I met him three days ago for the first time. He had an amalgamate of health issues -- heart failure, kidney failure, fluid on the lungs, possible heart attack, pneumonia, poor ventilation (high CO2 and low pH) -- yet he was in good spirits.
He was doing so much better yesterday, even to the point I felt comfortable letting him stay off his BiPAP. He was so happy, because the mask was causing his facial skin to break down, and his mouth was dry, and the seal was tight and uncomfortable.
He didn't even have to ask what day it was today. Yesterday he said he felt a little disorientated. I confirmed to him that after what he went through a little disorientation was completely normal. Yet there was none of that today. He was awake, alert and completely orientated.
Yesterday a five minute breathing treatment with him took a minimum of 35 minutes each time. And considering he received a treatment every three hours, I spent quality time with him. Yet he wasn't like most patients. Mr. Sower and I clicked.
First we talked about the Bible. I started the conversation by placing my hand on his Bible and asking? "So, you a diligent reader of this?" I could see a sparkle in his eyes. A conversation took off.
During a later visit he was watching a Fox News report about the new Congress, and he said, "So, what do you think of all this?" I had a feeling what his political affiliation was after our discussion yesterday, yet I didn't know for sure.
So I almost jokingly set the table, "So do you want me to tell you what I think you want to hear, or do you want me to tell you the truth?" I have to ask this because I know some people get angry when their political views differ from yours. Normally I'm not so blunt, yet I knew his personality.
"Nothing but the truth in here," he said.
So I relayed to him what I think about the goings ons. A brilliant conversation ensued.
Today his blood gas values were worse. His pH had not gotten over 7.3 the three days he had been admitted, and it's supposed to be at least 7.35. And yesterday it was 7.2. Today, however, it was 7.1. The problem was that he acknowledged to feeling great. "They say I'm getting worse, but I feel so good."
So I had to make him put on the BiPAP mask he hated so much. Yet he was wise enough to know the machine was his only chance to live another day. Due to his poor health he had made a declaration he didn't want life saving measures, and he didn't want a tube in his throat. So that left us with BiPAP.
Yet he wanted to eat first.
So just as he was getting ready to eat he asked me to tell him the truth about his condition. He said, "Dr. Kick is a good doctor -- I think. Yet he doesn't communicate well. In fact, I don't think he's sure enough of himself to be straight."
I was honest with him. That's all he wanted. His problem was not oxygenation, it was that he wasn't taking deep enough breaths. I encouraged him to focus on his breathing especially when he was off the BiPAP. I encouraged him to focus on his breathing even when he was on the BiPAP.
And, most important, I encouraged him to stay on the BiPAP as often as possible until he was better. "If you don't stay on the BiPAP, and if you don't continue to take deep breaths, your numbers will continue to go down and you'll peter out. I know you feel good right now, you'll just have to put up with us until you get better."
I laid it straight, yet I didn't take his HOPE away. Yet Dr. Kick wasn't as faithful.
"Thanks, Rick," he said. And just then Dr. Kick came in and laid the cards on the table. When Mr Sower asked, Dr. Kick said, "It's not good. You're going in the wrong direction. There's a good chance you're going to die." He laid all the cards on the table, from the pneumonia to the heart failure, to rising cardiac enzymes (indicators of cardiac bruising). "And there's nothing I can give you for the heart failure," the doc said, "because I'm afraid your kidneys will completely shut down."
I could see the life fall from the patient's face. I thought it was good Dr. Kick played it straight with the patient, yet he could have had more tact. He could have done more to give the patient hope. For even if the hope was bleak, hope can keep a person ALIVE.
"Put the mask back on him," the doctor said.
"I hate to do this," I said. I set the mask on his face, it automatically gave the patient a high pressure breath, and I secured the straps. I felt bad that I had spent Mr. Sowers time in conversation, because he could have been eating. Now he wasn't allowed to eat.
The doctor left the room. The patient was looking at his feet with a dreamy stare. He did this, and I almost thought I should leave the room so he could have a moment. Just at that moment he looked at me, and his eyes lit up.
Right then I was reminded of a discussion I had once, a post I wrote once, about how patient's who believe in God may be depressed, yet they aren't gloomy. Patients who don't believe take you into their dark world. Mr. Sowers was a believer.
I went to the nurses station and checked the chart. Mr. Kick wrote an order so the patient was no longer allowed to eat. "What a fool that doctor is," I said to the nurse. "How can a patient keep up what little strength he has if he's not allowed to eat?
"Don't lecture me," the nurse said, smiling. "I didn't write the order."
