Bourbon

Abstract

It's my first day on a new rotation-rheumatology clinic, with the attending physician who, I hear, crafts awful puns on the fly and lives for his so-called no-delta visits, his social time with his endless panel of stable arthritis patients. I log in to the health record, with the MS-DOS interface that hearkens back to my days as a 5-year-old booting up our computer with those big floppy disks. I'm greeted by a few notifications on the patients I cared for last month on the wards. A few consults completed, a few laboratory test results that I forward to the inpatient team. One notification catches my eye, a canceled laboratory order for Clostridium difficile. I chuckle-we all knew he didn't have C difficile. With the chemotherapy regimen that he was prescribed, he had plenty of other reasons to have diarrhea. I double-click, curious as to why it took this long for the laboratory to finally cancel this weeks-old order.The screen flashes to his chart, and I see on the display:Reason for Cancel: <death> I knew he was going to die. When I admitted him to the hospital for hyponatremia, we knew his cancer was terminal. I remember meeting him for the first time, the furrowing of his brows that spoke of the deep, bony pain that pierced through his ribs. His wife was there in the room, her hands clasped a little too firmly in her lap, donning that sallow yellow gown of contact precautions. He wanted the chemotherapy, he said. He was a fighter, he said, as his wife rolled her eyes and scoffed, muttering under her breath. She stopped me as I was leaving the hospital that day, and she confided in me that she didn't want the chemo for him, that he was too sick, that she had known him every day for 40 years and she could tell that he was in pain. He always says it's a 4, she chides, but I know it's a 7. But it's his body, she tells me. He wants what he wants.So, he gets his chemo, and he tolerates it well. I convince him to actually take his oxycodone when he needs