No. 14: My patient threw up all over me

7 minute read
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Intern Year:

I liked her right away. She was in her early 30s, chocolate-skinned with a wide playful smile, and wasn’t afraid to wear her purple bonnet around the hospital without shame. She reminded me of home (ATL, that is!); thick southern accent, kind to everyone that worked with her, while simultaneously sporting an “I know I seem nice, but don’t mess with me!” type of attitude. She went by “Miss Jay”, and she was one of the few patients that I felt would have become a close friend if we had met outside of the hospital.

She was admitted for severe abdominal pain, vomiting, and constipation that had lasted for about 3 weeks. She also had a hard time losing weight over the last few months no matter how hard she worked at it. “I know I’m big-boned,” she said, “but I SWEAR I been working out five days a week. Anddddd before you tell me abs are made in the kitchen, I been eating GOOD TOO. No salt, no sugar, no alcohol, help me Jesus, and no fat. But I haven’t shed a POUND. Somehow I’ve actually been gaining weight!”

On examination, she actually appeared slim… everywhere except her midsection. We ordered a CT scan of her abdomen, which showed inflammation around the pancreas (one of the organs) and a large, dilated stomach. She was given a diagnosis of pancreatitis and told not to eat in order to give her organs some rest. We gave her anti-nausea medications, and she seemed to be doing a bit better. The gastroenterology (GI) doctors wanted to send a camera down into her stomach to further assess some of the CT scan findings, but thought it would be helpful for us to place a nasogastric tube first (also called a ‘NG tube’, a thin hollow tube that is passed through the nose into the stomach) to suck out old food and acidic fluid that would obscure their view with the camera.

As the intern on her team, of course it was MY job to place the NG tube.

Placing NG tubes was not a fun activity for me. Patients hated it, and there was always the possibility of accidentally passing the tube into a patient’s airway and causing them to start to choke. I was nervous. And Miss Jay? She wasn’t having it. It took 30 minutes, four family members, two nurses and me to convince her that it was worth it. We told her she would feel better once all the fluid was out of her stomach, and it really had to be done before she could get her necessary procedure (#getthescope).

Once she agreed, it took another 30 minutes to get it placed. She jumped back each time the tube touched her nose. Once, I dropped the NG tube on the floor and had to get a new one. If I got the tube past the nostril and she started to cough, I would pull it out and start again.

FINALLY, I got it past her nose without her coughing or gagging. Success!!! As soon as I pushed the tube a little further, she started to gag a bit and…

LITERS of green-brown fluid came spurting out of her mouth and the tube and onto me.

*Let’s catch that in instant replay, shall we? I put the tube in her nostril. I pushed it forward a bit. She vomited multiple liters of chunky fluid. Straight. Onto. Me. WELP. At least we know it’s in the stomach.*

I couldn’t even jump back right away because I didn’t want to let the tube go and have it accidentally come out. I KNEW it was in the right place because I was basically wearing all of her meals for the last few weeks. No wonder she’s constipated, I thought. There must be something blocking anything in her stomach from getting out.

The next morning (and 3 showers later), the GI team performed an upper endoscopy (sent a camera down her throat to look at the stomach and beginning of the small intestine). A large tumor was found to be bulging into the wall of the stomach, and it was blocking any food from going through. They took a small piece of it to send to the pathology lab, and the next day the report came back: adenocarcinoma of the pancreas. She had pancreatic cancer. Not pancreatitis. CANCER. 

She was a vibrant, 30-something-year-old mother of two with her whole life ahead of her… and she had pancreatic cancer. We couldn’t believe it. For context, the average age of a patient with a diagnosis of pancreatic cancer is 70. Pancreatic cancer carries a very poor prognosis, and she would likely die within the next 6 months to a year, even with aggressive treatment. She didn’t have many of the major risk factors, like a history of smoking cigarettes or a family member with the disease. It was so crazy, and random, and depressing.

