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Title: Blog by Novelist William S. Frankl, MD

Peabody’s Corner: Darcy

Darcy

Patrick Russell, MD LOT 22, Clarenden Road

Clarenden , South Australia,

5157, Australia

Peabody’s Corner is a monthly feature of the Texas Heart Institute Journal. It provides a view of medical care which typified Dr. Peabody’s dictum that “ . . . for the secret of the care of the patient is in caring for the patient.” The following short essay in the’s Journal’s last issue (40 (1): 15-16) points out what medicine and medical care should be . . . And used to be. Rarely today, alas. The essay is beautifully written by an obviously literate and caring physician. So here it is:

He had been in the war. Not in a supportive role, but in a Halifax bomber—the British, 4-engine, heavy bomber, equivalent to the B-17. A gunner or bombardier, I do not recall which, he was there in the thick of it with his teeth clenched.

Darcy. A girl’s name. What teasing I would have endured in my neck of the woods growing up, had that been my name. But he was Australian. I imagined the use of his name in the cockpit during the heat of battle, flak thundering through the fuselage, a nonplussed commander smoking a pipe and calling to him calmly over his shoulder with a scratchy Sherlock Holmes accent, “Darcy, be a good chap and release the bomb-bay doors, will you?” Or, if addressing a gunner: “Darcy, could you be so kind as to return fire to the bloody mongrels?”

That was then—a man’s man with a square jaw, a dimpled chin, and a girl’s name. But now he was a pale and pasty convalescent at the crumbly edge of his life. He had been in hospital for months, delirious from various insults, spending time in 4-point restraints, with one-on-one nursing, his condition complicated by hospital-acquired infections. His imaging, electroencephalogram, and lumbar puncture results were normal. He was thin, feeble, and confused. But in the last several weeks, the lucid intervals were coming more frequently, and he was becoming manageable again.

I did not ask him if he actually wanted to go outside. I told him where we were going and helped bundle him into the wheelchair. And why not? The day was beautiful.

I rolled the wheelchair out of the elevator and down the long hallway toward the front entrance of the hospital, passing healthy visitors right and left as the bright light at the end of the hallway grew larger and stronger until we moved through it and left the air conditioning behind. Suddenly, we were in a different world. The midday sun was bright and Australian. I took a seat on a park bench with him beside.

His chin rested on his chest, face downward toward the white hospital blanket in his lap. He sat, vanquished and silent. I spoke some, mostly banter, while I ate my lunch. After 5 minutes, his head slowly ratcheted up until he faced the warm sun directly. I said something without much substance, like, “Feels good, doesn’t it?” because it looked like it did. He didn’t answer, so I went back to eating my lunch and looked at him again a few moments later. As his face warmed in the full sun, his cheeks pulled back his lips to expose stained dentures. This time a tear was slipping down the nasolabial fold on one side, then the other. He wept, with a trembling lower lip and eyes closed, as if in a prayer of contrition. As if released. There wasn’t anything for me to say or do, except sit and let him be. I was witnessing a day in spring. After 5 minutes, I asked him how he was doing. “Okay,” he said, eyes still closed, lip still trembling, his voice raspy and weak. Then he opened his eyes and looked at me. And he really looked at me. Eighty-eight years’ worth of living: sweaty, depression-era farm dust from unpaved roads; young romance and a simple marriage; the unspoken terror and violence of war children born, some dying too soon; the elation of grandchildren; the death of the love of his life after half a century; many things that I simply would not yet understand. Deep-set eyes, wrinkles, and bristly chin, he stared at me sternly, too manly to care about the drying tears on his chin or the clear drip from his nose. “It’s been,” he paused, swallowed, then continued slowly without blinking or moving his eyes from mine, “6 months since I have been outside.” His stare was both gratitude and matter-of-fact observation … as if I had done only what I had been told to do and nothing more. He stared a moment more, then closed his eyes and lowered his head again, new tears falling freely to his lap. He lifted his head once more to the sun, eyes still closed as he sobbed, then sat quietly for several minutes more.“I’m ready,” he said.

I threw my half-finished sandwich to the ants, wheeled him around past the college students waiting for the bus, white wires descending from their ears, and back to the ward.

We took trips outside almost daily. I ate lunch while he watched people getting on and off the buses. Sometimes he talked, telling short bland stories about the war, about growing grapes, about his family. With time, his expressions became more animated and his recollection crisper. After several months, he was discharged to a low-care nursing home, almost completely independent again.

There is no doubt that much of his apparent recovery happened as a result of good supportive medical care—attention to detail, vigilance for superimposed infection, avoidance of sedation, adequate hydration—a medical regimen in which every little bit counts. But good medical care often also includes things not necessarily learned in medical school: fetching a warm, wet rag for the face of someone vomiting; helping the nurse change the bed pad of someone incontinent of urine or feces, rather than delegating that to the busy staff to be done later; and taking the patient at risk of delirium outside for a bit of grounding with the sun. These are all kindnesses whose worth cannot be proved in terms of outcome, and they will never win anyone the Nobel Prize. But going outside seemed to help Darcy. At the very least, it was something I did for him that he enjoyed but could not reciprocate. It was an attempt to mitigate by some small bit the wintry suffering that happens in hospital. It was an attempt to help usher in spring. I once read that Osler’s dictum might be summarized as, “Do the kind thing and do it first.” Hospital work has further taught me that kindness need not be accompanied by deep compassion or empathy. I do not have to feel compassionate, in order to be compassionate. By small, kind gestures made quietly, as well as the grandstand diagnoses and the big saves, I make my life noble.

Surely Dr. Osler would agree. Surely Dr. Peabody would agree as well.


Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

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