Why Die?

On my first day of internal medicine clerkship, a man was brought into the emergency department on a stretcher coughing and comatose. I was told his blood alcohol level was over 400, enough to kill most people, and a quick review of his chart showed that he presented to the Elmhurst ED monthly in a similar predicament. Films were collected and showed evidence of a lobar pneumonia. We left him in an observation room to sober up and went on with our day, with plans to come back in the afternoon when the man could speak.

***
We are all products of the contradictions we carry, and while that may bring stress to some, I would argue that it makes all of us interesting in our own ways. I can rattle off my own contradictions with ease and, I admit, with mischievous delight. I like riding motorcycles and I think they are frightening deathtraps. I am a student studying in one of the most traditionally conservative fields and I have covered my body in tattoos. I am a native New Yorker with a burning love for the city and I concurrently hate everything about this concrete, rat-infested, BQE-having hellhole (screw you, Robert Moses!). Although with regard to this last contradiction, I’m willing to bet that every true New Yorker feels the same way.

***
After lunch, we jaunted down to the emergency room once more to find our patient yelling,
AY EM AY! AY EM AY! 

Leaving “against medical advice” (AMA) is when patients decide, against the advice of their medical team, to leave the hospital. To know specific bureaucratic hospital jargon? This was clearly not his first rodeo. The man was standing and swaying. A bright yellow gown indicated he was a fall risk, but I think he communicated that well before I noticed his garment. We sat him down. The chief resident explained to him that he had a bacterial pneumonia and would need to stay in the hospital for IV antibiotics. He said,
I don’t care.
I’ll take my chances.

While the intern scurried to get an AMA form, I looked at the man’s hands, which were bloated and pink as if they had been boiled. I asked,
Are your hands ok? 
Maybe he had an allergy? Allergies could make anything puffy. My third-year medical student brain perked up at the opportunity to catch a pathology that the rest of the team had missed. He mumbled, not looking at me,
Fell from a helicopter…
I later learned that the man was a Vietnam War veteran. After having returned from an unjust war, disabled, hated by civilians back at home, and left to navigate an underfunded veteran’s affairs system, it was no surprise that this man turned to alcohol and ended up homeless.

***
One of the more perplexing contradictions I hold is my anxious obsession for bodily safety and my belief that the world—and with it my own life—is imminently coming to an end. This belief that the world is ending probably has something to do with all the apocalyptic fiction I consumed growing up, and the fact that turning on cable news or scrolling on the internet would have you believe that we are living in a dystopian hellscape. Holding these two beliefs fosters an attitude where I can both take risks (after all, the apocalypse is right around the corner!) and protect myself while doing so. I offer an example to encapsulate this contradiction: I intend on getting a tattoo of the grim reaper on my thigh as a memento mori and I am, and always will be, the annoying friend in the car that makes sure everyone is wearing seatbelts.

***
The AMA form was brought in front of the man and a pen placed in his hand. He said, 
So, you want me to stay in the hospital for a few days while you give me antibiotics?
That is correct.
And if I don’t do that, I could die?
Yes, it is a very real possibility.

He looked at our masked faces. The pen was still in his hand, hovering over the signature line which, once penned, would release him from the dungeon that is the Elmhurst ED. His ballooned fingers trembled with the beginnings of what was likely alcohol withdrawal. Those hands that had known unspeakable pain—and were being self-medicated by the world’s most chemically simple (and physically damaging) anesthetic—those hands held power in that moment. The man tossed the pen down in a casual manner, which broke every thread of tension, and shrugged.

Eh… why die?

When I got home that evening after a long day, I went to my desk, and with a thick black marker I wrote on a piece of computer paper those two words in all caps. I pinned it up next to my desk. Something stuck with me about the man with so many brushes with death who said those two words in that order. Under my grim reaper tattoo I want those two words. And when my friends roll their eyes at me when I tell them to buckle up, I will offer those two words in response.

From the author: This is a story of a meaningful interaction with a patient, which caused the writer to reflect upon their deep-rooted contradictions.

George Danias grew up between Bay Ridge, Brooklyn and Staten Island, NY. They are an ISMMS grad and currently a PGY1 in psychiatry at NYU. They have interests in addiction psychiatry, community psychiatry, and psychedelic medicine research.