We got the cancer specialists on board, and she was discharged with extremely close follow up. I remember praying harder for her than I had prayed for any patient before.

About a month later, I was about to leave the emergency room after seeing a new admission, when I heard someone yell, “Dr. Oye? DOCTA OH-YAY!” I turned towards the voice and almost lost my composure. Miss Jay was back in the hospital, but she looked so different that I almost couldn’t recognize her. Her sunken-in eyes were highlighter yellow, a color I had never quite seen before on a human. Her skin had a gray hue to it that made her look ghostly. Most notably though, she was so skinny. It took every fiber of my being to make sure my face didn’t change as I walked towards her. I gulped hard, stifling back tears as I got closer. I had never seen someone so young look so sick.

She was panting a little when I reached her. “Man, yelling… took a lot out of me,” she sighed and laid back in the bed slowly. She turned her head towards me on the pillow and grabbed my hand with a squeeze. “I finally lost the weight,” she whispered with a small smile.

My heart broke. “I… I’m so glad to see you, Miss Jay,” I said. “I just wish I didn’t have to see you again in here.”

“I’m so…” she rested for a moment. “So happy you are here.” She took another breath. “They put me on another team than yours this time,” She took another breath. “I wasn’t happy about that.”

“Yeah, I’m on another rotation now,” I said, squeezing her hand. 

“Well, while I’m here…breath…will you come… breath…and see me whenever you have time?” She took another deep breath. “I’m… scared,” and with that she started to cry. Slow, silent tears, marching out one after another.

“I will visit you every day,” I said. “I promise.”

And I did. Every day that I saw her, she looked worse. Her eyes became even more yellow (I didn’t think it could be possible), her complexion turned more ashen, and she had less and less energy. She became skin and bones. One day, she started vomiting again. And the next, she started vomiting blood. And the next, she couldn’t tolerate food anymore…  It went on and on like this; every day she got worse.

On a sunny Friday afternoon, I told her I was going to be gone over the weekend. “One of my few weekends off!” I said with a weak smile.

“You deserve it,” She smiled back. “I’ll be here when you get back. Don’t worry about me.”

“Oh, I’m not worried,” I lied. “I’m hoping for the best for you.”

“You believe in God, right doc?”

“Yes. Yes, I do,” I said.

“They told me I’m going to die soon. They say I’m too weak for chemotherapy, and that I wouldn’t survive a surgery. So they aren’t going to do anything. So all I have left…” she started to cry. “All I have left is God. They want me to lose hope, but I have God.”

My eyes started to well up with tears and I was angry at myself for not holding them back. 

“Will you pray for me?” She asked. “Like…now?”

And I did. 

The next day, I woke up to an email from my former attending, who was still taking care of Miss Jay. It read:

“Oyetewa, just letting you know Miss Jay passed away last night. Her family was with her. They wanted to make sure I told you. Thank you for your excellent care, I know you made her last days a bit brighter.”

I was angry.

I was angry at God. Really? REALLY?! She’s in her THIRTIES for goodness sakes! Cancer? And she dies of CANCER?! She has TWO KIDS! And we PRAYED! 

When I returned to work, my mind was full of Miss Jay. I missed her. I was sad. I had been there for her, but I couldn’t fix anything. I met with the GI fellow who had been taking care of her, and we cried together. Everyone who had worked with her mourned. She had touched so many of the people she met in the hospital with her youth, her playfulness, her candor. She was gone way too soon.

To this day, my experience with Miss Jay has been my most emotional experience as a physician. Maybe it was because she was so close to my age. Maybe it was because she died so quickly after finding out she had cancer. Maybe it was the fact that she had gotten cancer in the first place. She reminded me that bad things happen to good people every day. Reminded me of how imperfect our world is. Reminded me that I couldn’t fix everything. Reminded me of my own mortality. 

But I was also happy to have known her beautiful spirit, to have been a small comfort in the face of a large trial, to have been a friend.

Sometimes, that’s all you can be.

Until next time,

Dr. Oye