Mind over matter
James smoked a pack a day. He was “never gonna quit”. He said “thank you ma’am” at
least 5 times each visit. He always wore a blue button down and a smile.
He came in one day for a routine appointment complaining of left arm pain. James
looked pale but his vitals were stable. I sent him to the ER immediately. “Straight
away Doc,” he promised, refusing an ambulance. He was diagnosed with an acute MI and
was stabilized then sent home to “get stronger” and consider bypass surgery at “a
later date”He was 85 years old.
“Do 85 year olds have a later date?” I mused.
I was new to medicine and all I seem to know was 85 was old. Surgery was tough and
85 was dicey. National conventions were questioning the surgical viability of 65 and
up let alone an octogenarian.
James had a demented wife who rarely spoke. Every week he would take his wife’s arm
and go to the community pond. There he would “pitch an umbrella lay out a sheet and
sit her down”. Then she would watch as his son and he fished. I imagined the scene
and the stripes on the umbrella and the checkered sheet. Her wide brim hat and brief
engaged look shaded by love. Her waving to him, him hooting and hollering bc of a
wiggling tug on a line.
“We can be out there for 3-4 hours. Mildred loves it!”he would beam. He said it was
one of the few things done so habitually that Mildred would really recognize both as
an event and as a marker of time.
“Is it Sunday yet?” Mildred would ask then trail off.
He came in post hospitalization recanting a near suicidal plan to undertake triple
“That sounds very challenging. Are you sure you are up to it?” I asked leery of such
“What choice do I have? I got to be there for Mildred. I got to take her fishing,”
Two months later he returned. I was wondering what he had decided to do.
“How are you feeling?” I asked.
“I feel tired but getting better,” he replied with a smile.
“How is fishing?” I inquired.
“Oh just the same as usual. I took Mildred last weekend. Didn’t catch anything but
she enjoyed it,” he said whimsically.
I felt sad that he was living to plant this umbrella for the love of his life and
had to face the growing unlikelihood of bypass surgery. Sundays were growing less in
“What did you decide about surgery?I asked.
“I like the scar,” he admitted unbuttoning his shirt.
I was confused. There was a knock at the door and my MA stepped in handing me a
stack of records. I looked at them quickly and realized James had been admitted 6
weeks prior while I was away and had triple bypass surgery unbeknownst to me! Seemed
he was in and out in three days! He went home and did not go to rehab.
“Sir, did you go straight home after surgery?” I asked bewildered.
“Oh yeah. Mildred needs me and we had already planned to go fishing you see,” he
replied matter of factly. I touched his sternal scar and said in awe, “That is one
hell of a scar, sir.”
I left work that day just beside myself. Clearer than ever I realized there are some
you cannot save even if the affliction is surmountable or small and yet there are
those who will NOT die or be corrupted because of sheer will to live. I want to be
ignorant to limits and fear. I want to just live without discrimination of time or
disabilities like James. I hope I can erase mental barriers for patients and grow
more faith in the reality that living is a mental game as much or even more than the
physical undertakings we think we master as doctors. Wanting to live and having
something to live for should be the search we join our patients in. It should be our
own life aspiration.
The prescription I want to write most days is for “Lover, dispense one, refills