Yesterday I had to tell a 50-something year old guy that he had hepatitis C. Turns out, when at Emanuel in the early 90's... when they saved his life, but not his left arm, they managed to give him Hepatitis C along with the life saving blood transfusions.
I thought about the fake patient I had to give bad news to, back in first year, trying to prepare us for this type of thing.
When it's the real thing, it's different, though I went about it in the same way. It feels different. As it should, I suppose, because this isn't make-believe. This is real. This man is real. This disease is real.
He had come in for a pain management visit, for his phantom limb pain. He woke up this morning, got himself ready for the day, for his appointment, unaware of what was to come. Just another day....
He had, in the early nineties, been working in some sort of large warehouse, and managed to get his arm caught in the door of an elevator. Bad enough, you'd think, but it grew much worse when the cable snapped, and took his arm to the bottom of the elevator shaft, leaving him behind. It was like something out of an action movie, or a bad horror flick. In fact, in Resident Evil, it happened to some poor soul, though it was her body that was taken down the shaft as fast as gravity could pull; 9.8 meters per second squared... leaving her head on the top floor of some office building.
To save his life, the doctors at Emanuel had to transfuse him with massive amounts blood, and other blood products, donated by altruistic souls, or perhaps destitute college students... trading plasma for tuition money. It's too bad though, that one of these life savers had Hepatitis C, and gave it away as freely as they had given their blood.
As I explained what the next steps would be- uncovering the genotype (which would likely determine if he could be cured of this, or eventually lose his life due to it) and the eventual biopsy to stage the progression of the disease; the destruction it had wreaked on his liver.... he just looked at me, silently, with an empty stare.
I think it's true, once you tell someone the bad news, "you have cancer" or "sorry, the HIV test was positive," they don't hear anything after that for some minutes.
I don't think he heard anything I said for a few minutes after the initial uppercut that was the bad news. He was dazed, punch drunk with just one shot; though a haymaker it was.
It took some time, and much repetition, but I think it sank in... as much as it could anyway.
It must have all seemed so surreal. I imagine being in his position, taking the handful of papers with information on Hepatitis C, the information I had written, the orders for bloodwork, biopsy and follow-up instructions...
Though it took over a half hour for the whole encounter, it must have seemed like it happened in a flash.... a complete blur. Not unlike when as a child, you took your bike down too steep a hill, with too little emphasis on the brakes, and a blatant disregard for your own health. you'd crash- with a flip over the handlebars, arms and legs flailing, torso flipping in what seems a far too fast manner for nature to allow. All you manage to see in a blur of colors as you're flung about, and you feel what you know should be pain, but it just comes to quickly to hurt now, it just feels.... unkind, and terrifying.... but it will, it will hurt. once your brain catches up to the physical assault, it will hurt.
I'm not sure if his brain caught up before he left... but i am sure of one thing; when it does, he will hurt.
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