Friday, August 24, 2007

Closing Time

"Closing" in the OR was a quiet affair, without the usual chatter and relief of tension that accompanies the last stage of an emergent operation. It was late, and so the surgical waiting room was deserted save for an elderly gentleman and his son. I approached with the familiar but profoundly uncomfortable feeling in my chest that comes when I'm not quite sure how to phrase something. For the past 30 minutes or so, my mind has been doing flip flops, seeking the right combination of words to express what we have found in the operating room, and what it means. I have been doing this for 13 years post-residency, but this part of surgery only gets harder with each passing year.

As I draw near, he looks up with faint hope but eyes that tell me he already knows what news I bring. It is not good. His wife of more than 6 decades is dying quickly, and there is nothing I can do about it. While I sit with the two of them, my mouth droning on about the "how," the "why," and the "what we did," it is clear that what I am saying is drifting away in Brownian motion without landing on a single eardrum. And that's OK with me, because I would rather not say a whole lot.

I explain that she will leave the OR and go to the intensive care unit; while there are many things we can do to prolong her life, the time gained would be negligible and the discomfort could be great. Making her comfortable, we agree, is the right thing to do until the inevitable end.

"She will be there in a few minutes, and I would be happy to take you in to see her," I say. It is a chance, I think, to hold her hand one last time, to smile and remember. But I am wrong with my assumption. "No," he says. "It's late, and I think I'll go home. She's not really in that ICU, anyway."

We shake hands, and he gives me his thanks --- an appreciation that I don't feel worthy of, given the outcome of my efforts. But as I have grown older, I have grown to understand his sentiments. His wife really isn't present in the ICU. The woman he loves is not lying in a bed with tubes and wires and strange people draped all around her. He is going home, where she lingers for a little while longer. She resides there in a way that a man never can, in the drapes that just match the pillows on the couch; in the pot of her cherished geraniums; in her collection of figurines, dishcloths, and little pictures all festooned with cherubic mice; in the smiling faces of their children in countless photographs on the wall; in the trailing scent of her favorite perfume. "I was lucky to have her," he tells me. I believe him.