Once upon a time, Miguel Martinez was the sickest patient in my clinic. I met him on my first day as a doctor. Illness seeped from every organ in Miguel’s body—heart, kidneys, bones, and lungs.
Miguel’s walker squealed under the force of each step as he trudged down the clinic corridor towards me. Rhonchorous noises poured from his tracheostomy as a grin radiated below his sweaty forehead. Initially, I feared seeing his name on my schedule, but my fondness for him grew through our frequent appointments.
In the spring, I calculated that he had spent more days in the hospital than out. He was getting sicker.
“Miguel, this isn’t working,” I said at our final clinic visit of that year.
“So, what are we going to do?” he asked with a wink.
I decided, with the help of my colleagues and attendings, to make him the focus of a pilot program for home visits. Week 52 of intern year became week 1 of our future.
On week 1, I walked into Miguel’s apartment for the first time. He greeted me warmly with one hand on his trach as the other nuzzled my hand to his face.
“Doc-tore Leeeemay!” he smiled.
The place smelled a little bit like old bananas. I saw that he had a crocheted table cloth with a small bouquet of silk flowers on top, and I knew we had a chance. We emptied his fridge of everything that wasn’t part of his new diet, which, as it turned out, left us with two browning bananas.
On week 2, I scheduled my visit at the same time as his home physical therapist. I saw him work for each raise of his leg, for each step to his bedroom. We would work; we would work even harder.
On week 6, he was down 10 pounds.
On week 11, I came with tools and masks. We ripped up his carpeting, filled with dust mites (and probably worse), washed everything from his clothes to his curtains, and covered his mattress in plastic. He threw away the pack of cigarettes he had been keeping for 7 years.
On week 35, his pulmonologist came with me to his house. We saw his oxygen tanks and supplies, all well cared for, and we saw the progress he was making. The tanks were occupying the space he needed for his new treadmill. Unhindered by the extra 74 pounds on his chest, his breathing had improved, and his tracheostomy was removed.
On week 63, he met Marcia. She said she had never seen Miguel before (though they had met 2 years earlier when he was 100 pounds heavier, barely moving forward with his walker). Miguel said that 57 weeks earlier, I had promised to prescribe him Viagra when he was healthy enough to walk up one flight of stairs. He walked out of his apartment, up and down three flights of stairs, and back inside with hand outstretched, waiting for his prescription.
On week 102, I presented Miguel’s case at Grand Rounds. I surprised the crowd by bringing Miguel on stage with me at the end, and he received a standing ovation. I could see it in my colleagues’ eyes: “I could do this. I will.”
On week 106, it was my last day of residency—my last appointment with Miguel. We hugged, cried, and said goodbye. He thanked me for seeing more in him, and I thanked him for achieving more than I had ever imagined. He walked out of the resident clinic, Marcia on his arm, because there was even more for him waiting.
But, of course, none of that happened. After a year of caring for Miguel in clinic, I never stepped foot inside his home. In reality, on week 1 of our pilot project, Miguel died.
Miguel’s daughter saw him in his bed, asleep and peaceful, and hadn’t woken him for breakfast. By lunch, she realized he wasn’t breathing.
I asked his daughter to call me back to let me know about funeral arrangements. But I hadn’t really spent those two imagined years in Miguel’s home, and his daughter didn’t really know me. She never called again.
I spent the day sobbing in my bed, curled in a ball as if protecting all of my memories and hopes for Miguel. I felt that maybe if I wanted it enough—if I cried it loud enough—I could erase time, exceed my own power as a physician, and actually make changes for patients that most of us only dream of. I fantasized about adding back lost time to the end of my patients’ lives and of enchanted weeks spent in their homes.
But Miguel was dead, and those weeks were nothing but a fairy tale.
Acknowledgements
The author thanks Dr. Anna Reisman, MD, Dr. Lisa Sanders, MD, and the members of the Yale Internal Medicine Writers’ Workshop for their support and review of the manuscript.