"I'll have to call Dr. Kick and be firm," I said. Yet I knew I wasn't aggressive that way with doctors, so the nurse said she would do it. "Just make sure he gets some food."
An hour later Dr. Kick was in the RT cave reading EKGs. I said to him, "So, that guy in ICU 34 is a challenge for you, hey?"
"No, he's no challenge," he said, "He's losing the fight."
What a frickin pessimist, I wanted to say to him. I'm glad I didn't choose this bastard as my doctor.
Yet before I had a chance to say anything my beeper sounded off. I clicked the button on it and the LED lit up. The message was for me to return to the unit, "Mr. Sowers wants to talk with YOU."
I knew what he wanted. I knew what he wanted to tell me just like I knew what my Christmas present was going to be every time my 7 year old asked me, "So, daddy, what do you think is in this box." Yet I pretended not to know.
I stood beside his bed. I saw he was trying to hold back the tears. His wife, a good friend and coworker, was beside the bed. She too was trying to hold back her tears. He said to me:
"I wanted to talk to you..." his words were choppy and muffled through the BiPAP mask. I knew what he was going to say. I just knew." There's something I wanted to say...," a long pause as he tried to collect himself. "Please bare with me...you'll just have to bare with me here."
I looked at his wife, a lady I had worked with for several years, and she too had tears in the corners of her eyes. They were both trying to be strong. Why do we always have to try to be strong? Why can't we just cry when the urge hits? That would be the more natural, healthy, way to do it. Yet he was strong, and she was strong for him.
"It's not often you find that kind of person -- someone you click with. You and I share the same interests. We're passionate about the same things. We talked about politics. We talked about God. Most important, we talked about God on the same level. It makes me feel like I have something more to offer... I wasn't prepared for that shocker this morning..."
"I can understand that completely," I said.
"I don't really feel like it's my time. I just feel like I have more to offer. I understand if HE wants someone with my gifts, yet if he has one more miracle, one more effort, I would really appreciate it right now. I just... I know we just met...It's very rare that you find someone you really click with..."
"I know," I said, "It's very rare to find someone you really click with. It's rare to find someone who has an interest in the wisdom you have to offer."
I really didn't know what to say. I tried not to say anything. I tried to say something. I didn't know what I was supposed to say. Yet I found myself talking. It was a rare event for me to feel like I had the right words.
Before we got married my wife and I had to visit a priest once a week for a couple months. The first thing he helped us do was determine our personalities. My wife determined hers in one session. It took the priest five sessions to determine my personality.
The reason it took so long is because, as the priest described it to me, was, "You are a special blend of personalities. You are all personalities. You have this rare personality where you blend with everyone. You are a combination of all personalities."
In fact, the priest then said that my personality is "so rare, that you are so peaceful and so phlegmatic, that your interested in nearly everything. Yet you are less interested in trivial talk, and more interested in in depth material such as politics, philosophy, and even faith."
The priest himself had a sparkle in his eyes as he realized my personality. I believe the reason was because of what he said next, "When I took the personality test, the same thing happened to me. It took me days to decide my personality."
The priest said, "When you were a kid you probably had trouble finding friends, because you were searching for someone to share your wisdom with. Chances are, you were a loner as a friend. You had friends, but no one you really clicked with. The reason is because few share the same interests as you do. And, chances are, based on your personality, you will meet five people (he showed me his five fingers) with your same interests, your same personality, in your entire life. And they will all be in your adult hood."
After a brief pause, he said, "And chances are also that you'll never meet someone your same age. There are so few people your same age with your personality that you will probably never meet a person your same age with your personality. Chances are you'll meet people older than you. Or when you are old, you'll meet someone younger than you that you'll completely click with. You'll feel a warmth."
I didn't want to say anything, so I sat in my chair next to my wife back then hoping the priest would go on. I wanted more of his wisdom; needed more. He said, "Not only that, yet you will never get to spend quality time with any of these people you click with. Chances are your encounters will be in passing. Yet you'll still want to share your wisdom. You'll probably have the urge to teach, or to write."
I think that priest was the first, my co-worker Jane Sage was the second, and now Mr. Sowers was the third.
So when Mr. Sowers said, "I felt a special warmth" during our discussions, I knew exactly what he meant.
"I don't mean to sound...", he said,
"I completely understand," I said.
"You can understand why I don't think it's my time to leave. I feel I have more to offer. I'd like to meet with you again and have another discussion. Many discussions perhaps."
"I'll pray for you," I said. He offered his hand. I shook it firmly. His grip was stronger than mine. His smile sincere.
He closed his eyes. His hand went limp. I placed my left hand on his chest. I close his eyes.
Mr. Sowers was 54.