The next symptomatic hint had occurred when the resident ordered Roso's stomach tube removed and fluids allowed by mouth. Within an hour his stomach blew up to twice its normal size, and he began to vomit. In no way could we have made him more miserable, what with the hiccups, the vomiting, and the lack of sleep; any one of them would have been enough to drive most people crazy, but valiant little Roso would still be there smiling every time I saw him. "Body no more strong," he'd say, always the same words, but carrying a slightly different meaning each time, depending on how he said them. "Body more strong soon"; I began to use his vocabulary in that curious way you do when talking to someone who doesn't speak very good English. You begin to think he'll understand better if you make mistakes, too. During medical school, with Spanish-speaking patients, I'd catch myself saying, "Operation you need inside abdomen." This made no sense, of course, because if the patient understood the words surely he'd understand them in the right order. Mainly we were trying to reach to these people, to connect.
So poor old Roso had been put on intravenous fluid accompanied by constant gastric suction through the tube that disappeared into his nose en route to his stomach. Racked by constant hiccups, he vomited every time we took the tube out, whether we fed him or not. Just a few days earlier the tube had gotten completely clogged up, so that nothing but food stood between Roso and death. When I irrigated the nose tube to relieve the clogging, out had come a glob of material that looked like coffee grounds. It was old blood. It was lucky that I liked balancing fluid and electrolytes, because several times a day I had to figure out how much sodium and chloride were in those fluids that came out of him and replace them, plus the usual maintenance. I even gave him magnesium, on the chance it might help, after I came across an article in the hospital library on magnesium depletion.
But Roso's big problem was inside, beyond my touch. Like Marsha Potts, he was leaking at the anastomosis site, the connection between the small intestine and the stomach pouch, except that in Roso's case the incision hadn't broken down. It was just leaking steadily all inside him, blocking his stomach and causing the hiccups, keeping him on IV fluids, driving his weight down every day so that now it was no more than eighty pounds. Fighting hard against the weight loss, which also meant loss of strength, I found articles about protein solutions and high percentage glucose solutions and tried everything they suggested; still he lost weight, going from merely skinny to the skeletal appearance of clear starvation. And through all this hell he smiled and talked his haiku. I liked him. Moreover, he was my patient, and I'd see him any time he needed me.
"Roso, how you doing?" I asked, looking down at him now. What a sight he was lying there in the gloom, wearing nothing but pajama bottoms, with an IV sticking in his right groin and the tube hanging out his nose. Every eighteen seconds his body twitched with hiccups.
"Doktoor, no more strong, too weak already." He managed that much without hiccuping. We had to do something. I had been plaguing the attending physician, the chief resident, everybody, but to no avail. Wait, they said. I knew we couldn't wait. Roso still trusted me, but his will was wearing out. "Doktoor, I no wanna live no more—" hiccup " — too much." No one had ever said that to me, and it stopped me cold. Although I could understand how he felt, I wouldn't admit to myself that he'd reached this point, because I had seen what happened to patients when they gave up fighting. They died, just drifted away. Something in the human spirit could hold everything together, even in the face of utter physiological collapse, until the spirit gave way and carried the body down with it. Sometimes the despair was so obvious you didn't ask a patient for normal responses, but Roso had spoken it, and that made his case different. I told myself that he just wanted to let me know he was near to giving up but actually hadn't yet.
He desperately needed sleep. Although I could give him that, it was a two-edged sword. Sparine, a potent tranquilizer, would knock him out, anesthetize even the hiccups. But with that tube down his throat he was in constant danger of pneumonia, especially if he was unconscious; without the tube he might vomit, and if he vomited while he was knocked out, he might aspirate.
The Demerol and the skinny old man upstairs still nagged me, too. His relatives had been splendid about everything, never sensing the doubt in me, taking my words at face value, not cringing at the autopsy request. What if I had told them that I only thought their father was dead? How could they know that the difference between life and death was sometimes not black and white, but gray and indistinct? Marsha Potts, for instance: was she alive or someplace in between? I guessed I could call her alive, because if she got better she'd be fine, maybe; on the other hand, she probably wouldn't get better, and at least part of her brain might already be dead. Some of her liver must surely be gone, in order for her to have jaundice and liver flap; her kidneys, too. Again, it wasn't black and white, any more than my decision about Roso and the Sparine. But Roso was in need of a rest, and I had an irresistible urge to do something. That must be a strong human drive, to do something — just as when somebody in a crowd faints, one bystander is sure to run for a glass of water and another always makes a pillow for the head. Both actions are ridiculous in medical terms, but people feel more comfortable to be doing something, even in a situation that calls for a type of action they are not equipped to give.
I had had the same sensation several times. Once, during a high-school football scrimmage, I had been hurled onto a pile-up just as a guy broke his leg with an audible crunch, the leg bending off at an angle below his knee. Although he wasn't in much pain, the rest of us were panic-stricken, and, true to stereotype, I tried to get him to drink some water. I think that at that moment I set out unconsciously on the road to med school. The idea of knowing what to do, of satisfying an urge to act, was overpowering.
So, all right, Peters, now you're a doctor — do something for Roso. Right, the Sparine it would be, and the second I made that decision, the happiness of positive, directed action flooded over me.
"Roso, I make you sleep you feel more strong."
As I sat down at the nurses' station, the almond-eyed nurse slid Roso's chart across to me. She looked even prettier than she had before. "Are you Chinese?" I asked, not looking at her.
"Chinese and Hawaiian. My grandfather on my mother's side was Hawaiian."
I thought it would be fun to get to know her. "How come you live at home?"
No answer to that. Well, the hell with it. I opened the chart to write the Sparine order. Too bad, though. She looked like all the girls I had expected to see under Hawaiian waterfalls. Only I hadn't been outside the hospital long enough at that point to see any waterfalls, and my sex life, if you could call it that, was restricted to Jan. Would she still be there, even at midnight?