The Road through Residency:

Silent Companion

Snow dances across the road as the old maroon Plymouth hurtles down the barren stretch of highway. The thin, pale man inside breathes deeply but rapidly as he grinds at the window crank on the door. With one hand on the wheel, he uses his other painful, arthritic hand to roll down the window for one last enjoyment before reaching his destination. The crank sticks but finally gives way, and cold winter air permeates the Plymouth. The driver smirks, looking down at the crank, admiring the old relic, which needs a little elbow grease but still works just fine. In the back of his mind, he wishes someone would think the same of him. From his coat pocket, he produces a pack of cigarettes, fondles one into his mouth and clicks his lighter into flame. A few puffs, and he blows smoke from his mouth, past his yellow-stained, patchy beard. He hasn't eaten for two days but has run through three packs of cigarettes in the same time. His bloodshot, age-worn eyes look up at the off ramp sign, and he exits the highway for the last time, along with his silent companion.

He finds a handicapped spot at the far end of the first row. After placing his oxygen tube around his face, he slings the small tank upon his shoulder, kicks open the door and with all his strength pulls himself to his feet. Immediately, he feels his sixty-seven years upon his back, weighing down on him. His blue lips huff and puff in the February air as he staggers into the emergency room. Still panting, he rests his hands on the check-in desk and he declares his purpose: "I'm… short… of breath."

Hours pass in the noisy arena as he lies on a stretcher. A small line in the back of his hand slowly feeds saline into him. Salt water, he thinks. Ten years on the sea, working my back into spasms, finally running as far as I could from that sour liquid, and here I am getting it pumped into my veins. He smirks again, and looks up to see a young man walking through the curtains. The doctor is short, his face covered with stubble, and his white coat is littered with coffee and ink stains. The youth in his eyes doesn't offset the dark circles under them, each ring representing another lesson learned, another hard night. The man answers his questions about weight loss, shortness of breath, medical history. Then the physical begins.

"You're going to do what?" asks the thin man.

"Sir, it's very important that I do this rectal exam. We have to make sure that you don't have any bleeding anywhere," the young doctor states.

"I'm not letting any boy-doctor… You know I came here because of my breathing. What does my rear end have to do with my lungs?"

"I'm just trying to exclude-" the boy-doctor starts.

"You can exclude this exam, because I ain't doin' it!"

His arms are folded in front of him, his intentions clear. I consider explaining what a rectal exam has to do with the lungs, but give up when it becomes clear my attempts at reason are more entertaining than enlightening. I complete the exam as best I can. On his lung exam I hear crackles throughout his entire chest. In his mouth I find thrush. He is thin, emaciated, and dying. I carefully broach the subject of HIV testing, but he is adamant against it, though his chest X-ray suggests a type of pneumonia seen almost exclusively in HIV patients. Over the next few days, I discuss with him my suspicion, my concerns. His condition deteriorates, and eventually we diagnose the silent companion that has accompanied him so long. He makes his wishes clear: no intubation, no mechanical ventilation. He wants to be comfortable. Throughout this process, I admire his ownership over his own existence, something so often cast aside in the immediacy of illness. His Plymouth sits in the parking lot for a short time, motionless, cold and dying. It has given one last ride for its owner, one last hurrah for the relic.

Three weeks later, I wake up to the sound of my beeper and answer a page about a new admission. I make my way to the restroom in the resident lounge and splash water on my face. As I look into the mirror, I see the rings under my eyes and notice that a new one has emerged.