Loren Black
August 25, 2017
My first task when I met Mr. Johnson, my only task, really, as I was informed, was to discuss with him the urgent need for a rectal exam. Even in the peculiar, parallel universe of the hospital, it’s most unusual that your first words on meeting someone include a request to stick a gloved finger up their, well, you know, for medical reasons. This issue of the rectal exam had been discussed with other providers before me, each time with the same response—a burst of language I suspect he'd rather hide from his pastor and a command that the provider leave the room without delay.
Maybe my attending thought that the seventh person in scrubs and a white coat would be just the ticket. Maybe the first six doctors who had tried were not enough to convey the gravity of the situation. Surely one more new and unfamiliar face offering a “Hello, nice to meet you, I wonder if you’d mind rolling over” was bound to succeed where others had failed. One could hope. I'm afraid though, that that wasn't the reason.
I'll reframe: most of what we do in medicine has both certain risk and possible benefit. My attending likely saw this as a rare case of unbalanced upside potential. Sure, Mr. Johnson needed a rectal exam—well, we needed the results of his rectal exam to know what to do next—but that's not why they sent in the most junior person on the team, who hadn't even earned the right to wear the long coat. No, that's not why at all. They sent me in because, although the odds that I'd succeed were ever so small, they were not zero. And whatever the outcome of my discussion of the rectal exam, Mr. Johnson was absolutely guaranteed to offer this medical student the opportunity to have a difficult conversation with a difficult patient about a difficult topic. Mr. Johnson was an avatar of all those things that made his medical team uncomfortable and they wanted to offer me a chance to share in their discomfort. Maybe I'd even learn something. Learn something from the object of our medical attention. The Mr. Johnson our team knew was, it seemed, a purely two-dimensional thing—a few unread words buried on an unnumbered page of an unimportant medical record. That there might exist a downside, as he saw it, failed to appear on our ledger.
And so, in no position to decline, or even to have much of a thought about the request, I marched off to see Mr. Johnson.
He looked like some combination of the best parts of Sidney Poitier and Charles Mingus, but worn down even beyond his considerable years, someone kicked around by Life. He allowed me in with a soft, gentle voice, not the raging fire I had expected after what I'd been told. Not welcomed exactly, more just consented to the presence of.
He was feeling fine, thank you, he explained, his gaze locked on the ceiling tile directly above him. I stood for a moment beside his bed, and watched him quietly. Actually, he wasn't looking at that ceiling tile at all. He was looking through it, staring softly up at the sky and the clouds above him, completely unbothered by the nine floors of hospital and suffering that lie between.
Yeah, man, you can take a look at my belly. Why the hell not?
I was not prepared for the war zone that lay beneath the clean, white sheets. Bowels. Not the juicy, graceful, meandering loops found in textbooks, or even the sloppy wet shoelaces of an open abdomen in the operating room. Right there before me, was the inside of his bowels. I'd seen a high output enterocutaneous fistula before, and it’s not pretty, but this was as though his guts were completely confused about which side was supposed to be in and which side was supposed to be out. Maybe they were simply tired of being constrained to life in a cylindrical coordinate system and instead were fighting physics, biology and anything else that blocked their efforts to make another way.
I know you think I need it, man, but ain't no way I'm gonna have you poking at me with your finger.
Defeated, I console myself with the knowledge that this had been a fool’s errand, and they had sent a fool to do it. Still, I had tried. My team doesn't look up from their computers, or even miss a keystroke when I return to our workroom and tell them the news. I can’t recall that anyone said anything whatsoever.
For the next three weeks, Mr. Johnson was, for me—and, I'm afraid, for the rest of our team—just another name on our patient list. Someone checked in with him every day, wrote a script for this or that—certainly for more morphine—and went on about their life while he lay there and watched the clouds roll by. This was good enough, by nearly any of the objective measures of modern healthcare.
Except that it wasn't.
I kept reading the daily progress notes accruing in Mr. Johnson’s chart. Wasn’t there something we could do? I’m certain that I wasn’t the only one troubled by the widening chasm between our solemn promise to care for this man and the dire realities of his condition. But why wasn’t anyone actually helping him? Why wasn’t I?
Another sunrise and sunset. Another. Nothing changed. Nothing except the increasing dose of narcotics we offered him so that we could pretend we were doing something. How feeble it was, the list of those things we could do for him. All of the cumulative knowledge and resources of modern medicine at our disposal, and yet he suffered. I felt—no, I was—powerless.
