The first case I followed at the VA was a challenging one.
He came in with weakness in both of his legs. The weakness had started nine months ago and had been progressively getting worse. Two months earlier, he had been driving his car to the grocery store, doing all of his shopping and then carrying the groceries into his house. Two weeks earlier, he couldn't drive anymore. Now, he was bed-bound.
We examined him, and couldn't find any reason for his inability to walk. We had the neurology service examine him, and they couldn't find a reason either. We scheduled him for some expensive tests, which told us only that his legs were weak-for some unknown reason.
The final diagnosis ended up being "idiopathic bilateral lower extremity paresis"-a fancy way of saying both of his legs were weak, and we didn't know why. We sent him to a nursing home where he could get some physical therapy-a "sniff," or skilled nursing facility (SNF) in doctor parlance-and pretty much washed our hands of the whole thing.
Of course, that's one way to phrase it. There is, of course, another.
The first patient I took care of at the VA was an amazing man.
When I first met Mr. H, I asked him about the time he spent in the service. He told me all about his year fighting in the Pacific Theater of World War II, when he was a 17-year-old kid from rural Kentucky, scared witless but not willing to quit.
He told me about how he landed on the beach, and how his commander told him to dig a foxhole because the Japanese were coming. He told me about how the Japanese started their charge at nightfall, and how they came in waves, and how he couldn't see anything and just shot into the darkness, and how he didn't know if the man in the next foxhole over was dead or alive, and how in between waves of the enemy he would hop out of his foxhole and drag more ammunition back to prepare for the next wave.
He told me about how midway through the battle, the Americans started shooting signal flares attached to parachutes into the air, which lit up the ground and the sky with an eerie red glow, which was kind of spooky, but at least he could see. He told me how he survived that night, but that he was one of the lucky ones.
He told me about the grenade explosion a month later that ruined his back, led to six surgeries once he got home and from which he never really recovered. He told me how he carried his fellow soldiers home after that explosion, because some of them were in worse shape than he. He told me how he laid in his hospital bed after that with fevers and chills, because somehow he had also contracted malaria.
He never told me he was awarded a Purple Heart; I had to hear that one from his wife.
When he left the hospital for the nursing home, I promised myself I would visit him. He was only going to the rehab facility on the first floor of the VA, I thought, and it would be so easy to stop by. And besides, I liked talking to him. I knew that he didn't get visitors every day, and I knew that he enjoyed my company.
I never did make it downstairs to visit him. Every time I thought I would get there, I found something else to do that was more pressing.
It's funny, because I thought I cared about Mr. H. I thought that we had bonded. I thought that I knew him as a World War II vet who was willing to give his life for his country, but instead just gave his back. I thought that I thought he was more than an "interesting case" that I could just ship out of the hospital and forget about.
But then I didn't go visit him. Maybe I didn't care as much as I thought.
Of course, there's a chance he's still there. There's a chance there's still time for me to tell the story another way.
Alex Fanaroff, Trinity '07, is a second-year medical student. His column runs every other Thursday.
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