By Tim Lahey

At 94, my patient V. was funny and flirtatious.  Her French accent made even the name of her life-threatening fungal infection sound poetic.

“DEE-seminated HEESTO-plasmo-sees,” she said, “Oaf the skin.”

I smiled.

I also admitted her to the hospital because our treatments were not working.  I hoped intensified wound care and antibiotics and a biopsy would help us turn things around.  A couple of days in the hospital would also, I knew, give us a chance to talk about whether all of this, any of this, was what she wanted…

As the infectious diseases fellow scurried around to see new consults, I snuck off to V.’s room.  Sometimes a visit to a favorite patient can help the hurry, the hard work, the constant interruptions, feel like no big deal.

We talked about how V. felt.  I looked at her skin and saw that her ulcers were worsening.  We talked about next steps.  And then she told me about the theft.

It was bad enough, she said, to share a nursing home room with “a daft old lady,” and to eat institutional meals.  But when her copy of Ron Chernow’s biography Alexander Hamilton disappeared one day, she said, “I shzust could not take it anymore!”

The nursing home staff had looked for the book – “Not so aard, I think,” said V. – but the book could not be found.  And so V. lost the ability to choose which story she would read.

By chance, I had just finished Chernow’s biography, and loved it.  I loved Hamilton’s pluck, his brilliance, his fevered writing.  I couldn’t stop watching as fate and his own weakness began to tear him down.¹

I had also seen Lin-Manuel Miranda’s hit Broadway musical, Hamilton, just before tickets started costing as much as a car.  As V. talked about her lost book, and about her lost independence, a lyric from the show wandered into my brain:

Death doesn’t discriminate
Between the sinners
And the saints
It takes and it takes and it takes
And we keep living anyway
We rise and we fall
And we break
And we make our mistakes
And if there’s a reason I’m still alive
When everyone who loves me has died
I’m willing to wait for it
I’m willing to wait for it²

The next day on rounds, I brought V. a copy of Alexander Hamilton, the biography.  I wasn’t sure this sweet old woman would have time to finish all 832 pages, but I wanted her to read whatever story she chose.

A few days later, all the doctors and nurses on all of the teams caring for V. encircled her bed so we could talk about what to do next.  A big surgery was proposed, and I for one was unsure V. would want it.

Before we could start, her daughter had a question: “Which one of you is… is…”

She looked at her mom, and paused. She tried again: “Which one of you is…” she said, and her mother pointed at me.

“Theess one,” she said, “he is Alexander Hamilton.” She smiled.

Nothing more was said, but the smile V. gave me, and the look on her daughter’s face, were enough to carry me through weeks of pages, progress notes, and emails.

So we started. We talked about disseminated histoplasmosis.  About wound care. About surgery. We talked about quality of life at the end of life.  It was hard, because we had so little for V. to choose from.

But I knew there was nowhere I would rather be than by her side.

Tim Lahey, MD MMSc, is a physician and ethicist at Dartmouth-Hitchcock Medical Center and Dartmouth’s Geisel School of Medicine.  He is Director of Education at The Dartmouth Institute for Health Policy & Clinical Practice, and a Public Voices Fellow at Dartmouth College.

 

References

1. Chernow R. Alexander Hamilton. New York: Penguin Press; 2004.
2. Miranda L-M, McCarter J. Hamilton : the revolution : being the complete libretto of the Broadway musical, with a true account of its creation, and concise remarks on hip-hop, the power of stories, and the new America. First edition. ed. New York, NY: Grand Central Publishing : Melcher Media; 2016.