November 24, 2000

Today I saw a woman who brought in her neurologically devastated 3 year old, her first child. For three years she has been thinking that he'll catch up to his peers but of course he never will, he'll never brush his teeth or walk or even say mama. He doesn't feed well because he has no appetite (part of his brain deficit) and isn't putting on weight. If he continues this non-growth he will compromise his immune system, get some infection, end up in the hospital, and after a few rounds of being rescued from death our drugs and interventions will be unable to halt the progression of bacteria into his defenseless body and he will get septic and die. Today I watched my attending try to convince her and her husband that the appropriate management is a g-tube, which is a flexible rubber cylinder that is surgically attached to the stomach then poked through the abdominal wall; basically a conduit into the stomach for "tube feeds." Mommy responded to this suggestion with shock and disgust but then daddy turned to her and said, "Baby he hasn't put on any weight in four months. He won't eat. This is the only way. Listen to the doctor." At that she became silent, softened, confused for a moment, and then with the force of a much larger person she gushed forth an eruption of tears and sorrow and pent up denial anger and why me's in front of her husband, her son, her doctor, and two medical students she had never seen before. One of these medical students wants to hurry up and finish all this med school bullshit so he can finish his oral-maxillofacial program and pull wisdom teeth eight times a day five days a week for $1500 a pop for the rest of his life. The other medical student was frustrated with the doctor he was following around, wondering how such a lame fuck could get patients to see him, much less charge them for his services. The other medical student's mind had been in some other place for a few hours and he just wanted to get out of that clinic and into the 45 degree sun on his 750 cubic centimeters of beat up motorcycle to race home to his bowl of beans, rice, and cheese and make some frozen spinach sauteed in butter and garlic with sliced mushrooms and scallions topped with chopped peanuts and pecans. And oreos with whole milk for dessert.