Living With the Patient
Authors: E. R. Watters
Journal: JAMA (2004)

HIS THICK COUGH SHOOK ME OUT OF DREAMS AND I TOSSED over, still aroused from these sounds as common to me as creaking floors or running water. He was more of a lurking shadow or some sullen, angry ghost than he was a breathing life. His face was hollowed and gray. And with each waking cough, I wondered if this was indeed his last. We woke each morning the same. My long hair matted, I passed him, clenching my bathrobe to my chest. I brought my toothbrush from its hiding place, an assurance that he hadn’t borrowed it while I slept (a precaution taken after I found my last toothbrush wet and yellowed just days after he’d moved in). Edging past a feces-stained toilet, I stepped into the shower. I kicked the lump of gray hair out of the drain and, using my toe, slid it up the bathtub wall. Later I slipped past him, hoping he wouldn’t attempt his idea of small talk, a barrage of accusations toward women or his contempt for doctors. I grabbed my cereal and milk and retreated to the “office,” a room consisting of a table and boxes stacked against the wall, my personal belongings stored and anxiously awaiting our departure. He had arranged himself in the center of our small house, stretched across the sofa, one eye on the TV and one on me, ready to slight me. I found myself scurrying from room to room, quickly closing doors to avoid his bite, and I was a teenager all over again: unable to confront him and rehearsing conversations in which I would feverishly rant, “You filthy, inconsiderate . . . ” yet knowing that he would have laughed at this display of emotion. We aren’t related. My husband and I had been renting a room in the house that belonged to his son, John. “I don’t know what else to do with him,” John pleaded to us late one night, perched nervously on the sofa arm, “He’ll just be here a couple weeks.” His father had just lost a foot to gangrene. He had been fired from yet another job and now he was homeless. “Sure, John, no problem,” we said. “How bad can he be?” we whispered in bed, later that night. “We probably won’t even see him.” A few weeks later, my arms full of laundry, I found him passed out on the basement floor. We carried him up the stairs as he slurred his words, his legs billowing like a child. We sent him off in an ambulance and sat on the porch steps, the 3 of us, and we worried. His son shifted around anxiously, worrying what had happened, worrying who was going to pay for this. We later learned that he was unconscious because of hypoglycemia. He was taking a medicine to lower his blood sugar and had forgotten to eat dinner. A month later, I found him again. This time John refused to call an ambulance. I didn’t ask why. Maybe John felt capable of managing it himself. I didn’t know what was right, but I knew I couldn’t let him die there with us just watching. At my insistence, John and my husband dragged him to the couch while I sifted through the fridge, anxiously reading labels to find the highest sugar content. The winner: jelly. I pushed a heap between his pursed lips and held his mouth shut until he submitted and swallowed. After a few spoonfuls, he sat up, squinted at us, and then turned to watch TV. “We found you on the floor again,” I said. “Must of not ate dinner,” he grunted. “Did you still take the medication to lower your sugar?” “Not sure,” he said and motioned to the heap of medications on the coffee table. John and I exchanged glances and I left to make his dad a sandwich, which he devoured. No thanks for the jelly. No thanks for the sandwich. I lay in bed that night fuming and wondering how he could value life this little. At his last hospital stay, he ran up a bill nearing $100000. A bill he never intended to pay for a life he never intended to respect. I wondered if I had done the right thing. The next day, I stumbled out of bed and headed for medical school, trying to pretend that my idealism and desire to help others was as strong as it was the day he moved in. I sat in the back of class and eyed my classmates. How would they respond to living with the patient? They wouldn’t just briefly visit a poor old man in pain but, instead, would see him as he really was: a bitter old man, fully responsible for wasting his life. Would they act like me—hiding, pretending he wasn’t there? Every time they turned their back, would they wonder if they would find him again on the basement floor? No matter how much contempt they had for him, would they find themselves worrying, wondering if he was taking his medications correctly and feeling that he was their responsibility? Feeling that each time he neglected himself, it was their job to pick up the pieces? Or perhaps they would resolve it in a way I never could. Perhaps they would dismiss their naivete and not cling to it as I had done. It’s a year later now; I live happily in another place, another home. It is clean and cozy here and I can see more clearly now. I visited John a few weeks ago, and I saw that nothing had changed. I saw the same sad old man, now one with the couch, his glazed eyes reflecting reruns of Columbo. His physician had given him a year and a half to live if he didn’t improve his health habits, but he has done nothing. I felt all my old anger return. I was angry that I had wasted my time and that I had made him my burden. He was a vampire. He took part of my life to prolong his own, and I had let him. Still, had he collapsed on the floor before me, I would have sprung to the fridge for jelly.