dates for the medications. I spoke to Paul's sister and told her it did not look good and that this illness may be the one that kills him.

Through all this Paul would continue to state "I love you with all my heart" when asked how he felt and he never once complained. The antibiotics finished and about ten days later Paul became septic and I sent him back to the hospital for the last time.

Paul had a seizure disorder and was on medication for it. The hospitalist in his wisdom did not think that Paul needed to take his seizure medication so he did not order it to be given. As one might predict Paul began to have seizures after about a week without his medication. The seizures were relentless and not easily controlled with his usual medication. He continued to have seizures for the next seven days.

On about day seven I received a call from his sister. She was in tears and told me the doctors were pressuring her to have a g-tube placed because Paul had lost the ability to swallow. She did not want him to have a g-tube because the only pleasure Paul had left in life was to eat and now that he was unable to eat she felt obligated to allow him to die peacefully.

She wanted Paul to come back to my building and be enrolled on Hospice. I asked her if she wanted me to intervene with the doctors and have Paul returned, she tearfully begged me to help her and Paul.

Knowing I was stepping on the toes of the Hospitalist I called him anyway. Within one hour and forty-five minutes Paul was back in the facility. The Hospice Nurse, Pastor, and myself met Paul's sister at the facility. The facility nurses were in tears and hovered about his bed providing ice chips to his parched lips and tongue. He mouthed to the LPN "I love you with all my heart" as she wet his tongue with the ice.

I got a voice message a couple hours ago that Paul has died. How fitting, a man who suffered the torments of the damned and never complained once, died on Easter.  

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