Song for Whoever

I’m in my outpatient clinic and running behind, as usual, and walk into the exam room and meet a new patient, which requires far more work than an established patient.

This is a 78 year old anglo woman who had vomited blood 2 months ago. She had a gastric ulcer that bled, was admitted to the MICU, and had an endoscopy, a procedure where a tube with a camera is put down the throat to examine the esophagus, stomach and the beginning of the small bowel. They found the ulcer, injected it with epinephrine and cauterized it. She is in my clinic for her follow-up appointment.

I am writing down this history and cataloging all the different surgeries she has had, trying my best to interpret them. She has a list that is very particular about dates and surgeons, and very vague about what was done:

1938: Mouth, Dr. Hunter
1956: Female, Dr. Semmelweis
1983: Cancer, Dr. Morgagni
1995: Leg, Dr. Virchow
1999: Cancer, Dr. Morgagni


After much effort and conversation, I figure out she had a tonsillectomy, hysterectomy, a knee replacement, and two simple skin cancers removed. I am writing this down when she leans over and says, ‘I like the color of your skin.’

I look at her, not exactly sure what she is talking about, and decide the best thing to do is go back to writing and ignore the comment.

‘I haven’t said one racist thing,’ she says, looking at me, smiling. I’m still not sure what to say, so I think for a minute and then say:

‘Look, you’re going to have to cut that shit out,’ I say. ‘The whole point of this is how becoming a doctor has turned me into an asshole, unable to relate to other people. If you start talking like a racist, it’s going to complicate the narrative.’

‘What are you talking about?’ she asks, smiling, but a little confused.

‘If my patients start making racist comments in the middle of their exam, the disconnect I feel can be explained because of you being an asshole,’ I say. ‘Calling attention to your flaws gives me a moral out. But I’m going to need to take responsibility for this. To make excuses won’t do. I may not be responsible for who I was, but I have to take responsibility of whom I’m becoming.’

‘So I’m supposed to lay back and pretend to be the helpless victim of a patient? You want me to get a stroller in here, or maybe complain about how I can’t afford my medications?’

‘Lie back,’ I correct. ‘And if you don’t start behaving I’ll meld you with a patient that has pancreatic cancer and is going to die a pretty horrible death, despite all my efforts to make him comfortable. I can do it with a stroke of the keyboard, and don’t think I won’t do it.’

She stares me down for a moment, but then looks down into her purse, pulling out her bottles of meds, listing them as she sets them on the small counter, ‘Nexium, Hyrdo-something-or-other, lisinopril, and the aspirin, which I don’t take anymore. They told me not to.’

I begin transcribing the list and hear her mutter, ‘people are going to spot this cribbing from Eggers. Postmodern crap is what it is. Laziness on your part, I should say.’

I ignore her and complete my exam.

When I tell her she is going to need another endoscopy she screeches, loudly for about two seconds.

She does not holler or gasp. She screeches. She screeches like an orangutan being poked with a stick: staccato and high-pitched. Then she stops and looks at me.

I try to maintain composure, explaining we need to ensure the ulcer healed. Oddly, given a simple explanation of why she needs it, she agrees.

As I walk her out I hand the nurse the chart and say goodbye to the patient, ‘nice bit with the screeching. It almost makes up for the other.’

‘You didn’t write that bit. I did that on my own,’ she said, proudly. ‘It just came to me.’

‘Well, thank you. I found it quite alarming at the time, but it was funny. Not many patients make animal noises when I tell them they need procedures,’ I said. ‘Anything else?’

‘There is one more thing,’ she said, leaning in toward me and eyeing the black nurse, ‘When I moved here, there wasn’t one black in this part of town. It used to be so nice.’