Charlie was one of my first patients as a real, grown-up internal medicine attending. He had end-stage AIDS and was admitted with sepsis, as I recall. He was so skinny, probably 90 pounds soaking wet, and covered in all manner of rashes, like a walking dermatology textbook. He was always cold and wore a knit hat low on his brow. In a rare instance of clarity, he told me that he made his hats out of old sweater sleeves. Charlie was in and out of it. He was my first patient as an attending who I thought likely to die on my watch. I gathered his family—two brothers and a mother, also tiny. They stood shivering in their yellow isolation gowns, and we talked around the AIDS. They knew he was very sick, but I did not want to betray Charlie’s confidence. Charlie kept hanging on and survived to be discharged to a nursing home, though he came back a month later and died in the intensive care unit. I saw his family again in the lobby; his mom was so small but so brave. I said a few nice things about Charlie, reiterated how sick he had been. They nodded.
Several months later, a familiar face showed up in my outpatient office. She was 91 years old and looked just like Charlie. I quickly recognized Lorraine as his mother despite meeting her only briefly. She was accompanied by her son, Charlie’s brother. Her resemblance to my former patient was strong, and it struck me how often we see ghosts, sitting with parents who have lost children or brothers who have lost brothers, especially in our community where violence, AIDS, and drugs have been brutal and prolific serial killers.
Lorraine quickly became one of my favorite patients, always in high heels and red lipstick, smelling faintly of urine. She loved to give me feedback on my appearance and would let me know if she liked my shoes or noticed me getting thicker. Three years later, Lorraine fell and broke her hip. I visited her in the hospital. She was delirious after her surgery but happy to see me. I had no doubt that she would make it, despite the mountain of odds stacked against her. I never heard her voice, gently teasing me, ever again after that visit. Like Charlie, she was discharged to a nursing home and came back directly to the intensive care unit septic, profoundly dehydrated, and covered in ulcers. When I saw her, encased in a thicket of tubes and probes, tongue protruding, no lipstick on, tears came to my eyes. I knew she would have hated to appear this way. I pleaded with her living sons to allow her to pass. Each in turn said, “I would let her go, but there’s no way my brother will agree.”
I sat with Lorraine, listening to the mechanical sighs of her ventilator and remembering our three years together, each one peppered with loss, more loss than one human being should ever have to bear. After Charlie died, her daughter-in-law, a constant companion on her medical visits, also passed away unexpectedly after bariatric surgery. And I recalled her telling me that another one of her sons had died years before Charlie following a random assault.
Finally Lorraine’s sons agreed to let her body rest, but on the day we planned to extubate her, they did not show up. I went home that evening and eventually they came to the hospital, her machines were disconnected, and she passed away in the early morning. I did not go to the funeral. I was nine months pregnant and had an ultrasound appointment that day. I saw my fetus in black and white while Lorraine’s body was being buried deep in the ground. For the next few weeks, I thought of her often but then became busy with my own new life as a mother and started to forget about hers.
When I sat down to write this piece, it took me a few minutes just to remember her name, though I felt such a need to excavate these memories and put them down on paper. As I wrote, I remembered her smudged red lipstick and sharp-as-a-tack mind. I thought of our first interactions during Charlie’s hospitalization, when I had no clue what a force she was. I traced in my mind our timeline of visits every other month, as I got to know Lorraine and the rest of her family. We celebrated many triumphs and mourned countless setbacks together, relating to her health and to her kids. I realized that Lorraine had taught me so much about the role family plays in healing and in health. To this day, I cannot think about Lorraine without thinking of her children, too many of whom had passed before she did. I miss seeing her and suffering through her jabs about my appearance, though I am so relieved that Lorraine will never feel loss again.