My pager went off late one afternoon with a message from the oncology service at my hospital, asking me to see a 70-year-old man with metastatic cancer and trouble breathing. I wasn’t hopeful. I had chosen to train in pulmonary and critical care medicine because I wanted to be someone who saved lives. But, it turned out, there was so much sickness I couldn’t fix.
The patient had worked as a mechanic. Vague pain led to a diagnosis of colon cancer that had traveled to his liver and lungs. Now, he was short of breath and might have pneumonia. His team was asking me to arrange a procedure, called a bronchoscopy, in which we insert a small tube with a camera at the end down the throat in order to look inside the lungs and suck out a deep sample to help find out what’s going wrong.
“We’ll get him on the schedule for tomorrow,” I sighed, suspecting that nothing I did would make him better. “No food or drink after midnight.”
In the waiting area outside the procedure suite the next morning, I went through the usual consent forms. He would be asleep for the procedure, thanks to sedative drugs we would run through the intravenous line. We would make him feel pretty good, but he would remember none of it. “Just imagine a really good martini – or two or three,” I joked.
It was the first time I had noticed my patient smile. “You know, I’m more of a Guinness man myself,” he said.
I remembered the first time I drank a Guinness, when I visited Ireland in medical school, and I thought now of those lazy afternoons, chatting with strangers, cozy inside a dark pub while it rained outside. “Alright, a Guinness then,” I told him, reassuringly. “Something to look forward to when you get home.”
But days passed and he was still in that hospital room. The bronchoscopy didn’t reveal why he couldn’t breathe, as is often the case. Maybe it was pneumonia, maybe it was the spread of cancer itself or a reaction to chemotherapy, but my patient just kept getting sicker.
His doctors decided that he might be too weak to eat or drink without food or water slipping down the “wrong pipe,” into his lungs. They wrote orders to keep him from eating and drinking. When I saw him each morning, I listened dutifully to his lungs’ unchanging cacophony of wheezes and crackles, and he told me how his mouth was dry, like a desert, and I told him I was sorry.
One morning, my patient’s wife told me that he had decided against any more aggressive procedures. No more blood draws or chest X-rays or antibiotics. He was dying, and he didn’t want to die with a breathing tube in the intensive care unit. The goal had shifted to making his remaining time as comfortable as possible. I stared at the sign still hanging behind his bed, NPO (from the Latin “nil per os,” or “nothing by mouth”) in bold black letters warning his caregivers that he wasn’t allowed to eat or drink.
I told the medical student I was working with that we were going on a field trip — to the liquor store. “Won’t we get in trouble?” he asked.
I hoped not. But I had promised my patient a beer when it was all done, and that was a promise I could keep. So that afternoon, we trooped to the liquor store across the street form the hospital and bought a cold bottle of Guinness Extra Stout, which the medical student tucked inside the pocket of his short white coat. We giggled about the bulge the smuggled beverage made in his coat as we rode the elevator back up to the patient’s room.
I pulled the nurse taking care of my patient into the hall and told her we had something to show her, gesturing to my medical student waiting anxiously in the corner. He slipped the bottle out from its hiding place. “O.K. with you?” I asked the nurse. She nodded. I had given my patient’s wife a heads up earlier in the day. We were ready. “Alright,” I said. “Let’s do it.”
The hospital room was abuzz with the excitement of the illicit. We closed the curtains. My patient looked calmer, awake despite the morphine, and breathing a little more comfortably. His wife was sitting at his bedside, awaiting our arrival. My medical student pulled the brown bag out of his coat with unexpected flourish.
“I figured I’d get you that Guinness I promised,” I said. I held it up to the patient’s wife first, who nodded encouragingly, and then turned around and showed my patient. He smiled – a Guinness man after all. It was only after I struggled with the cap that I realized none of us had a bottle opener. My medical student saw me casting about, grabbed the beer and expertly flicked the bottle on the side of the table. We all laughed in surprise as drops of beer ran over the side of the bottle and onto his hands. The room smelled like a party.
We poured some of the deep brown brew into a small cup and handed it to the patient’s wife, who slowly wet her husband’s dry lips. He licked his lips and closed his eyes as he tasted the beer.
“Is that O.K.?” I asked.
My patient gave me a thumbs-up. I wished that I had known him better. “Cheers,” he said.
“Bottoms up,” I replied.
A few days later, my patient died in that room. There were no more procedures. I didn’t save his life. I thought again of that first taste of Guinness I’d had, while a medical student visiting Ireland. When you first sip a Guinness, you taste something crisp, but there’s also the bitterness of hops, and then behind the bitterness, the scent of caramel.
And now, years out of medical school, when I think about being a doctor, I think of adrenaline and a rush of decisions and that hope of saving lives. But I also think of that moment in the hospital room – love, a smuggled beverage shared around a bed, alarms silenced, curtains closed.
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