Bahamut translated means Dragon King. He was a 24-year-old who had been admitted to my service the night before. On checkout rounds I remember being impressed by the sheer multitude of pathologies that were at play in this young man’s body. The primary ailment was lymphoma – a cancer of one of the lymphatic cells of the immune system – which had spread aggressively throughout his body. He had sustained multiple rounds of chemotherapy as well as surgery for the large lymph nodes that had started to compress the vital organs in his body. One of those organ systems happened to be his kidneys, resulting in the need for dialysis. If you can imagine being strapped to a monolithic machine for three hours at a time, three times a week, watching as your lifeblood is removed, purified, and placed back into your body, you can imagine dialysis.
This young man had certainly been cast a hard lot, and my walking into his room and actually seeing him for the first time confirmed everything. Sitting back on his bed, he was a small and emaciated-appearing young African-American man, hair cut tight to his head, his face aged beyond its years and set to a slight grimace. It was hard not to feel for this young man’s plight. This particular admission had resulted from an infection that we suspected was from his dialysis access. We had hit him hard with antibiotics and were conferring with the nephrologist and vascular surgeons as to whether the access needed to come out. Our workup had only begun, and the infection could certainly have come from elsewhere, which is what we were hoping, as we really didn’t know how many more surgeries his frail body could handle.
It is so very easy to be caught up in the throes of management. I recall walking into the room and going about my usual assessment – greeting family members, talking to the patient, reviewing vitals, doing a brief physical exam, and discussing management options in that non-conclusive way that interns seem to be excellent at doing. The patient, probably weary of seeing yet another new face in the endless saga of his care, did not offer much. Everything seemed to be going well, and I had a number of patients ahead of me during rounds, so I excused myself politely the moment that I felt the internal gyroscopes within my head say, “OK, time to move on.” Just as I was leaving, I noticed a Nintendo Gameboy by his bed. Inside was a game called Metal Gear Solid: Ghost Babel. Having been brought up through med-school on a steady diet of video games, I simply remarked, “Hideo Kojima is a genius.”
Hideo Kojima is the name of the man who designed the Metal Gear Solid series of games, regarded by many as some of the best gaming experiences out there. I don’t really know why I said it. Perhaps on some level, I did want to connect with this young man who was only a few years younger than myself, but I truly can’t say. It was as if a dampened fuse had finally lit, as he took my final communique and ran with it.
“Damn straight. Tactical espionage action, Bro.” There. Finally. A smile.
(To be continued 12/21)