The third patient was mine, and her passing cut more deeply. Years ago, she taught me that microscopic polyangiitis does not recur, except when it does. I distinctly remember calling her from my hotel room in Chicago, starting in a reasonable voice, but eventually shouting into my cell phone that she needed to go to the hospital now because she was developing the first signs of glomerulonephritis.
After years of having quiescent disease, however, she was unconvinced. She told me about her weekend plans, which included a birthday party that she was looking forward to, and she stated, firmly, that she would go to the hospital on Monday, after her personal obligations had passed.
I should not have been surprised. You could always tell when she was in my clinic, because she made me leave the clinic door open; shutting the door made her feel confined. I was also instructed not to call her “ma’am,” because this made her feel old. There were a number of other rules that I accommodated, wordlessly, knowing that I did not stand a chance of winning any argument with her.
When I saw that her chronic kidney disease had jumped from stage 3 to stage 5, I knew, metaphorically, that this would be the end of her. She was fiercely independent, and I knew that relying on friends and family to take her back and forth to dialysis sessions, three times weekly, would kill her inside. So she left on her own terms; before dialysis could be initiated, she ended up in our emergency department, hypotensive, with polymicrobial sepsis that was resistant to everything that was thrown at it. She left as she would have wanted, in a blaze of defiant glory that suited her personality more than any end I could have imagined for her.
And now, to number four. I had met her by accident. She was scheduled to see my colleague, whom she had met during a prior hospitalization. She had arrived on time for her appointment, but a week early. My colleague was out of town, and the patient, who was reluctant to make the long drive to Richmond again the next week, had asked if I could see her, instead. I agreed, but insisted that she wait until I was finished seeing my own clinic patients. I remember seeing her husband through the crack of the door, sitting patiently as I ran past, ministering to patients I thought of as mine.
