One Afternoon in Clinic (As Featured in ‘Pulse’)

By Miranda Haslam, M1

One doctor, four hours, fourteen patients.

Fifteen patients, if you count the one who showed up but didn’t have an appointment.

Dr. N saw him in the waiting room anyway.

He came in a wheelchair, oxygen tank in tow.

Miranda Haslam at her White Coat ceremony

He didn’t introduce the man sitting next to him in the waiting room. He didn’t need to. The similarity in their facial features left no doubt they were brothers.

The clothes he wore were a symbol of poverty.

The lines on his face told a story of hardship.

The wheelchair and oxygen tank consumed his personhood, a badge of illness.

We were already running behind in seeing patients for the day. The nurse practitioner had called in sick, and there was only one medical assistant for all three physicians in the pulmonary clinic.

When a nurse told Dr. N that the man in the wheelchair was in the waiting room, that he didn’t have an appointment, that he was requesting to see her specifically, I expected her to tell the nurse to send him away. To tell him that she was too busy. To tell him to come back when he had an appointment. I think the nurse expected that, too. But instead, Dr. N walked out of the clinic and into the waiting area without hesitation.

She crouched down by his wheelchair so she could speak to him at eye level, as if it were completely natural for her to be seeing a patient in the waiting room. Meanwhile I stood awkwardly to the side, unsure of how to approach a patient outside of the familiar boundaries of an exam room.

I learned that the man was recently discharged from the hospital for a COPD exacerbation, what I gathered was the last in a long chain of hospitalizations for COPD exacerbation. Later, I learned that he had just completed treatment for cancer, that he had an inoperable tumor. He was living in the limbo of waiting to learn if the treatment worked. With his oxygen flow on high, he was still struggling to breathe. His brother sat by his side, not saying anything. He didn’t need to. As a first-year medical student, I may not know much medicine, but as an older sister, I know the face of a concerned sibling.

The man in the wheelchair told Dr. N that it was getting harder to go to work. I was shocked. Shocked that this wheelchair-bound man with his poverty and hardship, with his oxygen tank and distraught brother, with his incurable disease and inoperable cancer, had a steady job. “I can’t do much there anymore, I pretty much just show up,” he said. It sounded like he worked in some kind of warehouse or factory, somewhere that would be hard on a body with healthy lungs. His rail thin body had been visibly weakened by the string of hospitalizations and years of steroid treatment for his COPD.

I told myself that I was not judging the patients we saw in clinic that day. I was shocked again when I discovered my own lie.

After writing him a prescription for pulmonary rehabilitation, Dr. N and I walked back into the clinic. She told me that the man’s best hope was a lung transplant. Having recently finished treatment for his cancer, he had to clear the landmark of two years cancer free before he would be a transplant candidate. She told me that she hopes he will make it the two years.

If I were the one allocating organs, I thought, I would give one to this man. The man with the brother who loves him. The man who keeps going to work, despite debilitating illness. The man who kicked cancer’s ass only to fight a losing battle with his own lungs. The man with the audacity to show up to see a doctor with whom he didn’t have an appointment because he cares that much about his own health. I told myself I wasn’t judging the patients we saw in clinic that day, yet somehow, I had decided that this man deserved new lungs.


Michael Vitez, winner of the 1997 Pulitzer Prize for Explanatory Journalism at The Philadelphia Inquirer, is the director of narrative medicine at the Lewis Katz School of Medicine at Temple University. Michael.vitez@temple.edu