“The treatment is really a cooperative effort of a
trinity- the patient, the doctor, and the “inner doctor.”
“Rise and go your way; your faith has made you well.”
-Gospel of Saint Luke
I met him as he recovered from his appendectomy. He was in his mid-twenties; he was pursuing an advanced business degree at a local top ranked university. His significant athletic prowess had put him through college. He worked for a large corporation, and they were impressed enough with him to pay for his studies and his salary while he was a full-time student. He had a bright, beautiful, devoted wife and a two year old son. He was the kind of person on whose shoulders we build this country. He worked hard and he gave it his all, and he knew that if he kept this up society would reward him in a big way. All he had to do was to keep impressing everyone who came in touch with him, and he’d be set for life.
Until he became ill. “It” started with joint pain and stiffness all over his body. He had unexplained fevers and rashes. By the time he finished brushing his teeth in the morning he ran out of energy; it took a supreme effort to drive to school and sit through his classes.
He consulted his doctor. The right blood tests were done, but he had a rare illness and the results, though glaringly abnormal, were misinterpreted. He received inadequate medicine at ineffective doses, and he continued to get worse. On the way home from school one day he felt that his abdominal pain, which had been bothering him for a while, significantly worsened. His wife took him to emergency, where he was found to have a ruptured appendix.
Everyone heaved a sigh of relief. It’s not good to be sick, but it feels great to (finally) know what’s wrong with you. Many patients tell me that they’d rather have bad news than linger in pain without an answer. I can see their point.
Unfortunately, the ruptured appendix was just another link in a devastating chain for him. When the pathologist looked at his tissue under the microscope it became evident that this was not a simple case of appendicitis. He had a rare form of vasculitis, an illness that makes blood vessels become inflamed. In his case the swollen arteries had clogged and ruptured, depriving the intestinal tissue of its normal, healthy supply of blood. His appendix had burst because of gangrene. Soon many of his tissues began to suffer the same fate.
I was called when his pathology report came back. It became my job to tell this appealing family that their husband and father was in danger; that he urgently needed treatment; that the medicine I would have to use was potentially toxic; indeed, that there was a fair chance that my treatment could kill or permanently cripple him.
The interview went remarkably well. Maybe because they were young, and reality had not yet sunk in. Or they were so well educated that they could understand everything I said, and they understood that there was no choice. Once his sutures came off I started him on a regimen of chemotherapy and cortisone.
The first month went well. After five weeks his blood pressure crept up, as well as his blood sugars. About two months after his first treatment I received the dreaded phone call: he had developed a high fever, and he felt very weak.
The emergency department confirmed that his white cell count was very low. One of the major defense systems against infection could no longer be relied upon. Within a day after admission he developed a red rash all over his body. His blood pressure dropped to close to unsustainable levels. It was clear that he had sepsis, an infection in his blood stream. The next day the lab confirmed that he had fungi in his blood, a rare occurrence in people who have intact immune systems.
New medicines were started. He got worse. His kidneys began to fail. There was no indication that he would improve. I called the medical school and went over the case with a faculty member that I trusted. No new ideas were forthcoming. On a Sunday afternoon, in the middle of an empty nurses’ station, I prepared myself to tell him and his wife that I had run out of bullets; that there was a very real chance that he would not survive.
I sat on one side of his bed; his wife on the other. She leaned her head against his. There was no light in his eyes, as if it were a supreme effort for him to keep them open. As I began to talk something very similar to anger came over me. It slowly traveled through my system until all of a sudden I understood: I was not about to lose this fight. I had planned to deliver an introduction that would allow me to gracefully surrender later on. Instead I began with a bang:
“We’re going to beat this. You’re going to get better.” His wife smiled, as if she expected nothing else. I saw a glimmer of light peek through his eyes.
“We have the right diagnosis. You’re getting the right medicine. You’re an elite athlete; your body’s strong. You know better than anyone that talent alone does not win games: you have to want it more than the other guy.”
Now, for sure, I could see from his look that he was buying into this.
“You’re in the ring fighting a heavyweight. He’s gonna land some blows. We have to hit back.”
I closed my speech by promising him that soon, when he was up and about, I would treat him and his family to dinner at a local Mexican restaurant.
“Margaritas are on me. We’ll have a drink together and forget that you were ever ill.”
We shook hands and I walked away. I asked myself if I had done something wrong by exaggerating the positive. In the end I decided I had to trust my instincts.
The next day he ate. His pressure came up. Within three days his kidneys opened up. After this his progress was off the charts,as one would expect the finely tuned athlete to respond. At his two month follow up, when I was sure that kidneys, liver, and all pertinent organ systems were normal I asked him to allow me to make good on my promise.
“You don’t have to do that…”
I told him that of course I did. The next week my wife and I had a nice Mexican meal with this beautiful family. Yes, there were toasts to life and good health. And margaritas.