Successful Excuses

I walked into the exam room and introduced myself, “Hello, my name is Katie and I will be performing your ultrasound today.” The gentleman on the bed smiled softly and said hello. I explained the exam, and what I needed him to do and then I started. I shook the bottle of warm gel to get the liquid to the tip of the applicator and as I tried to squeeze it, the entire cap flew off and blue ultrasound gel ended up all over both of us. We both sat in shock for a few moments and then laughed nervously, apologizing profusely as I frantically tried to clean both of us up. He just chuckled and said it was truly no problem. Ugh, I was so embarrassed and annoyed. I just wanted to finish this one last patient and go home.

While I continued to apologize, he calmly and softly said “Trust me, gel is the least of my worries, I have liver cancer.” I, of course also knew he had liver cancer, I had reviewed his chart and the abdominal ultrasound I was about to perform was to track the size and location of his liver metastasis. Normally patients don’t speak so calmly about cancer, so I was taken aback just a bit. I replied, “I know, I’m so sorry.” “Don’t be,” he said, “I’ve had a really good life.” I didn’t even know this man, and yet my eyes filled with tears threatening to spill over and I felt as though I had a frog in my throat. By then I had managed to get the gel cleaned up. I grabbed another bottle from the warmer, double-checked to make sure the lid was on tightly, and I started again, this time we both laughed a little when, thankfully, the cap did not fly off.

I began the exam, taking sweeps of his abdomen as if it were second nature, saving pictures and measuring lesions as if it were any typical exam. Of course, it was not a typical exam, this man was dying. There was nothing more the doctors could do for him, except to make him comfortable and attempt to manage his pain. This time could be spent with loved ones instead of me, a stranger, here to push on him and cause him more pain, but he was voluntarily part of a research study, all I could do was hope it would help someone in the future.

I continued my protocol, and he began to ask me questions, not about what I was seeing. He wasn’t worried about making silly jokes or trying to get me to give him a diagnosis as most other patients do. I had my canned response ready “I’m sorry, I can not give results. The images will be read by the Radiologist and then the results will be sent to the ordering doctor and they will be the one to give you the results.” This is usually met with, “Oh, right. You’re just the picture taker, you don’t know what you’re looking at.” Which was of course an infuriating and insulting comment. Of course I know what I’m looking at, this is what I went to school for. I had to learn anatomy and physiology. I have to know what normal and abnormal looks like so I can “take the picture” so the doctor sees it. I am quite literally the eyes for the doctor. If I miss it, the doctor will miss it. I have too often been the first to know of someone’s cancer, of someone’s baby who no longer has a heartbeat, someone’s blood clot, someone’s ectopic pregnancy threatening to rupture and cause internal bleeding, someone’s abdominal aortic aneurysm sitting in their abdomen like a ticking time bomb. I see these awful things, I know these horrible truths before the patient does, before even their doctor does, and I see these things while keeping my poker face, unable to give away the good or bad I am seeing. He began to ask me questions, personal questions, which I was not ready for.

