At the End of Life by Lee Gutkind

Author:Lee Gutkind
Language: eng
Format: epub
Publisher: Fourth Chapter Books
Published: 2012-03-19T04:00:00+00:00

So Bernie’s face, shining with discovery, annoyed me, and I listened impatiently when he announced that Mr. Stone was suffering from a genetic disease: alpha-1 anti-trypsin deficiency.

“Not just regular old asthma!” he exclaimed.

I searched my memory. This meant that his blood did not produce the enzyme that protected the elastic scaffolding of his lungs, and his alveoli, the little sacs of air that delivered oxygen to his bloodstream, were collapsing like so many burst balloons. Mr. Stone’s disease would inexorably suffocate him, and not even the best lung specialist or the most advanced drugs would be able to save him.

His stubby finger on the page of the opened textbook, Bernie looked at me eagerly.

“Bernie.” I glared at him. “Have you written his orders yet?”

“No, I, uh, I just got his old charts, and I, uh . . . ,” he stammered, and I rose to the hunt, tasting blood.

“You are reviewing his old charts, and Mr. Stone is crumping in there,” I said severely. Bernie looked alarmed and shriveled up a little. Turning away, I reached over with a little resigned sigh and stamped an order sheet with Mr. Stone’s plastic hospital card. I scribbled down his diagnosis, condition, diet, activity, and lab work. I paused and looked over.

“What do I want to give him, Bernie?” I shot the question irritably.

“Um, aminophylline?”

“That will help him sometime tomorrow, Bernie; meantime he’ll go out on you.”

“Well, uh, probably some antibiotics?”

“His airways, Bernie! We have to try to open his airways, remember?”

“Well, I know you called respiratory.” Bernie was sweating now, and he kept flicking the end of his ballpoint pen nervously.

“Oh, never MIND.” I turned and began writing. Bernie was hopeless. He leaned over to peer at the order sheet. “Steroids, Bernie. He needs steroids.”

“Sure . . . sure! I was just going to say that.” Bernie took out his dog-eared copy of the Washington medical manual hastily and thumbed through the section on asthma.

“The dose is . . .”

“I know the dose, Bernie, thank you very much.” I finished the order sheet, handed it to the ward clerk, and left Bernie in a dismal heap at the desk.

A half hour later, I came back to listen to Mr. Stone’s lungs again. He had improved slightly. Now at least I could hear some wheezes. He wasn’t so tight, but I was still unhappy with his exam. His muscles were working visibly, and despite his smile, I could see he was tiring out. Upon my questioning him, Mr. Stone shook his head. No, he had never had to be intubated and placed on a respirator. He shot a glance at his wife, who sat in the armchair near him. Her lips tightened.

As I knotted his hospital gown and picked up my clipboard, I asked her if they had any children. Yes, she nodded, a son and a daughter, both in their teens. I chirped politely in response, and she looked up at me.

“They both carry the gene,” she said, then paused. “I’ve told them they should choose appropriate careers.

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