You lied to me

Here is an essay written by Cameron Page, presented with his permission. It recently won an award called the Marguerite Rush Lerner Award. This prize is given annually to a Yale graduate student in one of the health sciences.

“You lied to me.”
No one had ever said that to me in the hospital before.
“Why did you lie to me?”
Why, indeed?

I had met her the previous day, when she brought her son to Coptic Hospital in Nairobi, Kenya, where I was doing an infectious disease elective.

Her son was eight years old and HIV-positive. He had a fever and was breathing fast. Jason, the infectious disease fellow from University of Minnesota, listened to the boy’s back and looked at his X-ray. “Pneumonia,” he said.

While the son slept with an oxygen mask on, Jason spoke with the mother: “He is very sick. The first 48 hours are the toughest. It’s only after that that we can start to be optimistic.”

Jason excused himself for a meeting. I didn’t have a meeting. I sat at the foot of the sleeping boy’s bed, across from his mother, where the sheets were stamped “CH” in large faded blue letters. The mother put a thumbnail between her teeth; folded and unfolded her arms; looked at me and then away. She wore a flowery print dress with lace at the neck, as though she’d been suddenly called away from a formal ball.

“What will happen if he can survive this one?” she said to me.
“Well,” I hesitated, “it depends. He may be developing resistance to the anti-retroviral medicines, in which case we would need to switch him.”
She looked confused. “You give him new medicines?”
“Maybe. It depends on—“
“Better medicines?”
“Well, just different. He won’t be resistant to them.”
“The new medicines, they will make him healthy?” She was leaning forward now.
“Well, his viral load should drop, and hopefully his CD4 count will start to rise--“
She tossed off my jargon. “They will make him better?” Her eyes carried not just a question, but a plea.
I paused.
“Yes,” I said. “They will make him better.”

With the new medicines, I said, her son wouldn’t get sick as often. He wouldn’t need to take prophylactic antibiotics every day. I told her about other children I’d seen, just as sick as hers, who had made complete recoveries. I described their weight gain, their increased energy. How they played soccer in the playground after school, just like the other children.

Her smile was a tiny burst of joy, like the hug of a small child.

When I left, she squeezed my hand. “You are a good doctor,” she said. I brushed away the compliment. I told her I would talk to the pharmacist about the new medicines.

The boy died later that night, while I was eating dinner at a Korean barbecue restaurant.

The next morning she was waiting for me. Her face told me more than the empty bed did. Her eyes tore at me with unfocused rage, and despair.

When she called me a liar, I thought of defending myself, reminding her that she had asked me to speculate. It was her hypothetical question to which I’d responded. But I stopped before I opened my mouth, because that would have been another lie.

The truth was that I had indulged in the fantasy too. I had taken comfort in imagining her son’s long, happy life. Our bedside chat was as much for my benefit as hers.

She lectured me, yelling in my face. What about the weight gain? What about the soccer in the playground? She was firm, business-like. She wanted an accounting for every misleading statement I’d made. Rigors of anger and injustice swept across her body.

She had asked me to comfort her, and I had built that comfort from the only material I had: hope. I had done it unthinkingly, instinctively. I had not considered that hope is a shaky scaffolding, and when it collapses, the fall to earth can be long and the landing hard.

A thousand fits of rage would not bring her son back, and she seemed to realize that suddenly. Her hands dropped to her sides, and she wept.

We'd had no right to be hopeful so early. Jason had been cold, but right.

In the end, all I said to her was “I’m sorry.” I said it over and over. I was sorry for her son’s death. I was sorry that I wasn’t there when he died. I was sorry I misled her. Ultimately, I was sorry that I wasn’t a better doctor, a doctor who could understand that comfort is a double-edged sword, a sweet that can quickly turn sour.