Some patients are a little hard to take. I had one like that. A big tall man with a wife and two small children and ... lung cancer. So why was he hard to take?
He had had a life threatening illness a long time before, having suffered an intracranial hemorrhage from a berry aneurysm of the cerebral artery. Yes, I know, stop with the big words and tell us what it means!
One of the blood vessels running into the brain has a weak spot. Weak spots in vessels under pressure form a bleb - like the bike tyres. Because the area is weak, it swells and then can burst or leak. When that bleeding happens the blood will track into the brain and cause a stroke, or it will flow into the space around the brain. This 'space' is a layer filled with fluid called cerebrospinal fluid (I know big words again, it's not my fault! Really, that's what it's called! We will call it CSF!) that provides a cushion for the brain. So the blood can flow into the CSF area and coat the brain.
When this happens, the brain gets really irritated! The patient gets sudden severe headache and can pass out, become brain damaged, a 'vegetable' (horrible name but more horrible condition) or even die.
So that's what happened to him, but he recovered with some changes in the way his brain worked. Where you and I might think a thought and keep it to ourselves, he did not. He was 'dis-inhibited'. It's a little hard to take because it's so confronting? Questions like "are you married?", "got any kids?", "where did you spend your holidays?", "who gave you the tie?", "where did you go to school?". No questions were taboo. No questions were malicious. No answer was unacceptable!
But after the initial gasp, I just packed away the discomfort and settled in to enjoy the ride!
He had a real bad disease and he came back pretty often for more treatment, so I was subject to a lot of questions. To make matters worse he had developed brain secondaries and was on a steroid tablet. Happy pills! So you can imagine the combination of the dis-inhibited being uninhibited! I took my medical students to see him - they get that 'kangaroo in the headlights' look when they are out of their comfort zone, and I thought he would rattle them (that allows me to then make some points to further their education). I thought they needed to meet some one like him.
During the teaching session I got a call and wandered off for two minutes before returning. On return I heard him address the blond petite medical student as "Barbie Girl". They were all laughing. Before leaving he wanted to know if he was going to see me next week and I told him I would be at a course. Before long he had all the details! Seattle, needles, prostates and finally the big question - "what are you going to get me?"
I hesitated momentarily and as that happened, I saw what lay ahead of him and how we had become more than usually involved. "I'll bring you something back" I said, wondering just what would be the right thing.
In Seattle, I visited the Space Needle and traveled to the top. Glorious! You have to do it one day! Of course like all good tourist destinations, you exit through the gift shop and there it was! A baseball cap from the Space Needle. This was it - he was going to lose his hair soon!
I arrived back at work on Monday and there outside the department he was. Not waiting, just good timing. He was heading in for his treatment. I called out "Hey, come here, I promised you something!" He stopped and looked startled as I thrust the cap into his hand. "See, the Space Needle! I told you I'd get you something!" More quiet than usual he said thanks. I ushered him towards the machine for treatment.
That was the last I saw of him.
Until last week .... the nurse collared me in passing to say, his wife called in to say that he died and to say thanks for looking after him .... oh and by the way, guess what he is wearing in his coffin?
