On House, M.D., there was a character named Wilson. He was an oncologist.
I remember an episode from season one. It was the season finale, or at least pretty darn close to the end. The episode is called “Three Stories.”
There’s a scene where House is standing at the front of a lecture hall, twirling his cane. He’s addressing a room full of med students. They must be in their first or second year, since in the U.S., I’m told that you don’t start seeing patients until your third year. House is talking about an patient of his. The patient is dying.
“I have a friend. He’s an oncologist. He’s so good at his job, that when he tells a patient that they’re dying, they thank him. Can you believe that? They say “thank you” when he tells them that they’re gonna die. “I’m sorry, but we’ve done everything we can. You’re going to die.’”
I can’t help but think of Wilson. What’s it like, to tell someone they’re going to die? What’s it like to carry that weight—the burden of someone’s life? What’s it like, knowing that you did everything you could, but still, somehow, some way, no matter how hard you tried, you failed them? That you were somehow complicit, responsible, guilty? Do you remember the name? The room where you broke the news? Do you remember their face? Do you remember the look in their eyes, when you told them that the end was coming, and that there was nothing they could do about it?
It’s her first day at the clinic. Well, technically, she flew in from Bali yesterday, but this is her first full day. Her orientation, in more ways than one.
I don’t remember how my morning routine when that morning. I think I said good morning—drank some freshly brewed Timorese coffee, ate a roll smeared with jelly; maybe Senora made eggs that morning. I remember waking up at 6:59AM to my cell phone alarm. I remember actually hopping out of bed instead of just rolling over and going back to sleep like I do most mornings. I remember us walking—my roommate, me, and the new girl—we walked the thirty minutes to the clinic.
She was clearly exhausted from the chaos of adjusting to a new environment. We all were, in some small way. Some of us were just more used to the chaos than others. But through the layers of exhaustion and jetlag, I glimpsed excitement. It was there, and it was real: she was excited for her first full day here. She was excited for 8AM rounds, for meeting all the patients—for real, authentic, hands-on clinical experience. Nothing like med school, no sir. This was Timor. It was real.
When we walked through the gates of Bairo Pite Clinic thirty minutes later, our smiles were huge. It was only 8AM, and I already had sweat dripping down my back, but the new girl’s excitement was infectious. “Bon dia,” we chirped. “Diak ka lae?” Our smiles faltered when a nurse ran up to us. “Douter?” she asked. She was wearing a face mask. But it was 8AM. Who wears a face mask at 8AM? Even the grounds crew doesn’t put on their face masks until around 9AM, and that’s for sweeping the TB wards. How odd a greeting—a nurse in a respirator mask.
We followed the nurse to general wards. To the isolation room off on the right—bed number one. I think that’s what the bed is numbered. Bed One. Right next to the nursing station. I know who’s there. My roommate knows who’s there. The new girl doesn’t. She’s barely spent an hour on the clinic grounds yet. What kind of welcome is this? It’s not even fair.
His vitals. He’s not breathing right. It’s not chain-stoking, it’s different. It’s like he’s breathing in slow motion. His eyes are open. There’s a breathing tube in his nose. I haven’t seen him in two days. I should have checked on him yesterday. I didn’t know he was this bad. Nobody knew he was this bad..
She’s freaking out. She takes his vitals, stares at the machine. She’s not tapping her feet or wringing her hands, but her eyes are wide. There are still bags under her eyes. She’s weary from traveling. And now this. Her first day at the clinic, and the very first minute, she’s greeted with this.
There are no doctors around. Just a few worried nurses. The nurse who called us over is standing in the doorway, unsure of what to do. I’m just an undergrad, damn it. I don’t know what to do. I don’t even know what the numbers on the machine mean. My roommate is a year younger than me. We don’t even have stethoscopes hanging around our necks.
Her eyes are frantic. They dart around the room, searching for answers. She’s the fourth year med student, after all. She’s supposed to know what she’s doing.
“Should I call Dr. Dan? I’ll call Dr. Dan.” He’ll know what to do. He’s been here for so long. But before I can even unlock my phone, he’s at the door. He must have been standing outside of Maternity, waiting to start rounds. I wonder who called him over. He says hello, but his face is grim. I plaster myself against the wall, trying to stay out of his way. He takes the patient’s vitals with his stethoscope. He ignores the machine. He shakes his head. The patient’s family speaks English. They hear what Dr. Dan is saying. They understand what he’s saying, but they don’t get it. Nobody gets it, it’s happening too fast. It can’t even be a quarter past eight.
“No, no, no. I don’t understand. He was fine ten minutes ago.”
He’s gesturing wildly, stabbing the air with his finger.
“No, look, I took a nap. It was 7AM, and I just woke up ten minutes ago. You know, to feed him some more rice, to make him eat. And then suddenly, suddenly, this! He is breathing, breathing like this. Like this. Like this.”
He mimics his brother’s pained raspy breathing. “It jumped to 173! Wh-what is this mean?”
Dr. Dan shakes his head. He says something to him—something in English. I don’t remember what he said. I just remember pieces. I remember, “I’m sorry.”
The brother is almost shouting now—shouting at no one in particular. He’s shouting at Dr. Dan, shouting at his comatose brother. “He was fine yesterday! Talking, eating, all fine!”
“I’m sorry. I have to get back to rounds. Max, would you stay with them?” Suddenly, I’m not useless.
