Customer Service

Customer Service

He was a disheveled man in a gown that was missing a tie on the left so the front
would fall of the left shoulder exposing his sunken chest. No one cared because he
was slouched in bed and incoherent. A thinner younger man who looked like him sat at
his bedside reading a magazine. Same chin, same brow. Better shaven. The IVs flowed
into the slouched man in bed antibiotics and fluids. Nothing was absolute.
Everything looked generic and non specific. The slouched man was a thing.

I spied him as I walked pasted the door to the computers.

I read the chart with disinterest. I tried but I couldn’t muster a care. Something
about a man on hospice for 3 months for heart failure and failure to thrive.
Something about a brother taking him off to have a psych evaluation for depression.
Something about hope.

I felt already fatigued.

I think seeing the slouched man drained me. “Dragged out of hospice to have another
go at it, ay?” I thought trying to push the cynicism down.

I walked in and introduced myself. I was asked to assess his kidney function and to
determine the best fluids.

Sodium 158. Creatinine up.

The slouched man laid dried as a potato chip in bed. His brother barely looked up.
He still turned magazine pages. I went about examining the potato chip. I then stood
back studied each hanging plastic baggy on the IV pole. The brother and I finally
made decent eye contact and I asked a series of questions.

“His wife did this,” his brother said.

“I’m sorry?” I tilted my head perplexed.

“His wife pushed him off a ladder 6 months ago and he hit his head and since then he
doesn’t act right,” the brother said.

“Oh? Then what happened?” I asked. The color came back into the room a little. Not
full technocolor but a pale interest. The story unfolded and time slowed a bit.

“He was very sick after and then he just wasn’t getting better. I don’t know …
They said he should be on hospice,” he explained.

So many questions came up as the water pushed against the dam.

The gates were opening. We were going there. Maybe.

I couldn’t contain the rapid fire of question. My agitation and impatience began to
show all over my body. I was itching to know what then, why, who, so what, which,
how, what then, what then, what then, what now?

The brother answered in a strange guarded round about that left me unfed. I ran out
of time and so I laid out my plan for the day and left.

The next five days I missed the brother 4 times. The fifth day the slouched man was
not eating but short of breath, no talking except to his brother who swore he made
perfect sense.

“Margrabmlfsn,” the slouched man mumbled.

“I’m sorry I missed you all those days,” the brother said.

I nodded though I felt a sense of failure as if I was caught evading the brother.
Perhaps I had.

“Before when he was on hospice did he eat? Did he talk to you much?” I puzzled.

“He and I would go out sometimes to a game but then he got to where he didn’t want
to go and talked about dying a lot,” his brother shared. “I asked the psychiatrist
if we could get his mood better maybe… Maybe he would get better. I thought it was
something we hadn’t tried.”

“Liar!” I almost blurted. “Really? How could he go to a game? Look at him!” I thought.

I had a non eating man drowning in the fluids I had infused for 5 days. Then I had
to binge him on diuretics followed by the absurd rise again of the creatinine that
signal the quintessential herald of “damned if you do, damned if you don’t”.

I didn’t know if I wanted to time a visit on the sixth day to see the brother or
not. I hadn’t moved his brother any closer to being medically stable for transfer to
psychiatry for the last ditch effort at installing vigor.

Damn. There he was. He was sitting reading the same magazine as the last six days.

“I’m glad you’re here. What do you think? How is he doing?”the brother asked.

Sigh.

My sighs betray me.

“It’s like this…. It’s …. Sigh…. Ok…. We need him medically stable to then
get the inpatient psychiatric evaluation but he isn’t eating and isn’t able to
balance the heart failure with the kidney disease. He has us backed up against a
wall,” I spoke as I created imaginary walls with my hand gestures and mimed a box.

The brother looked blankly at me.

“What is this guy expecting? What does he want from me? A miracle?” my eyes darted
away to look at the poor paint brushes and the thick gluey paints I had on hand to
work with. The broken canvas laid gurgling intermittently in bed. He stirred while
we talked, as if he had something to add we would fall silent. Over and over he
added nothing to the plan.

I left again that day demoralized. I was uninvested fully. I didn’t feel the
objective. I wasn’t on board.

I ran into the Hospitalist on the case and we rolled our eyes together. I asked
plainly, “What are we doing exactly?”

The Hospitalist was quiet as if he hadn’t  thought from day to day about that sole
question. I shrugged a little then it came out. “Customer service,” I ventured. It
fell on the ground like a joke told too soon after the wounding. I was ashamed. I
was defiled by the dark side of sarcasm and I wanted to care about why this man was
here tossing his hat back in the ring. It was an untucked shirt. It was a mess going
no where. I felt like I was sucked into an impossible situation where I would fail
to fix the slouching, heart failing, kidney failing, none eating, nonsensical man.

On the seventh day I decided I would figure out this math. One brother broken + one
brother not =…

I came into the room to examine the slouched garbling man. I greeted the brother. He
greeted me but coldly. He stood watching me. I did my diligence then asked him out
into the hall.

“Ok. I need to tell you I don’t see him getting well enough to go to psychiatry and
even if I could get him stable it would be short lived and he would become unstable
and they would send him back to inpatient and then over and over but never able to
really achieve any psychiatric resuscitation,” I said hoping the brother would jump
the train.

