David Kopacz, MD
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Short Stories

Some Problems With Technology

Unpublished | Written 1992-1993

Mr. J says, “Well you are the doctor, what do you think about my prognosis?” I think to myself, I don’t know this guy’s history, he’s not my patient, I’m just pushing the chemo that Dr. A told me to give him. “You know, I haven’t read your chart, so I don’t know if your cancer has spread outside of your colon and that is the way you determine prognosis.” Fuck, I remember this guy had Duke stage D cancer, but I can’t remember what that means, it is one of those things we had to memorize in pathology, but that was more than two years ago, fuck, I feel so incompetent, why can’t I remember anything important? “You really should ask your oncologist, your cancer doctor, they would know your case better and know what was found during your colon resection. “But you’re a doctor what do you think?” He’s got me there, “Well, have you lost any weight?” “No, doc.” This guy has a fair amount of meat on his bones…he looks pretty strong…he can get out of bed…I think he has at least 6 months…maybe a year, who knows, H’s dad was 48 with no significant past history and he gets up after dinner and says he doesn’t feel well----------SCD-(sudden cardiac death)-----what do I know about this guy’s cancer? I have seen people who are going to die, they look sick…this guy doesn’t look sick, just old, “Well I don’t want to tell you anything wrong, but you don’t look like you are going to die soon,” (for at least 6 months, what the fuck! that is not going to sound good to him, it does to me…6 months, that is not bad…he probably won’t die next week, I mean that is the difference between doctors and laypeople, they think doctors know everything, when they are going to die, they think doctors can cure all sorts of things they can’t, learn that now, that they can’t cure that much, mostly just diagnosis and manage a slow death…maybe hook some shit to you…stick some tubes in your orifices…suck your blood through needles every morning…don’t get me wrong, it’s not hopeless! Doctors can cure a lot of things, but probably not as much as you think).

The next day, I wake up and run down the stairs to 7B. in the hospital you have to walk fast because there is chronic time pressure (CTP), like you are a type A personality, I grab my toothbrush, at least I’ll start the day with my mouth clean instead of all slimy and my sweaty feet…same socks as yesterday, and my face all oily and a group of nurses stop me…something about an order crossed out for Mr. L, for his flexible sigmoidoscopy…so they cancelled it, I get that tired angry defeated final disappointment feeling, I know what they are talking about, I didn’t mean to cancel the flexi-sig, just the NPO order, later I found out that was wrong too, I instantly get mad at myself for not writing clearly, at Dr. A for always being in such a rush and expecting me to do all these things that I don’t know how to do, I mean, fuck, I can’t even remember what I have been taught, what is Duke’s stage D? But I mean so much of what I do during the day is stuff that I have never been taught how to do, I either sit incapacitated by doubt or do something, anything, and learn from my mistakes and have my mental health shot to hell by stress, what kind of fucking education is this???

The next day I take Mr. L down for his test he didn’t get the night before…in the elevator a patient gets on at 5 and I say what floor are you going to and he says 1, and I say do you mean 1 or G, because when I first came to the VA, less than 4 weeks ago, and I got off on 1 instead of G and I had to take the stairs down to G to get out of the hospital…I remember last night watching the beautiful orange sunset and people walking eight floors down on the street going about normal people things like relaxing and eating and sleeping with lovers and I felt trapped and this guy says real nasty-like if I had meant G, I would have said G, now kindly push 1…and there is that feeling of utter defeat and despair, I mean, I think what I have learned best is learned helplessness, and I say I only asked because a lot of people think that 1 is the lobby, and I think, what the fuck…this guy hobbles in on crutches and I offer to push the button for him and he jumps down my fucking throat…fuck him…fuck this place…fuck these people…do they just lack any appreciation of how they make other people feel, I mean, sure you can only quantify life or death or electrolyte imbalances but doesn’t anyone here have any empathy?

So Mr. L goes to his test and I am post-call so I plop down in the waiting room and watch tv…it’s one of those shows with the compassionate concerned host, “this disease for which there are no telethons, no fund-raising drives, yet this disease takes away that which is the truly human part of us, our memory. Just think, experiences, loves, memories of our families and friends, that is what defines us, makes us who we truly are. Memory is what gives life meaning, without it we are no more than animals, living only for the present. The mind is every bit as important as the heart, which we know how to care for with low-cholesterol diets and exercise. So take care of yourself, especially your mind.” Who is this geek? Is memory what gives life meaning? I don’t think so, it defines us over time, but isn’t the present more important than the past, isn’t that Zen…isn’t that Nietzsche? What does this guy know, he’s full of crap…some appropriately compassionate host waxing philosophical... “Excuse me, do you have the time honey?”

“Yeah, it’s about 11.”

“Thank you.” A short pause, “Do you know anything about these brain X-rays?”
It is this little old lady with a cane, slightly swollen ankles and coke-bottom glasses, it’s difficult to see her eyes because of the thickness of her glasses and the angle she is positioning her head, at a tangent to me, “You mean a CAT scan?”

“Yes, I guess so, my husband went for one and he’s already been gone for half an hour. Do you know if there is any medicine that can help him get his memory back?”

“Well, how old is he and why is he getting the brain scan?”

“Well three years ago he had this tumor behind his eye that was as big as a pear and he had his eye taken out and now he is going blind in his other eye and my daughter came over with his granddaughter and he doesn’t even know he has a granddaughter and he said what is that animal paw doing there and it was her little leg and now he doesn’t even know I’m his wife and he thanks me all the time for all the help I give him but he doesn’t know I’m his wife and every night he says, well, I better call a cab to pick me up and take me home and I have to tell him that he is home and I am his wife.” Her eyes are clear blue and watery, not the old foggy grey eyes so many old people have, but I can’t see them through the coke bottles, only when she turns her head away for a moment do I get a glimpse of them. People often get emotional like this and throw doctors’ interviews off track because it causes discomfort, we’re not trained to deal with unquantifiable variables, you know, emotion, stuff like that.

“So did these memory problems come on right after the eye tumor and were the symptoms sudden or gradual?

“The pear was about three years ago, but the memory problems started 6 months ago when I was at my daughter’s and he calls up and says, ‘Beth, come home quick, they’ve taken everything, everything’s gone!’ And my god, I run home and everything is there and he’s scared and he says that there are men in the bedroom carrying away the furniture, but there is no one there. I just take care of him the best I can, but he doesn’t even know who I am now and he bumps into things in the house and I am afraid he might fall.”

“Has he had any emotional instability, like angry or violent outbursts?”

“Oh no, he’s quiet, but he doesn’t know who I am and we’ve been married 47 years and he is a good man, I don’t want to put him in a nursing home, can they help him?” I touch her arm, sometimes it is for me.

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