His questions were not inappropriate, just atypical to most patient questions. Most patients, if they are nervous, will ask if you’re married, do you have kids, did you have to go to school for this, do you just love your job since it looks so easy. These were not his questions. He asked me questions which I actually paused and thought about. He asked me what made me want to become a Sonographer. I was first shocked because no one except other Sonographers call a Sonographer a Sonographer. I let out a small laugh, and then answered his question with a question. “Do you want the truth or do you want the answer I give in job interviews.” “The truth of course, I’m not looking to hire you, you’re already here.” I laughed again, almost forgetting that I was still measuring cancerous lesions all over his abdomen, and I told him the truth. “I was working for an industrial construction company, and was bored out of mind. I fell into that job when my sister called me one day asking if I could help out and do admin work for a project that was going to be working seven 12’s for six weeks. I said sure, and then I worked there for five years. It was supposed to be temporary, but it was easy work and paid okay so I just never left. But I was bored, single, and didn’t really know what I wanted to do when I grew up. I was in my twenties, and liked that I could do what I wanted and when. But, I was still bored. My mom, who works in healthcare and had been pre-med, had become interested in becoming a Sonographer. She couldn’t make it to the information session at the school, and I told her I would go in her place. I went and I thought it looked interesting, it would be challenging, and I could actually stretch my brain, plus it paid well. So I started doing the prerequisites. I became a Sonographer, my mom chose not to. So in a way, I sort of stepped into someone else’s path.” He thought about this for a moment, “So, do you enjoy your job, or do you feel like you are living someone else’s life?” “No, I love my job”, I blurted. “I do really love it. It’s like solving a puzzle with each patient. I’m proud of what I do, I do help people, even though I usually don’t get to see what happens to people. They leave the exam, I know their results and then I never see them again. That part is frustrating, I feel like I never have any closure.” “I can see how that might be frustrating,” he said as he looked down. “You know what is going to happen to me, you have closure there.” I nodded as my eyes filled with tears again. “That is the worst part of my job,” I said clearing the growing lump in my throat. “I just wonder if this is what I was put here for? I have all of these different ideas, from inventions to starting a non-profit, and I feel like I just don’t know where to start, and if I put a lot of money into something and it fails, my family would be worse off then if I just stayed doing this.” He looked concerned, like a dad would, but I didn’t even know if he had children, he seemed to be keeping the conversation away from himself as much as possible. “What if your invention helps people? What if your non-profit saves someone?” he asked. “I suppose it’s possible”, I replied. My daughter had a stroke at birth and my mom is losing her vision. I want to start foundations or non-profits for both of them. I have ideas for inventions to make parent’s lives easier, I guess I’m just scared. I’m scared of failing, I guess I’m also a little scared of succeeding also.” He nodded knowingly, glancing at the top of my machine where my journal was resting. “Is that where you write down all of your ideas? In your little black book? I used to have a little black book (chuckling), but it wasn’t for my grand ideas.” I laughed, “Yes, I have to write everything down or I will forget. I use it for everything from grocery lists, and things to do, to my grand life-changing ideas!”

The exam was over. I had taken all of the images and measurements I needed. I cleaned up the gel for a second time and then we just smiled at each other for just a moment. I excused myself so he could finish cleaning up. I went to my workstation. Tears threatening to brim over. I felt horrible that this man was going to die. I didn’t even know this man, and yet I had confessed to him my fear of failure and success, I had not confessed that to anyone, not even my husband. I told a stranger that I was scared of failing, when he was dying. My fear seemed so trivial now in comparison. I took a deep breath, and returned to the room. He was waiting patiently with the blanket pulled up to his chest and his hands neatly folded on top. Transport came in just behind me, as he was wheeled away, he reached for my hand, “Katie, I hope you find something that helps you lose your fear. I know you will be great.” My words caught in my throat, and I just smiled and nodded. I squeezed his hand and then he was wheeled away.

His words repeated over and over in my head “I hope you find something, I hope you find something” as I cleaned up and restocked the room. He was a sweet man. I looked at the clock, a heavy sigh of relief relaxed my shoulders for the first time that day, it was time to go home. Time to go see my family. I reached for my journal, chuckling to myself as I recalled his little black book comment. I stopped, noticing my journal was thicker, bulging in fact. I removed the elastic band that keeps it all together, and there was an envelope stuffed inside. There was a note on the next blank page in my journal, “Katie, you already have what you are looking for, now you don’t have any more excuses. Take a chance on of one of your ideas. Do it for yourself, the success will follow.” My hands were shaking in nervous anticipation as I opened the envelope. The strength in my legs could no longer hold me as I collapsed in disbelief, I was staring at $20,000. I had to count it three times before I could pull myself up off the floor. Even then, I could barely gather the strength necessary to move my body, I crawled, trembling, to the counter for something sturdy to hold onto. It didn’t seem real. Was it real? Was he real? This has to be a dream, right? What do I do now? I hugged my little black book to my chest and I let the tears that had threatened to drench my face so many times already that day, to finally be freed. No more excuses.