Ghost of Summer, 1988

      He was Admission Number Five from the emergency department during the last week of June 1988. I learned of him through the triage resident, who said he was an easy admission, and for an inefficient Day 3 intern like me, he was something like a gift. I was told that he had uremia due to HIV nephropathy but was not a dialysis candidate; however, that brief case summary would fail to convey his full significance for me. I found him supine on a gurney, cachectic and delirious, his brown skin marked by severe eczema—and we were the same age. Ascertaining his wishes was difficult: no family or friends had accompanied him to the hospital, and his respiratory distress made speaking nearly impossible. My lasting impression was that due to the end-stage nature of his AIDS, he had previously chosen not be dialyzed, but the process and documentation of that decision was not shared with me. Nonetheless, due to delirium or a wish to die, he kept removing his oxygen mask. Seeing this, my senior resident, who was in his final days of training, declared, “It's a statement,” turned toward the door and walked out, leaving me with the patient. Now alone with him, I spoke into his ear, asking about his feelings about death, specifically if he had religious beliefs. With effort he turned his head to me and nodded, but that is the only communication I was to receive from him. I recall this as the first time I heard a pericardial friction rub, and he was also the first patient to die under my care; a man whose memory I cannot exorcise.
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