The wake of a red sox fan

They stood in line before the lifeless body. As they passed, some knelt and crossed themselves, others stood in solemn reflection, while others smiled while remembering distant and pleasant experiences past. This was the first wake of a patient I had attended in my near two decades of being a physician. Although tempted to attend previous funerals, wakes, or other memorials, it was as if an invisible impregnable barrier had always prevented me from going on these other occasions. Although if asked, I would have answered that my reluctance was due to time constraints, family and professional obligations, or the fact that it is too impractical to go to all patients' funerals. However, if entirely truthful, I would acknowledge there looms inside a sense of guilt and self-doubt whenever a patient succumbs to nature's course. Was there anything we could have done differently? Even if I feel that our actions were entirely appropriate and death was inevitable, there is a fear that the disconsolate family, grief stricken at their loss, might harbor resentment toward the medical system that could not sustain their loved one. I could find a dozen excuses for missing this one. This death was a testament to medical misadventures; unable to treat his simultaneously failing heart and kidneys as an outpatient, I admitted him to our house staff team for inpatient care. Thinking that perhaps his respiratory compromise might be in part due to pulmonary infection, antibiotics were added to his inpatient regimen. Abdominal pain and toxic megacolon from colitis of “unclear etiology” begat colectomy, which later proved to be due to C. diff infection. Overly aggressive diuresis while in intensive care led to the consideration of dialysis when his kidneys decided to go on a temporary work stoppage. He developed life-threatening drug-induced thrombocytopenia. Prolonged duration of intravenous lines led to bacteremia and vegetations on his combined pacemaker and implantable defibrillator. If a complication could occur, it did, and each one was more serious than the last. Yet through it all, as if he were back in the military 60 years ago, he battled with bravery and quiet dignity, always possessing a warm, almost illuminating, edentulous smile. Even though his hearing aides were lost on multiple occasions during the hospitalization, he still would attempt a weak, hoarse response to any question posed, though his responses often had no relationship with what was being asked. When it was my turn to assume my inpatient ward attending responsibility 10 weeks later, I was assigned to his team. I was not surprised when I found him to be one of the house staff's and students' favorite patients. Mr. B. was one of my first patients as a practicing primary care physician at the Veterans Affairs hospital where I work. A typical member of Brokaw's “greatest generation,” he had served in Europe during World War II, first as a paratrooper and then as a medic. Typical of his humble, hard-working generation, he had seen his share of bloodshed and was willing to proudly sacrifice his life in service to our country. He never talked about his experiences, never thought he deserved any special treatment or expressions of gratitude. It was only after his passing, did I learn of his wartime contributions. He was much more likely to talk about his Boston Red Sox, his four children and ten grandchildren, his work in a paper mill, or his dedication to his town's beer league softball, where he was aptly known as “the commish.” I knew then and know now how fortunate I am to care for him and patients like him, who are, unfortunately, soon facing extinction. He was an old man at the end, 83, but his beloved baseball team, the Boston Red Sox, had never won a World Series in his lifetime. As I stood before him, I recalled our years of talking baseball, me a devoted, borderline rabid, Yankee fan; he an “unofficial official” of Red Sox Nation. As the years passed, his hearing failed, and my teasing shouts and baseball discussions could be heard by passersby in the halls, but hopefully not by HIPPAA inspectors. Was Williams better than DiMaggio? How about Munson and Fisk? Was this finally Boston's year? Could he ever forgive Buckner? If time allowed, we could passionately discuss these topics forever. I had thought of wearing my Yankee tie to the wake, but chose a generic baseball tie so as not to offend my patient, my friend, during our final visit. As I moved among the remaining family members at the funeral home, I was warmly welcomed, not made to feel like the engineer of an out of control train that had tragically crashed. I had led them through emotional peaks and valleys, informing them that I didn't expect him to survive each dramatic decline, only to be proven wrong, over and over again. After watching him extricate himself from throes of death on several occasions, I almost thought that he possessed some unnatural power to overcome any tremendous adversity and cheat death, that he was invincible. Anyone who could survive the psychological and emotional torment of experiencing fierce combat on the field of battle, a wife's long struggle with Alzheimer's disease, and, especially, being a lifetime Red Sox fan, could survive anything. Unfortunately I was wrong. Throughout his long, arduous hospital course, at every emotional family meeting his family was incredibly supportive as we careened around each perilous, hairpin turn. Wanting to offer him his only chance at survival, I recommended to his family that he undergo pacemaker/defibrillator removal. Despite knowing the risks, they agreed to proceed. Why not? They trusted me. Unfortunately, he never recovered after the surgery and expired peacefully soon thereafter. Ironically, the family thanked me. He lay in repose as he would have wanted, surrounded by loved ones and bedizened in his beloved Red Sox jacket, with an adjacent red and blue Red Sox baseball and baseball glove. I thought I detected a hint of a smile. He liked his team's chances this year.