And then, three weeks after I began to pay attention to Mr. Johnson’s situation, something changed. I saw a new note in my mid-day chart review that looked different. It was a written by a provider I didn't know, someone not from our team. Here were two little words sitting side-by-side like songbirds on a barren branch, and just as out of place in a medical record: “jazz guitar.”
Later that day, I found a spare moment between alternating bouts of being busy and pretending to be. I picked up my white coat—I’ll tell you why in a moment—and walked down the stairs toward Mr. Johnson's room.
May I come in?
Sure, man, do what you do.
I was not coming in as a doctor—I wasn’t a doctor anyways. I was only a medical student, a mere smear of a thing, that lowest, rough-hewn part of the towering, invisible totem pole on which eagles rest. I was the part that gets covered over any time leaves go unraked or snow goes unshoveled. It didn't matter, because I wasn’t coming in to talk about his medical situation. I took off the white coat I had brought for precisely this purpose, and although his eyes never strayed from those private, gentle clouds dancing only for him, I made sure he knew that I hung it on the outside handle of his door. Yes, the outside handle.
“I wonder,” I began, “if you’re more of a Wes Montgomery or a Grant Green guy. Personally, I’m more Grant Green.”
His head came off the pillow and he looked right at me. Ah, there he is.
Not sure where his clouds went just then but they were suddenly less interesting than they’d been all these days.
Was he busy right now?
Naw, man, I’m just hanging out. What else can I do?
“There’s nobody around here who likes jazz, or really even understands it,” I confided in Mr. Johnson. “Would it be alright if we just closed the door and listened to some of the greats?”
“You’ve got music with you?” Mr. Johnson asked incredulously, as if I had John Coltrane hiding in the closet or something.
“Absolutely,” I reassured him, “I have a phone packed with my favorites right here in my pocket. It won’t be high fidelity, but it might do. Would it be alright if I put on some Kenny Burrell?”
"Hell yeah, it'd be alright," came his reply.
And with that, the floodgates opened. Mr. Johnson started to tell me a strange, fascinating, and non-linear story just as it appeared in his mind, weaving between past and present tense, from the Los Angeles of his youth to—how did we get to an alley behind a bar in North Carolina? A story of drugs and being in prison, then out of prison and back on the streets, because where was he supposed to go? Into another dark and smoky club as the heroes of my youth played on stage while he waited at a table in the back, ready to carry their horns to the trunks of their cars waiting out back. Anonymous and unknown, he had touched and been touched by whatever magic those instruments knew, whatever life had been blown into them all those years ago.
Did I know Bird? Now, seriously, Mr. Johnson, what kind of person would I be to walk in here and ask if you prefer Grant Green or Wes Montgomery without having just about worn out Charlie Parker's classic Ornithology?
"I'm not really sure how this is possible, but I don't actually have any Charlie Parker on my phone," I apologized. "It kind of strikes me that we could use a little Joe Hender…"
"Joe Henderson?" he asked, finishing the sentence for me. I’d called his bebop and raised him hard bop.
"Aw, man! That'd be just right." He smiled.
Mr. Johnson handed me the phone, which had been resting on his lap offering the music that had become our medium. I realized that I had been sitting in the hospital chair, feet up on Mr. Johnson's hospital bed, just listening. He had been sitting up. How long have we been talking?
I started the album and let it play. The room filled with a tenor sax unlike anything else. That unmistakable sound. Mr. Johnson picked up his story right where he’d left off. As with every conversation I've ever had about jazz, it was a hop around the lilypads from musician to musician. Unlike the others, though, this one didn't make any sense. It seemed equal parts fact and fiction, a tapestry of things he'd done and things he'd only dreamed. He can't possibly have been there for all of this stuff, because the dates are all wrong. And yet, it was so obviously true. And it was a joy, an honor, and a gift to be there as the story rolled by.
Listen, man, and it’ll come… Wait, I think I get it now. It was his improvisation, lick after lick of better times and dark days, triumph and calamity. The story of his life laid down atop the awkward chord progression we were feeding him here in the hospital.
"Clifford Brown and Sonny Rollins," he tells me. "They was cats...they was cats."
For the rest of my days on service, I carved out as much time as I could to sneak off to Mr. Johnson's room when no one was looking. We would close the door, kick back and just listen together. It was genuine. It was real. Sometimes it was two minutes, sometimes twenty. Sometimes he spoke, sometimes he didn't. But we always listened.
We never did get that rectal exam.
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