The brother recanted his idea of how his brother would maybe have another chance.
How he brought him here to get that chance. How he just has to try.

One brother broken + one brother not = guilt

The gates were opening. We were going there.

Time stopped.

It became clear. They became people. The technocolor set in fully.

“I see. I understand. Listen, ok?  I’m sorry if this is too presumptuous. Bare with
me,” I started. The brother folded his arms and stood leery. “About 6 months ago my
older sister got into a bit of a mess. It was more of the same actually. I usually
rescue her. She asked me to help her out and honestly I just couldn’t. I called my
mother and told her I just couldn’t because I was tired and so busy and overwhelmed.
My mother let me off the hook and I carried on. My sister did whatever she does.
Last month my sister’s  niece tried to kill herself and I was devastated. I felt
like I could’ve and should’ve done something 9 months ago when she needed help but I
truly felt so broken then. I truly truly truly hadn’t anything then to give. Her
problems were so snarly and I just didn’t see a way out for her  except to assume
her life. She never accepts my better judgement so it’s a no win anyway. I called my
mother to confess my failing and remorse,” I exposed my naked pride.

“What did she say?”the brother suddenly seemed interested  and the technocolor came
on for him.

We were flesh talking.

“I had cried to her saying to her that I just needed her to know I didn’t have it to
give away then but that I wish I had! I felt such a failure that I didn’t dig deeper
and deeper to get that little bit because perhaps I could’ve spared my niece. My
mother said the most amazing thing and I say this to you.”

The brother unfolded his arms and for a brief time he was ready. He was going to
receive the cleansing.

“My mother said, ‘Jeannie, no. No. You are a giver. You give. That is your nature.
If you did not it was because it was not the best thing. In fact it would’ve hurt
the plan. You doing what you always are known to do would have caused more harm. If
you are not able then it was not meant to be. There are worse possibilities.’ Do you
understand?” I shared.

The brother’s eyes started to well up. I thought he might collapse under the lifting
of burden.

I continued, “Do you see what she meant? My mother said the only reason to go
against a nature is because it harms not helps and somehow the universe knows this.
I bet you have always rescued your brother and tried to protect him. I bet you have
always bore weight so he might have less. I bet if you had done “more” you and him
would have had less. Maybe he would be mad and then you two wouldn’t have spoken at
all.”

“I …. I….” Now the brother was fully crying. The cholinergic faucet poured out
and he cried with all the works of a red face and dripping snot. He was at the dam’s
release. “I have thought for so long that I should’ve told him to not marry that
woman. That I should’ve insisted but my god he was so set on marrying that bitch.
Then… Then she poisons him and tries to kill him. Do you know I have the medical
power of attorney because she just threw it away when she was done with him?”

I pictured the wife tossing aside the rights and the slouched man. He had become a
thing. I imagine the brother picking up what the world saw was a thing and taking it
to a ball game and taking it off hospice and guarding it from sharks like me.

“I’m sorry.” I admitted. I touched the brother softly. I meant it. I was thinking of
my sister and how I never want her hurt and yet I was impotent to help her too at
times. “I’m sorry,” I said again this time for also tossing the slouched man aside
at first.

We stood in the hallway with people passing us. I was grateful for the carpet to
somehow keep the cold floor away from our warm words. The hospitals are slowly doing
away with the matted carpet for wood flooring or tile to avoid infection and
contamination but often the noise and echo tasered healing efforts.

“Listen to me. If you would’ve said more or done more your brother would likely have
pulled away from you. You did ALL you could then. Bringing him here, you did ALL you
could. Do you understand? It’s ok. You are forgiven. My mother forgave me and lifted
the weight away. Let it do the same for you,” I said and rubbed his shoulder to
paste the sealant on.

The brother wiped his nose and nodded like a child. Here he was decimated to being 7
years old all over again but he safely could go there. He thanked me weakly and I
hugged him.  We spoke logics then we parted.

I texted the Hospitalist, “The brother wants hospice.”

The next day I heard hospice came and took the slouched man home.

In the hallway I got the “what were we doing for seven days?” look from the
Hospitalist. I just shrugged. I was embarrassed by the intimacy of caring.

Two months later I got a letter. Hand written on baby blue paper with no lines. It
started by recounting who he was and ended with, “Billy passed away finally like he
wanted for months now. He actually thanked me and we got to be as close as I always
felt we were those last days because I could stop feeling responsible for his
choices. I wanted you to know that you sharing about your sister and your mom’s
words helped me too. I wanted you to see Billy as he was. I have enclosed a picture
that was in his memorial.”

The next page was the obituary that said Billy served in the military and listed a
dozen names of family left behind including children grown. The picture was this
handsome man in uniform with a mischievous smile and compelling eyes.

The letter was signed simply Jared. There was no address. There was no way to find
Jared ever again.

I was crying as I shot a photo of the letter and texted my mother to let her know
how she helped me help someone else. How she taught me what burden is and how to see
burden and to lift it.

I think people wait in long lines and poke around in lost corners. We are called to
help navigate people. They call it “customer service” and make us less by this
description. They tell us we must appeal to wants. Doctoring is about caring. That’s
all. Caring is not customer service. It’s exposing vulnerability in trade and
healing at cost.

You are givers by nature. If one day you cannot give perhaps you would’ve done harm.
Forgive yourself often.

Care always.

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