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My monthly obligation, a burden with no renumeration other than a vicarious pleasure in suffering others the effort of my thought, ideally should relate, at least obliquely, to food, or education of some sort, or self-improvement even. Sadly, this month falls far short of that. Perhaps it’s the product of the book I’m re-reading for my book club. At any rate, for what it’s worth, I’ll put it out there with everything else. I called it “Mr. Hayden.” And, yes, I changed the name.

Mr. Hayden

After 25 years of seeing patients, there are those who’ve left an indelible imprint in my memory, as familiar as an old photo in a frame hanging in the hallway that you pass by every day. This is one of those.

In the third week of my internship I met Mr. Hayden when my team switched from the GI surgery service to the vascular service at the VA hospital. He was in his sixties at the time, a veteran of the Korean War. His hair was iron grey and cut close to the scalp, more of a stubble, as though he shaved his head but had neglected it while in the hospital. He reminded me of Anthony Hopkins in Silence of the Lambs, or I should say that Hopkins reminded me of him because the movie hadn’t been made yet.

Pale blue eyes and a square face that seemed to crack in half with a smile were further complimented by an offset nose that had been broken several times and a scar running from below the left eye down to the side of his mouth, almost parallel to the nasal-labial fold. When I pulled open his hospital gown to auscultate his lungs early that morning before rounds I saw a curious red and black tattoo over the left breast with two crossed swords and a shield with the initials “A.B.” in the center of it; there was a faded scroll below with words I couldn’t make out in the dim bedside light. I didn’t ask him about it because it struck me as somehow ominous, and besides, I couldn’t understand Mr. Hayden. He had a neurological condition that wasn’t specified in the charts that were at the nurse’s station (charts 11 of 12, and 12 of 12). He could say only simple words in drawn out monosyllables, mouth stretched wide with the effort of speech; and he moved his arms in a reptilian fashion next to his face as he talked, trying to form the words with his hands, and even that was laborious, as though he moved through an invisible medium of thick molasses.

Mr. Hayden was what we called a frequent flier. He was in about as much as he was out. His most frequent problem was severe venous stasis disease, a vascular problem from impaired return of the blood from the legs back to the heart. He had chronic ulcers on both legs that would heal up, then he would be discharged, wouldn’t comply with the treatment plan, and end up back in the hospital, often with infections and other related complications.

His body was a proving ground for interns and medical students because of his frequent visits and needs. I did my first central line on Mr. Hayden, my first skin graft, my fist unna-boot. Some other lucky resident got to fix a right inguinal hernia and I remember checking to see if I could find one on the other side for me to fix. “That’s alright, Mr. Hayden,” I said as I helped him stand at the side of the bed on swollen legs, “just turn your head and cough.” I didn’t find one.

My chief that year was Joe Long. He rolled in every morning at 6:30 with a 32oz Big Gulp Coke, and me, two other residents, and three medical students would take him on rounds. We had already written all the notes and collected all the a.m. labs and x-ray results. As we stood outside of Mr. Hayden’s room, Joe asked, “Who saw Mr. Hayden?”

“I saw him, Joe.”

“Did you like his tat?”

“A.B.?…not sure what to make of it; wouldn’t say I liked it though.”

“Stands for Aryan Brotherhood.”

“Oh,” I said, feeling stupid.

“Yeah. Seems that Mr. Hayden got into a knife fight while stationed overseas and when the anesthetist put him to sleep he didn’t realize that the oxygen tank was empty…six minutes of anoxia. When Mr. Hayden woke up, he was the way you see him now.”

“Hmm…” I nodded, “I’m guessing the anesthetist was not a member of the A. B.”

Five years of my life race by. I’m standing at the foot of Mr. Hayden’s bed. He’s recovering from a Carotid Endarterectomy I did on the right side. It’s my last day on the Vascular Service. I’m moving to the University Hospital for my final four months.

“Good bye, Mr. Hayden.” I said, “You’ve always been a good patient, and taught me much. Thank you.”

“Goh….Baaaah…”he said, with splayed fingers, palm out, straining at the side of his mouth.