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Smell the Roses:
A Medical Narrative of Lessons Learned
Mehul V. Raval
How old was he? I can’t remember exactly, maybe 16, maybe older. I knew him for too short a time to concern myself with small stuff like age. In medicine, in life, we constantly strive toward an ideal of quality over quantity. Seize the day, smell the roses, and glasses that are half full are the common clichés we employ to express our inability or perhaps inadequacy when dealing with the dilemma of the ticking clock. Constantly marching ahead, each second is sure to follow the next with the same segment of time filling each movement of the clock’s longest hand. Much like the beating of the heart, the regular rhythm and rate become a cadence to which we become so accustomed, time ticks away and the heart automatically pumps without a second thought from us. It takes a monumental event to make us appreciate the moment in which we all live…or cease to live. Sometimes that moment is a joyous one like the split second photo finish between two track stars, or that buzzer beating prayer of a shot from half court that ends the heated rivalry between those two teams down tobacco road, or the birth of a first born child. Other times that moment is a tragedy. It may affect the nation like a space shuttle that explodes before our eyes or a plane crashing into a tower. It may affect the entire world, perhaps with loss of a species to human sprawl or passing of a beautiful leader whose generosity and smiling face inspired millions. But many times the utmost tragedy is the loss that manifests its effect on individuals. Such was that moment, those seconds when one heart stopped beating and dozens of others pounded in the ears of friends and family, that he made us all realize the true epitome of quality over quantity.
I didn’t know him as well as many of the other medical staff present during the 16 hours that encompassed his final admission, or the 16 years of “significant past medical history including…” but I did witness the impact his life and death had on all those nearby that day. His family spoke of the past few weeks and of their enjoyable Thanksgiving vacation. The smiling father never took his eyes off his dying son during the standard History and Physical Exam conducted by this still nervous third year medical student. His father spoke evenly and answered the questions he must have answered hundreds of times with a patience I find admirable. He left behind a twin brother and younger sister who exuded a sense of admiring love for him that served to contain their monsoon of emotions. His mother was a different story. Her emotions were open for all to see. Damp cloth to forehead and hand in hand, she sat by her son’s side conducting her motherly duties and showing unyielding hope and faith, occasionally wiping a stray tear from her cheek before it made its way farther down her face. She was the glue that held this family together, not just on this day but over the years and years he had fought, accepted , and fought the Ewing’s Sarcoma, the above the elbow amputation of his right arm, the diagnosis of leukemia, the bone marrow transplant, and now the impending illness. Together the family sat through the checklist we call the Review of Systems. They watched as we conducted the Exam. As we left the room, the intern on our service turned to me and said, “Never forget the way that patient looked, the way he answered questions, the way he felt cold and sweaty on exam, or even the smell of his room. That is a septic patient if I’ve ever seen one.”
I went home that evening and I called my mother. We spoke about things that don’t really matter and that I don’t really remember. What I do remember is making it a point to tell her that I loved her before hanging up. Meanwhile, he was transferred to the Pediatric Intensive Care Unit. His night there would be his last. His respiratory status slowly declined and when the time came for him to face intubation or face quality over quantity, the family and medical staff that loved Aaron so much made the choice to move him to a private room. That morning his room was a place where we could seize the remaining time he had, it was a place to smell the flowers his life embodied, and a moment to realize that his life had been so full of love it could never have been half empty. The list of people he has touched in his 16 years is countless…but please add one more…thank you, for in your life and in your death you have reminded us all of a valuable lesson. |