Related, yes--but Can You Really Relate?

"Well, son, I'll tell you:
Life for me ain't been no crystal stair.
It's had tacks in it,
And splinters,
And boards torn up,
And places with no carpet on the floor—
Bare.

But all the time
I'se been a-climbin' on,
And reachin' landin's,
And turnin' corners,
And sometimes goin' in the dark
Where there ain't been no light.
So, boy, don't you turn back.
Don't you set down on the steps.
'Cause you finds it's kinder hard.
Don't you fall now—
For I'se still goin', honey,
I'se still climbin',
And life for me ain't been no crystal stair."

- Langston Hughes "Mother to Son"

____________________________________________________


"I'm leaving. Somebody need to take this IV out my arm."

"But sir, you had a heart attack. We need to have you stay for this procedure. It's important."

"I got stuff to do." He began looking around the bed for his shoes. He wasn't bluffing.

"But sir, you had a heart attack. What could you possibly have to do that is more important than getting this taken care of?"

He turned and looked at me like I was stupid. I immediately regretted that rhetorical question.

"I got to get to work that's what. If I don't get to work, then I might lose my job. And I can't lose this job. . . .man, look--where that paper you said I got to sign? I got to go."

"But sir, you aren't even 50 years old. You really should stay for this cardiac catheterization. It's the only way for us to tell exactly what is going on with your heart vessels."

"And the only way for me to check on my mail to make sure nobody mess with it and check on my job to make sure I don't lose it-- is to go." This guy simply needed to go. Simple as that. I needed to take it up a notch.

::sigh::

"Sir?"

"Yes, ma'am?"

"Do you have children?"

"Yes, ma'am."

"How many?"

"Three boys."

"How old?"

"13, 9, and 7." I then asked their names, and he lit up when he rattled their names off and showed me a snapshot of them on his cell phone.

"Hmm. What about them? I mean your three boys, sir? This is life or death. Your boys could--"

He cut me off.

"Look, doc. I know you mean well and all, but don't you get it? Stuff is f---d up out here. Folks is out here working they fingers to the bone and still getting let go off they jobs! Maybe you don't know 'cause you up in this hospital with some kind of security that most of us don't know sh-t about. Yeah, I do care about my health. I do. But I also care about my house. . .and my kids having a house. . .and my wife having a house. Man, it's somebody just waiting for me to drop the ball . . .to take my place on my job."

What to say? He had a point. I wanted him to stay and get his cardiac catheterization. I really felt convinced that some kind of intervention in the cath lab might save him from a future event. I felt that this new knowledge of him having 3 manchildren made it even more important that I fight for their dad. But his point was a good one. 

I implored him one last time. "But your boys, sir. Your boys need you alive. They do. I hear what you're saying, I really do. But when it comes to your heart--"

He interrupted me again, this time his voice rising over mine in firm authority. Somewhere between anger and frustration which I couldn't tell whether was directed at me or not.

"Doc! DOC! We muh-f--kin' LOSIN' out here, do you hear me? LOSIN'!"

He slammed his hand down on the tray table next to the bed, and it made me jump. His eyes were sparkling with fresh lacrimation that no way, no how would he let become tears. The mounting emotion froze me in my tracks. I backed into the bedside chair and sat down quietly.

And I stopped talking. I finally. Stopped. Talking.

"We LOSIN' out here. . . .Muh-f--kin' LOSIN'! I'm a grown man and my house could get foreclosed on ANY DAY now. ANY DAY, do you hear me?" I kept staring at him without blinking. Don't talk. Just listen. "F--K a CARDIAC CATHERATION. I need a JOB to feed my FAMILY. Sh-t, I'm already muh-f--kin LOSIN' and I GOT a job." He put his head in his hands and shook it. He took a deep drag of air in and sighed an exasperated breath. He looked up and softened his voice apologetically. "Look here, doc. . .I get it. I really do. I know what could happen. This heart thing is some serious sh-t, I know. But what I need you to know is that a man needing to feed his family is also some serious sh-t. Some real, real serious sh-t."

I felt like I was being suffocated by my ignorance. Simply assuming that this patient, this man, lacked insight into his illness when it wasn't that at all. I still didn't know what to say so I just pressed my lips together to keep them from parting and saying the wrong thing. . . . . . . watching him talk with these animated hand gestures that seemed to be in slow motion. I did my best to internalize his words. I asked myself:

Do you have to chose between getting life saving treatment and getting to work to clock in? Or get to your mailbox to make sure your mail isn't stolen? I mean, comparatively speaking, hasn't your life been a. . .well. . . crystal stair?

"You see this, doc?" He held his forearm out for me to see. Snapping out of my silent dialogue, I took in the crude tattoos scrawled on his arm. "This from the pen, doc. The penitentary. Dealing them drugs. . .servin' them crack fiends around the way. You know how hard it is to get a job when you a convicted felon? You know how hard it is to keep your job when you a convicted felon?" The eye contact was searing. I was scared to even blink out of respect to him. "I didn't have sh-t growin' up. Not sh-t. Now, I'm sayin'. . . I ain't never got high or nothin', but I did serve crack to people in the hood for years. . .goin' way back to junior high school when crack first got hot. Man, I had money fallin' out my pants. . . .fly cars. . .jewelry. . .all that sh-t. All the dudes I looked up to--this is what they did. Sold rocks. So that was all I knew. But then that sh-t ended real ugly when I got locked up. 5 years, doc. I was locked up for 5 years--when my little man was still in Pampers. It was real f--ked up. I hated that my little man had to see me like that." He paused for moment, almost like he needed to process the memory before going on. "And I'm sayin', doc. . . that sh-t was some real easy money. . . .and bad as sh-t is out here right now. . . ."

He wiped his face with his hand . . .like he was wiping the whole thought of that memory away. . .the easy money. . .all of it. "I can't go back to that life. I won't go back. That's why I got to get out of here. Gotta get to my job. If I lose my job. . . man. . . Where that paper? I got to go. " He leaned on his back in the bed and began pulling up his pants and fastening his belt buckle. He was 100% serious and his mind was made up.

::silence::

I numbly slid the "Against Medical Advice" form toward him on the tray table.

"I'm sorry," I murmured softly while looking away sheepishly. "I'm. . .sorry."

He signed the sheet and handed back to me. He looked back up with sad eyes . . . . full of troubles and knowledge of a hard life with tacks and splinters and boards all torn up . . .

"Yeah, doc. I'm sorry, too."

***

When I left his room, I replayed all of the hard choices that he had to make every single day, and how, for him, they are just as "life or death" as his decision to not have a cardiac catheterization. And I thought about my own life, too. And the fact that all I knew about "splinters, boards all torn up and places with no carpet on the floor" was when the poet Langston Hughes penned those words--and when my college-educated mother and father recited them to me as a child. A far cry from how my patient came to know the same.

I then resolved that my patient was "still climbin'." The only way he knew how.