The unanswered question

By Stephanie Spann, MS3

Editor’s note: All names have been changed and identifying elements have been removed from this piece

I was called to go see a consult in the ICU during my general surgery month.  Her name was Ms. Smith and all I knew about the patient was that she had an ileostomy bag and she was no longer putting out stool.  I went to the ICU, knocked on the door, and my eyes fell on the patient lying in the bed.

She was a frail, thin African American woman who smiled at me as I introduced myself.  Aside from the nasal cannula that was giving her supplemental oxygen, she looked pretty healthy to me.  She was smiling, laughing and able to tell me all about her medical history.  She was diagnosed with Scleroderma 27 years ago, and this disease had given her a tremendous amount of trouble.

After hearing her diagnosis, I looked more closely at her body, looking for the tell tale signs of the horrific, unrelenting disease.  She looked remarkably young, probably in her 40s, because the disease causes your skin to tighten, but I knew that her true age was 67.  Her fingers were curled inward, permanently stuck in this position, and her lips were slightly pursed together.  Her lungs were being slowly destroyed by the disease, as the normal tissue was being replaced by scars. She told me that her entire colon was removed one year ago because the disease had caused sclerosis of her colon and it no longer worked properly.

Now she must rely on the ileostomy bag attached to her abdominal wall in order to pass stool.  She was sent to the ICU, because now she was no longer passing stools in her ileostomy.  She told me that she feared that this meant that the disease had now progressed into her small bowel.   I told her that we would talk to the same surgeon who performed the hemi-colectomy and see if there is anything that he wanted to do.  She smiled and said, “Dr. Clark, oh how I love that man!  He promised me that he would always fix me, and so far he has!”   She then asked me if I could find out for her if she could have a Pepsi.  Apparently she was told that if she had an ileostomy bag that she could not have the carbonated drink.  I promised her I would try to find out for her.  We chatted for another five to ten minutes so that I could get to know her better.  By the time that I left the room, I had struck up a friendship, and I looked forward to talking to her the next day.

I left the room and closed the door, wondering to myself why this sweet woman was even in the ICU.  She looked too healthy to stay in the ward designated for the sickest of the sick.

Later that day I found Dr. Clark and told him that Ms. Smith was in the ICU.  He confidently said, “There’s nothing for me as a surgeon to do.  Tell the team to call me back when she needs to be fixed, and I will fix her”.  He was extremely confident, almost to a fault.  He was very skillful, and everyone in the medical center knew of his talent.  An air of awe and respect surrounded him, making him somewhat difficult to approach.  I never thought that there would be a tender side to him, that is, until the following day when I went to visit Ms. Smith again.

Overnight, Ms. Smith’s condition deteriorated significantly. She spiked fevers and became septic from an unknown cause.  When I visited her in the morning, she was out of breath and struggling to say even one word at a time.  I was touched by the fact that she still managed to say “Good morning, Stephanie” even though it took her at least 30 seconds to say those three words.  I told her to not talk anymore and to rest.  I would look up everything I needed to know from her chart so that she could catch her breath.  I walked out of the room, shaken by the fact that she now was requiring the maximum amount of oxygen that we could give her, and she was not having any symptomatic relief.

A CT scan was ordered that morning, and the surgeon and I looked at the results, saddened by what we were looking at.  Her lungs were almost completely destroyed by her disease, and now her small bowel was infiltrated by fibrosis as well.  There was no surgical treatment to be done, because now, she was terminal.  We knew that she did not have much time left, and the surgeon slumped down in his chair in disbelief.  We both remained silent as we let the images sink in.  After two minutes had passed, which felt like an eternity, the surgeon stood up and beckoned me to follow him out the door to the ICU to talk to Ms. Smith.

When we both got to the room, Ms. Smith smiled weakly at us.  She managed to whisper “hello” and waited expectantly for Dr. Clark to say what he was going to do to “fix” her.  Instead, Dr. Clark sat down on the edge of the bed, took her curled hands into his own, and said, “Ms. Smith, I told you to call me if you ever needed me to fix you, and I would.” He paused, tears glistening in his eyes.  “I’m so sorry, but I can’t fix you this time.” As the reality of the words sank in to Ms. Smith, Dr. Clark tried to remain strong, but I could tell that he was struggling to choke back the tears.  Ms. Smith nodded her head once and told Dr. Clark thank you for all that he had done.

In the next couple of days, I had to switch to another hospital because it was the end of my rotation.  I do not know what happened to Ms. Smith, but I know that she only had a couple of days to live.  I just cannot get the courage to search the obituaries to know the inevitable truth that she must have passed on.  I think about Ms. Smith frequently, and there is just one question that eats away at me and I know in my heart that I will never know the answer: Did she ever get that Pepsi?