University of Minnesota

“If It Isn’t Fun.” – The Night Rachel Died

Rachel was re-admitted at midnight on a Saturday night. She was considered terminal. As usual, I had the duty. It was a huge medical service for only two interns, but those were the days of teaching-hospital internships when you only got off one or two nights a month and the only pay was your health insurance premium.

I had finished evening rounds and was eating a fourth meal of the day in the staff cafeteria — the one luxury of an indentured service — when they paged me back to the ward for Rachel’s work-up. Rachel had arrived exhausted. And I was a zombie after only two hours’ sleep in the last 24.

Rachel told me right off that she had come back into the hospital to die. Thin, wan but not wasted, she was lovely, with curly black hair, alabaster skin, large black eyes, and a sweet, oh-so-sad smile. When I opened her gown at the back to auscult her chest, the diagnosis, malignant melanoma, was instantly clear. Black, fungating masses were just under the skin. I listened carefully to her lungs which then were quite clear and her heartbeat that was strong though rapid. The melanoma of her eye had been found too late for enucleation. It had spread widely and rapidly.

Rachel’s husband had left her off in the admitting room and returned home to care for their young children. Alone, she seemed to want to talk but I was too tired to respond.

“What books are you reading these days, Doctor?”

I hadn’t the heart to tell her I was reading the newly published book by Kinsey, Pomeroy, and Martin, Sexual Behavior in the Human Male, that had hit the medical world and the public like a bombshell that winter.

So I replied, “Nothing worthwhile, I fear.”

I then wrote orders for the narcotic, Dilauded gr. 1/16, that she had been getting at home, every four hours as needed for discomfort, and hooked up a glucose and saline mixture. I was annoyed that I couldn’t get the I.V. drip to run as slowly as I wanted, at 30 pulses a minute, no more, no less, as I bent the metal disk over the tube, the regulator of I.V. drip rates in those days. It haunted me as I went to my quarters that the disk seemed to have had so little tensile strength, no “oomph!” I had to fiddle with it several times, and once as I stood there, the drip completely escaped control.

The last thing I thought of at 1:15 that morning, having been up since four o’clock the previous morning, was that maybe I should call the nurse to check on Rachel’s I.V. But I was asleep before I could roll over to lift the phone.

Some time later, my phone rang insistently.

I still start when I hear a phone ring. Calls I received as a medical student, intern, resident, and then chief resident on call were associated with such stress that the ring itself has become severely aversive.

The ringing finally jangled into my clouded consciousness. Nurse Thurston said, “Come quickly, Dr. Blackburn, it’s Rachel!”

There was very little left of Rachel by the time I arrived. The nurse had found the I.V. running in an almost steady stream when she had checked it minutes before. Rachel’s lungs were full to bubbling, her eyes turned up, dull and lifeless. In moments she was gone.

She would have died in a few days at most, but she should have been able to see her husband and children one more time, perhaps to say some things she needed to say to them. At least she could have smiled that haunting, sweet, oh-so-sad smile a last time.

Back in bed, I cried myself to sleep

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