An Exchange to Remember
I had a powerful exchange with a patient at the clinic, who came in to be cleared for surgery.
He was going in for a procedure, getting his graft replaced for hemodialysis, and needed an internist to give the ‘ok’.
The visit may have begun as routine, but ended as anything but.
Assessing.
To assess his level of functioning, I asked if he was able to climb a few flights of stairs without feeling winded.
It was one of the standard set of questions I normally asked in my evaluation prior to surgery.
The look he shot my way was one of surprise, and I fully expected him to respond in the negative.
He was in his 70’s, after all, and on dialysis three times a week.
But instead, he exclaimed with pride:
“Doctor, I ride my bicycle every day, for 10 to 15 miles. I biked from Montreal down to Teaneck, New Jersey just the other day.“
I must have taken a step back in surprise, as I did not expect this from the man sitting in front of my eyes. 
He was elderly and very thin, his skin hanging on him – the hanger of his body as a support – like an oversized coat.
His back was hunched. Kyphosis, we called it in medicine.
He appeared tired – we refer to it as ‘fatigue’ in medicine because we are forced to use the right code – and it seemed that the weight of the world was being carried on his pale and drooped shoulders, all at once.
Window to the Soul.
Beyond the light that reflected from his eyes, I saw something deep.
Behind the surface, lay something grand, although I couldn’t have guessed what it was.
I hurried past and brushed away my thoughts, having to maintain a professionalism while at work which often involved pushing aside unnecessary chatter or thoughts.
Examination.
I considered some of his objective findings.
His vitals signs were superb: blood pressure optimal, pulse better than most, dipping down into the 50’s in that healthy-kind of bradycardia we see in the athletic types.
The physical examination, other than his nonfunctioning dialysis access, was unremarkable.
When I interpreted his EKG later in the visit, I reported back to him that it looked impeccable.
“Better than some of my 40 year olds!” I told him.
He smiled at me with palpable excitement when I told him.
But what came next, was a total surprise, as I imagined our visit had ended there, when I gave him my ‘ok’ to clear.
What happened next was the so-called ‘reveal’, has it had been hidden all along because it touched my heart, part of the encounter. It had been hidden all along in the depths of his eyes’ twinkle.
His Story
He had been extricated from the country of his birth, Romania, and shipped off to Ukraine, where he was saved by a lone farmer once the Germans came to take them away. He was only 5. His mother had dropped him off there, in the barn where he hid, surviving on potato skins. Miraculously, she made it through the war separately and on her own.
His father and step siblings did not fare as well and disappeared, not to be heard from again. He recounted these stories as matters of fact, without displaying much emotion. I asked what he thought of modern day Holocaust denial, and of countries that chose to remove its studies from their curriculum. He turned to me and said:
“I think children need to go there and see for themselves. When you see for yourself, you cannot deny.”
He continued, describing the different concentration camps he visited later in life and started to weep as he recalled the ‘children’s shoes’. This was what really hit him. The piles of children’s shoes.
He described the area just outside the crematorium, where the bodies were burned.
There, lay a small, pearl bathtub. It had been used by the crematorium director himself to bathe in each day after work, washing off the remains of the day’s burnt flesh, the ash and the dirt.
Again, he cried.
I took a step back, this time in theory, and took my own brief mental survey.
My patient was here, waiting for surgery, having gone through so much in his lifetime, and yet not quite ready to give up.
The bad experiences of his past did not impact the hope that he seemed to hold for the future.
After all, he was there to have his body fixed.
He was looking to restore his health, to live through many more years, with the optimism that those years would bring with them a better future than the past he had experienced.
He smiled when he told me about his family. A wife and two children.
‘Oh, and four grandkids!’ He added, glowing.
I wished him “to 150”, on a twist of a popular Jewish greeting in which we wish life until the age of 120.
“No,” he said, looking tired, “that’s too long.”
“Then to 120,” I quipped, settling on a still-note-worthy in-between.
He chuckled and exited the room, leaving behind him the remnants of unforgettable impact.
I never imagined this would come from a standard 20 minute pre-operation clearance visit. It was simply moving and not to be forgotten.
So Much More Than Meets The Eye Click To Tweet
Note: permission given by this patient to share his story on this site.