Fragile Warriors.

Abstract

“Well, back when I was in the service, I was real fit then.” It's with these veterans that the contrast between their previous healthy young selves and their current states is most drastic. In their 20s, these men were warriors—brawny, fierce, trained for combat. Perhaps these were the very men who protected my grandmother, a young pregnant woman fleeing south in the 1950s with other civilians on the Korean peninsula. I recall my grandmother's tales of “Yankee men” doling out cornmeal nutrition packets in Korea and of that one particular redheaded boy she found dead in the driver's seat of his tank. Now one Korean War veteran sits in the heart failure clinic, holding in his swollen hands a flimsy piece of plastic nasal tubing that connects him to his oxygen tank—quite literally, a lifeline. The dashing Yankee man my grandmother used to talk of so admiringly, ever so charismatic and indomitable in her stories, sits here now so shockingly vulnerable. More than once during my time at the veterans' hospital, I have paused and wondered how most of these men engage with me so amiably, with no hint of racism, despite having been raised well before the civil rights era. I wonder if these elderly men now see in me a native young Korean woman from their robust 20s. I hold on to my first hospitalized patient's hand as Mr. G, a Vietnam War veteran, whispers, “I'm too scared to die.” He is cachectic, his frame already the size of a prepubescent boy's, but his eyes communicate a haunting desperation that is full force. I squeeze his hand and nod. Then, perhaps a bit unjustly, as if in a convenient cliché, I see a flashback of a younger Mr. G in Vietnam, grenades flying by. Was he more or less terrified to face death, then? Was it necessarily older age, becoming dialysis dependent, or being in this acute inpatient setting that incited the fear of death in him? Frustrated with Mr. G's obstinate refusal of palliative measures, some providers imply that he is naïve—that it is time he finally confronts his qualms about death—but in sitting and nodding with him, I cannot help but think that this could hardly be Mr. G's first timid dance under the conceptual penumbra of his own death. And I get a dull nauseating ache, wanting to be with him in his fear now, wanting also to hold and comfort his 20-year-old self back then, terrified and running through the rubber trees. For physicians and their patients, the medical examination room can be a sort of confessional—where patients' most private thoughts and subconscious fears present and provide an unusually intimate window into their lives. Yet for these veterans, I suspect the horrors of war may well be their dominant reality, even as I sit with them now, beaming at the robust connection we have just achieved. That is to say, even the most-connected patient–physician interaction may represent but an ephemeral moment in the greater context of the long rich journeys they've arduously trodden up to this medical meeting. As a newly minted physician, I hope to gain insight into the various phases of adulthood through a heterogeneous group of patients. My more fundamental goal, though, is perhaps to better understand the multiple phases of a single person's life. I long to know Mr. G as the psychologically complex adolescent enlisting in the military, as the middle-aged man adjusting to postwar facade of calm, and as the dying, scared man he is now. I step out of the heated family meeting discussing Mr. G's goals of care. Representatives from the various medical and surgical specialties head out, rushed toward their next patients. During the meeting, Mr. G was referred to as “dear husband,” “our father,” “my grandpa.” He dominated the full attention and goodwill of so many highly specialized professionals. But when I swing by the room an hour later, Mr. G seems anything but exalted, bare bones beneath a thin cotton gown, in a hospital bed that is literally a full meter below anyone else's eye level. I go and sit with him a brief moment, holding his hand. He looks over at me with those sorrowful, earnestly horrified eyes, and whispers, “I'm scared.” I nod.