It’s always hot in the general wards. The brother and his brother in law brought a fan in, but it doesn’t help much. Four people are crammed in there, but I’m the one who’s supposed to know what’s going on.. It’s only been a week since the twins; I can’t do this again. His eyes are open, staring at the ceiling. He’s staring at the ceiling fan, asking it to start working again. The awful, raspy breathing has stopped. His heart beat is still at sixty, but in a few minutes, it’ll be at forty. Then twenty. Then nothing. Soon his heart will stop beating. There’s no oxygen going into his lungs. We can do nothing.
I wish I had a stethoscope. The machine still says 173; 173 over something. It beeps every twenty seconds. I don’t know what it means.
Please, please stop looking at me. I’m sorry, I don’t know. There’s no air going on. No, it’s not. Yes, he might have a very faint heartbeat, but it’s going to stop soon. The blood that is bleeding into his brain, it’s stopped his breathing. His lungs no longer work. His heart will stop pumping blood to the rest of his body soon.
I’m speaking to them slowly. I always speak too fast. I always mumble. Everyone says my English is too confusing, too American, too low. I’m speaking deliberately. The two men standing in front of me, they speak excellent English. They both went to university. I spent an hour talking with them last week on their first day here. They flew two thousand miles to be here. They really care a lot about him.
They were worried. They got a phone call, and that was it. They were told, “he’s not well. He is very sick.” And just like that, they flew over. Jobs on the line, lives on hold. All the way here, just for this. They bought him a plane ticket home, for crying out loud. For July 3rd. We thought he’d be better by then. We thought he was faking the numbness. I mean, he was ashamed. I would be ashamed too. But no, you can’t fake some things. You can’t fake bleeding in the brain. He can’t be 30,000 up in the air, he’ll die. Come on, guys, please be reasonable. We don’t know if he’ll be ready by July 3rd, we just have to wait and see.
The machine still reads 173. Why doesn’t the mute button work? It says “SOUND: OFF” in bright green letters. I check for a pulse on his wrist. Of course I can’t feel anything. But I don’t know for sure. I don’t know anything. I’m as useless as this damned machine.
He starts crying. I don’t know what to say. His brother is dying, and he’s thousands of miles from home. He seemed so determined when I first met him. He’s short, and walks with a blustery air about him. I remember the first time I met him on rounds. He spoke confidently; matter of factly. They sat in the office with me, and I explained what little I knew. It was an idle Sunday, and I was confident too. I remember that I was confident that he would make the July 3rd flight.
He’s starts sobbing. Wailing, into both of his hands. He seems so broken, so defeated. How do I even begin to empathize? His brother in law walks over, and stands there beside him. He places a hand on one shoulder, and stares off into the distance. His eyes are dry, and his mouth is thin. Unlike his brother in law, he’s tall and thin. He hasn’t said a word; he hasn’t made a noise in ages. I ask him if he wants some time alone with his family. He nods.
I feel like a doorman. A security guard. A guard dog. I pace back and forth in the lobby outside the nursing station. There’s a candle and a statue of Mother Mary just next to me. There’s bright sunlight streaming in through the open doorway. And behind me, there’s wailing, crying, sobbing. He’s speaking in a language that I don’t understand.
Patients and their families drift by me. A little girl looks cautiously at me. She can tell something is wrong. I wonder if she thinks that I look sad because of her. I hope she doesn’t think that. She hasn’t done anything wrong.
I try to smile back at her. She usually smiles back. She has the cutest damn smile when she smiles. Please smile. Please don’t be afraid of me. Please don’t be afraid. I know you don’t understand, and I know you can’t hear me, but please don’t be afraid.
One of the second year med students walks slowly towards me. I nod silently to him. He has a stethoscope. He always has one around his neck. He’s been here for almost two months. He knocks on the door, and we enter the room together. The brother has stopped crying.
He asks us to tell him what is wrong with his brother. He’s still in denial, asking questions we’ve already answered. The second year med student checks for a heartbeat. He checks his chest. He shakes his head.
“I’m sorry. He’s gone.”
A nurse comes in to take away the machine. To pull out the breathing tube. To take out the IV. Blood still comes out. There’s still blood in his veins. We close his eyelids. He stopped blinking long ago. The brother wants a picture. He wants a picture for their family. We help him sit the patient up, and his back is still warm. It’s hot and sticky. The bed is drenched in sweat. A gasp of air escapes his throat. His head lolls to the side. It makes me jump a little. I hope they didn’t see me jump. I feel bad that I jumped. We clean him up a little, wipe the blood off his arm. We clean the sweat off his brow. We straighten up his pillow, and sit him good and proper.
I pass by him an hour later. The brother is sitting outside the general ward. Around him mill his late brother’s friends. They’re talking to his brother in law. They’re sorting out the proceedings.
“A box to put him in?” they say. “A place to bury him?” they ask. The brother just sits there on the bench. He’s not asking any questions. He’s just gazing out into the distance.
His eyes are dry now, and he doesn’t say a word when I walk by him. He has that vacant, far-off look in his eyes.
I wonder if it gets easier. I wonder if it gets better. Because right now, I’m just so tired. It was so, so difficult, and I didn’t even do anything. I couldn’t do ANYTHING. I just stood there. Silent. With the easiest job in the world.