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The Art of Medicine

The cost of our care

Reed, Harrison MMS, PA-C

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Journal of the American Academy of Physician Assistants: January 2018 - Volume 31 - Issue 1 - p 58
doi: 10.1097/01.JAA.0000527703.85450.0a
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A crowd had gathered by the time I arrived.

Announce yourself, a mentor once told me, everyone is waiting for you. I called out a greeting to the moat of white coats around the hospital bed. Grim faces turned my way.

I squeezed past the group of oncologists to the edge of the bed, reached for the skeletal hand that rested on the white sheets, and smiled at the face behind a plastic oxygen mask. Somewhere in the crowd, an intern began a narrative as long and convoluted as his patient's hospital course. But I only half-listened. I already knew the story. Old man. Cancer. Radiation, chemotherapy, surgery. Adverse reactions. Pneumonias and intubations and prolonged mechanical ventilation. More infections. Needles and tubes and complications. Flesh and bone gnarled by disease but even worse by the cures.

What doesn't kill you makes you much, much weaker.

The man in front of me matched his chart: black and white text now shades of pain. His thin skin stretched to show off every bone; it sucked into the crevices of his ribs with each breath, an animated anatomy lesson. His eyelids relaxed in the deep craters of his skull, as if the slightest grimace might waste precious energy. His voice came out a breathy whisper, barely audible over the hiss of oxygen.

If this man had flirted with death before, they were now officially engaged.

The intern finished his story and stared at me, hoping I would jump in and write the next chapter. This patient had already suffered a thousand hardships in the walls of our hospital. And now the numbers flashing on his monitor begged to do it all over again. But mercy begged to differ.

I sent most of the physicians and nurses out of the room, took off my white coat, and sat down. The man's wife faced me from across his bed, waiting. I looked into his eyes, held his brittle hand, and asked what no one else had.

Do you want all of this?

His gaze drifted off to some other realm. He shook his head no.

I stood up and took a last look at the man, scarred inside and out. The greatest achievements in science had made this possible. We could reach into the murky waters of death, farther than ever before, and pull people back out of its depths. But they emerge changed: alive but rarely whole.

This is the real cost of our care.

I turned to leave the room but some internal tether held me. For the first time, I noticed the man in the next bed, the patient who shared this room. I cocked my head to the side and our eyes met. There was something familiar in that face.

“Do I know you?” I asked him.

“I don't know, maybe,” the man replied. “A few weeks ago I was in the ICU.”

Connections formed too slowly in my brain. They needed some help.

“What's your name?” I asked.


Yes, that seemed to fit.

“Kenny, what's your last name?”

He told me and the last neuron clicked into place. Memories flooded back like a dam had burst: Kenny lying in a bed, electrodes on his bare skin. Kenny jolting as electricity ripped through his chest. Kenny on a ventilator. Kenny in shock. Kenny without a diagnosis. Kenny spiraling toward death. Kenny's father shaking his head at my feeble condolences. Kenny's wife in tears.

But this Kenny was a different man. No tube protruded from his mouth. No plastic lines plunged into his neck. No glaze of death covered his eyes.

“Kenny, I took care of you for 2 weeks in the ICU,” I said. “You were one of the sickest patients I ever had.” I couldn't stop the next words from tumbling out of my mouth. “You should be dead.”

Kenny laughed and pushed the breakfast tray away from his bed. “I know, that's what people keep telling me,” he said. “But today I walked down the hallway on my own.”

I reached out to shake his hand, if only to make sure he wasn't an apparition. It pulsed with the warmth of life.

I clutched Kenny's hand a moment longer and for the first time all morning I felt truly grounded on Earth. But I knew it wouldn't be long before my hand once again reached into the abyss of death, hoping to find someone on the other side. Hoping to grasp them before they slipped away. Hoping they felt me and squeezed back.

Hoping they could afford the true cost of our care.

Copyright © 2018 American Academy of Physician Assistants