Merry Christmas, Ed
The blood bank nurse stuck her head into my office (which is clearly a space that was formerly a closet) and said, "Joel, could you come here and look at Ed for me?"
The person in question was not dead (nor is Ed his real name), nor was he a small piece of tissue or body part. Rather, he was an elderly man, conscious, and clearly trying not to puke. Why, then, was I, pathologist-in-training, being asked to look at him?
We pathologists generally do not rub up against the patients that we serve. Occasionally we'll field an angry phone call from a patient about an overdue test result, or see an anesthetized patient's surgical opening so that the surgeon can explain what information they want before removing the organ in question. There are some pathologists who regularly see patients in order to sample their tissues, but the majority of pathologists are safely sequestered in dimly-lit offices, surrounded by books, stereo equipment, and espresso makers, calmly and quietly contemplating the Mysteries of Human Disease.
But I am on blood bank this month, and so my life is different. My pager bleeps urgently several times an hour from 7:30 a.m. to 5:00 p.m., triggered by clinicians baying for my blood (not my personal blood, though I'm sure they'd take it in a pinch). I'm summoned by clinical teams to round on patients on the ICU, and I go to patients' bedsides in order to remove their ill humors. In a lot of ways, it's disturbingly similar to my dimly-remembered former life as a medical student. I also am in charge of keeping an eye on people who come into our blood bank to donate, and that's where Ed came in.
Ed is in his late 80s, a retired professor, who comes to our blood bank as often as he is allowed in order to donate platelets. A donor is able to safely donate platelets every four weeks (as compared to eight weeks for red blood cells), and Ed usually appears exactly twenty eight days after his last donation. He donates platelets because he knows that we're always short on platelets (we have to store them at room temperature, so they only last five days [as compared to red blood cells, which are kept refrigerated for 42 days]). He also knows that we're less likely to get platelets from donors because it takes longer to donate. I have a personal stake in keeping our platelet supply healthy, because 90% of the fights I have with clinicians involve them wanting an unreasonable amount of platelets (from my point of view) and my ignoring their patients' clearly defined critical need for platelets (from their point of view).
Someone had told Ed all this, and he made a point of giving us what we most needed. Today, however, things weren't going well. He was pale, clammy, and felt nauseated. The nurse checked his blood pressure: 80/50. I pointed at the table next to his bed. "Hey Ed," I said, using my you-must-not-be-about-to-die-because-otherwise-I-wouldn't-sound-so-cheerful voice, "it looks like you gave us a little extra today." Instead of the usual unit of platelets, there was a unit of platelets and two bags of plasma. Most donors would handle the loss of 700 mililiters of fluid without trouble, but Ed had clearly given too much.
We gave him a liter of saline, and he perked up right away. My pager snarled at me, so I went back to my closet to catch up on the various arguments I was having with clinicians. A little later, the nurse appeared at my door again. "Could you have a little talk with Ed? He's almost 90 years old now, could you maybe let him know that he's done enough for us? We think he's a little too frail to keep this up."
I always do everything my nurses tell me, so I gamely sat down next to Ed's bed and, by way of broaching a painful subject, checked his pulse. "How are you feeling, now?" I asked.
He grinned at me and pointed at the I.V. the nurse was disconnecting from his arm. "Good! That stuff you gave me hit the spot."
"Well that's just salt water. What we took from you is a lot more useful. I'll trade you saline for platelets all day long."
Shaking his fist gleefully, he said, "I've got more to give. You'll see me in four weeks!"
He'd pre-empted me, now. I was hoping he'd still feel a little crappy. His enthusiasm made turning him away harder. Maybe he had a newly diagnosed heart condition or something. If so, I could make this whole thing his doctor's fault. "I was going to ask you about that. Are you regularly seeing a doctor for anything?"
He twinkled at me. "Nope! I'm the picture of health."
"And have you ever had something like this happen to you when you donated in the past?"
"Nope! I'm not sure what happened today."
I gestured at the plasma. "Well, we accidentally took a little more than you're used to."
He laughed, and pointed at the nurse. "Well quit it! I almost puked on Nurse Barb over there!"
Alright, best just to say it. Ugh, I felt terrible about the whole thing. So I weasled a little. "Ed, this is a hard question for me to ask, but do you think that maybe you should stop donating? Maybe what we had today was a warning."
He sat up a little straighter and looked me in the eye. "No, I don't agree with that. You get to be my age, well, it makes me feel really good to come here and give you people platelets. I know how much you need them, and I like to think about the good they're doing. I'd feel pretty useless if I couldn't come here and give, and when I sit down to eat, I like to think about how I'm going to be coming here to help in a few weeks, and how all the time, whether I'm thinking about it or not, I'm making more platelets for you, here."
I raised my hands, supplicating. "We certainly appreciate your gifts, and you've been so generous, I just want you to think about your own health. Maybe talk it over with your wife."
He barely let me finish, and his tone made me feel that he'd keep on saying the same thing, forever. "It makes me feel really good to come here and give, and you can count on seeing me in the new year, and I really hope for peace in the new year. I was never for this war in Iraq and I said so from the get-go..."
And we talked for a few minutes about the problems in the Middle East, and about history, and about what we hoped would happen in the future. And then he got up and, very carefully, walked out of the blood bank. Whenever he saw someone he knew on the way out he said, "See you next month!" And every person replied, "Merry Christmas, Ed!"