The Angel

First note the picture. It's always good to have a face to associate with a voice. This one was taken a few days ago before going out to an orchestra benefit dinner. I wasn't on call and wasn't driving, a rare confluence of events that I used to maximal advantage. The night started early and ended at around 4 am.

Earlier in the week the evenings activities were not so pleasant. I was awoken by the beeper at about 12:30 am. Not yet deeply asleep, but I had gotten a taste and wasn't happy about driving in to the hospital. The patient was an unfortunate 28 year old man who had testicular cancer that had relapsed. He was on the Cancer ward and the Oncologists had been tormenting him with various poisons under the rubric of chemotherapy. Apologies to my Oncologic colleagues, but despite their claims of cutting edge treatments, oncology is so barbaric as to be medieval. They give the chemo and sit back to watch which dies first, the patient or the cancer.

Chemotherapy is also a commercial enterprise that the oncologists do quite well with. They buy the chemo wholesale, sell it to the patient (or more correctly the patient's insurance company or Medicare) retail, plus an infusion fee. Quite a little profit center and the main reason oncologists drive Audi A8's or BMW's, while us humble intensivists are cruising around in eight year old Hondas. They also give the chemo at their "Infusion Centers" during the day and then drive on home. When the poisons do their trick and the patients get deathly ill, the oncologist is nowhere to be seen.

This night the House doc had talked to the oncologist on call, whose only order had been "Consult Critical Care". The patient had been in the hospital for several days with complications of chemo. In particular, his bone marrow was suppressed and his white blood cell count was perilously low. He had been getting antibiotics and narcotics for pain control but had developed a distended, painful abdomen, fever and hypotension. The differential diagnosis included an acute abdomen, sepsis or ileus (gut paralysis) due to narcs.

I got into the car and cruised towards the highway, hunched over the wheel, driving by habit more than active attention. Then I felt a pressure from the back seat, as in a mass of air being displaced. I willed myself not to look in the rearview mirror. A low chuckle emanated from behind me, air moving across inhuman vocal chords.

"Fuck you.." I growled, staring straight ahead at the road.

What might have been laughter, but came out more like a snake hissing. "Alas, I am beyond the pleasures of the flesh."

"Bummer. How about kissing off then?"

Again the low chuckle, a creaking of ancient skin folds. "This one is mine...."

I thought about the case. Definitely sick, but young, possibly with stores of resilience that had not yet been exhausted. "In your dreams, asshole. That's where he's yours."

"Alas, no sleep, no dreams."

"Yeah, well, join the fucking club."

The chuckle sounded again and then it was gone. The pressure dissipated and I was alone again in the car. I reached over and found some music on the radio, cranking the volume to blow away the lingering traces.