62 year old gentleman with history of ESRD now 2 years s/p live donor kidney
transplant presenting with several weeks of worsening abdominal pain. His name was Mr. S, he was the first patient I followed on my medicine rotation. He started out like most old men in the hospital, crochet-y, mildly racist, and adorable to a fault. I began every day of my two weeks with him the same way, waking him up at 7 am, poking him where I knew it hurt and asking “does this hurt?”. By day 4 he began asking about my life and I about his. We would share small glimpses of our stories with each other in between the regular abdominal exams. He would tell me about his daughters and what compelled him to move to Boston from Columbia 30 years ago. I would tell him about my cat and explain why I spoke English so well, ending every conversation with a reassuring note about how we’d figure out the cause of his pain. A few more days rolled along and by day 9 we had the results of his splenic biopsy, post transplant lymphoproliferative disease, he had widespread diffuse large b cell lymphoma. The decision was made to hold off on telling him until we had the results of his cytology and tumor markers, another 4 days. Every morning for the 4 days that followed involved pleasantries and dodging the elephant in the room, “do you guys know what the problem is?”. I’m not sure what happened to Mr. S after I left the renal service. I checked the list daily after I left until one day “poof” he was gone, either from the service or this world. I’ll never know which.
Avilash Das, M4 at Boston University School of Medicine.
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