Six Word Story

By: Emma Fenske, DO

Veteran

I remember first meeting Mr. B not at the Veterans Affairs hospital, but at a tertiary care center during an inpatient wards rotation. He had already been admitted several times prior, and even then, it was clear to me that he desperately needed a primary care physician. I imagined he needed someone to help anchor his care and, hopefully, keep him out of the hospital.

He and I agreed I would become his new doctor, a decision that felt simple and practical at the time. My primary care panel was, in fact, based at the VA. This effort felt as though it would allow for both continuity and stability, despite so much unpredictability. 

Admissions

After that initial discharge, he was, unfortunately, admitted several more times. Each admission felt familiar and frustrating, complicated not just by his medical conditions but by the weight of his social circumstances.

He would leave the hospital early, via patient-directed discharge, to return to work, desperately trying to make ends meet. He supported not only himself but also a younger fiancée living overseas. Every time he was scheduled to see me in clinic, he seemed to be admitted again, forcing yet another postponement of our meeting.

I followed along anyway. I tracked each hospitalization, reviewed discharge summaries, carried forward the to-do lists that seemed to lengthen over time. Once, I even visited him while he was inpatient – trying to maintain some thread of continuity in a system that kept pulling him back into acute care. 

Decline

Months passed before I finally saw Mr. B in clinic. By then, I had almost forgotten what he had been like when we first met. I suspect he had forgotten me, too. I was just another physician in an ever-growing rolodex: neurosurgery, oncology, infectious disease, and now primary care.

When I knocked on the clinic door and entered, I was surprised. The man in front of me barely resembled the patient I remembered. He was cachectic, his clothes hanging loosely from his frame. This was a stark contrast to the rotund man with the witty New York accent, the one whose protuberant belly I had palpated for tenderness during a prior GI bleed admission.

This version of Mr. B felt quieter. Smaller. More fragile.

Anger

I remember anger swelling inside me.

Anger that his cancer and infections had gone incompletely treated. Anger that I could not help him fully grasp how sick he truly was. Anger at myself for becoming yet another doctor gently introducing the idea of hospice. It was as though we had two completely separate agendas. 

I was angry at the possibility that someone might be taking advantage of him from another continent. Once, he showed me a video of his fiancée – young, laughing, surrounded by friends at a night club. He told me how much money he sent her, large sums, to help her through school. The thought that this might be a scam unsettled me deeply and essentially set up shop in my brain. I was uncertain of whether to protect him, challenge him, or simply listen.

Hope

One day, while discussing goals of care, Mr. B told me plainly, “I want to beat cancer and go to travel overseas.”

I sat with that statement, suspended between honesty and hope. I wasn’t sure which parts, if any, were realistic or attainable. I didn’t want to extinguish his optimism, but I also felt a responsibility to be truthful.

Still, there were signs of improvement. He was gaining weight and getting around easier. He stood with less effort, more confidence. He was doing what he loved again: cooking. And yet, I wondered quietly: could he tolerate a sixteen-hour transcontinental flight? Would his body allow him to reach the place his heart longed for?

Commiserating

I staffed the visit with my attending, feeling defeated. There was no real progress, but also no clear decline.

During the visit, without prompting, Mr. B said, “I’m just not ready for hospice.” And I realized that even that was something. Naming what he wasn’t ready for felt like movement, however small it actually was.

I felt a deep sympathy for him. For his passion for life. For his desire to connect, to love, to hope. For his insistence that he was not done yet – not ready to close the book on himself.

And in that moment, I understood that sometimes our work as physicians is not about fixing or curing. It does not need to feel transactional. Sometimes it is about bearing witness and walking alongside someone as they decide, in their own time, what they are ready to face.

Ultimately, by caring for a veteran whose life moved through repeated admissions, quiet decline, moments of anger, persistent hope, and shared moments of commiseration, I learned that medicine sometimes asks only that we remain present.

Emma is a current Addiction Medicine fellow at OHSU. She has a passion for narrative medicine, advocacy, addiction medicine, and end-of-life care. She hopes to pursue a career in general internal medicine and addiction medicine in the future. When not working, she can often be found running long distance, riding her motorcycle, or stopping mid-sentence to note a cute dog.