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Night Float in the Hospice

During my residency I kept a diary as a way to relieve some of the sadness related to the death and dying that I witnessed.  I recorded various encounters in a series of vignettes.  Although these are a bit long for a blog, I thought I’d share a few now and then in the hope that they’d preserve the memory of those who are gone.  All personal data have been removed so that the identity of the patients is protected.


It’s 3:00am and I was paged to examine yet another patient who had fallen out of bed – to rule out a hip fracture.

Too tired to read the chart prior to examining the patient,
I thought I’d leap right into the physical exam.  I assumed that the patient would be the usual
elderly woman who, in her sickened delirium, thought she was at home and tried
to walk by herself to the bathroom and fell en route.

I marched into the room and stopped at bed 23.  All my pre-conceived notions evaporated as I
looked at the young man before me.
Emaciated and stiff, with all four limbs contracted, he lay on the bed,
clinging to a thin white sheet.  The
whites of his eyes flashed in the darkness.

“Hi there.” I said, trying to seem casual at the sight of
the living corpse before me.  “I’m Dr. Jones.  I heard that you fell.  Are you in any pain?”

His eyes suddenly fixed themselves on me and he spoke, not
with a thin raspy voice, but with the robust youthful voice appropriate to his
age rather than the decrepitude of his body.

“I’m in no pain,” he said.
“I was trying to sit down on the chair.
I thought it was against the wall, but it was actually a couple of feet
away.  So when I leaned on it, it slid
and I fell on the floor.”

“Do you think you broke anything?” I asked, trusting in his
judgment as his mental status was clearly in tact.

“No, I just scraped my butt,” he said, pointing a frail
finger towards his sacrum.

“Did you hit the floor hard?” I asked as I used my pen-light
to examine his back side.

“Not really,” he said.

“Would you like me to order an X-ray of your pelvis to see
if you broke anything?”

“I don’t think I need it,” he said.

“Well let me see if it hurts when I rotate your leg in your
hip socket, ok?”  I pulled down the sheet
and asked the young man to allow his right leg to fall to the side.  As I looked down at his hip I gasped slightly
as his inner thigh came into view.  A
gaping ulcer lay before me, deep to the bone, exposing tendons and ligaments
with pus, and red knobs of flesh surrounding a football sized hole in the man’s
groin.  His paper-thin scrotum lay stuck
to his left thigh.  The smell overcame
me, it was at once wet and fetid, with a hint of chemical odor from the
antibiotic ointment that was clinging ineffectively to the fringes of the wound.

“Oh my God.  Does that
hurt?” I stammered.

“No, not at all.”

“And does it hurt when I rotate your leg in your hip
socket?” I asked, trying desperately to remain focused on the task at hand.

“No, it doesn’t.”

“Well, then,” I said, gathering my faculties.  “I don’t think you broke your hip.  And if you don’t want an X-ray, I don’t think
we need one.  Perhaps you’d like to go
back to sleep and get some rest?”

“Yes, that sounds good,” he said, drifting off into a
morphine induced altered state of awareness.

I wandered out towards the nursing station, looking around
vaguely for the patient’s chart to make note of my “fall assessment.”

One of the nurses anticipated my need and handed me the
thick plastic folder.

“What does this patient have?” I asked.

“Oh, he has AIDS and metastatic anal cancer” she said as she collected some sputum in a clear plastic cup.  “He’s 38 years old.”

“The same age as my boyfriend,” I thought to myself.  “And why exactly did he fall?” I asked the

“I was trying to help him to get to the commode,” she said printing something on a label.  “He fell because I wasn’t strong enough to
hold him up.  My right arm is a little
bit weak.”

“And why is your arm weak?” I asked, assuming that it was
because of a small strain injury.

“I have breast cancer,” she said, finally making eye contact
with me.

“Oh my God, I’m so sorry,” I said, feeling the weight of her
diagnosis amidst a ward of terminal cancer patients.

“Well, you know the funny thing is that my husband is
particularly upset.  He doesn’t want me
to have a radical mastectomy.  He says
that it would hurt to see my body differently than he’s used to… he likes to
think I’m still the bouncy cheerleader I was when we first met.  To see me with only one breast is upsetting
to him.  And quite frankly, I’m afraid he
won’t be attracted to me anymore.  That’s
what scares me the most,” she said, becoming misty-eyed.

My pager let out a familiar series of beeps.

“I’m so sorry,” I said, squeezing the nurse’s shoulder.  I paused and tried to be encouraging: “Well, even if you need a mastectomy – I’ve seen some great reconstructive surgeries
where the breast can be reformed at the same time with an implant.  Maybe you’ll be a good candidate for that
surgery?  I’m so sorry that I have to
run… can we talk later?”

“Sure,” she said, smiling faintly.


This post originally appeared on Dr. Val’s blog at

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One Response to “Night Float in the Hospice”

  1. nurse4eva says:

    Dear Doctor..What has been your experience with Hospice care? Would love to see a blog in reference to this compassionate approach to terminal  patients.

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