An Uncloudy Day

March 31

By Jacqui O’Kane, DO

“Hey Dr. O’Kane. Just wanted you to know that your man Mr. Parker (pseudonym) is on the med-surg floor.”

The text message from the social worker interrupted my Friday afternoon reverie, presenting me with a dilemma: Do I visit my ailing patient, or do I head home as planned?

To understand why I felt conflicted, allow me to give you some background on this patient. Mr. Parker was a 50-something-year-old man who had been dying since the day I met him over two years ago. He presented to my rural family practice as a classic “blue bloater,” his chest distended by the ravages of end-stage COPD, gasping for each breath via non-invasive ventilator. He had been in this sad state for several years, in and out of hospice care. He was in hospice because he clearly qualified, carrying a prognosis of less than six months to live due to respiratory failure. Yet he kept living—and offending others with his persistence—allegedly making lewd comments to hospice workers whenever he became hypoxic, which was often. So he got himself blacklisted from every local hospice, a badge of dishonor that he wore with pride.

Additionally, Mr. Parker had particularly poor hygiene. He was perpetually redolent of urine and dank body odor. Cockroaches scurried between the crevices of his generous abdomen. His skin was shrouded in oozing scabs, which he picked at with his long grubby fingernails. It seemed that his brother, who was his caregiver, had his hands full. At one point I called Adult Protective Services to ensure Mr. Parker’s safety. Incredibly, they determined that his living conditions were acceptable.

Mr. Parker’s mobility declined in 2022, to the extent that his brother could no longer transport him to my office. So we had monthly televisits, ostensibly for me to provide palliative care. I would refill his prescriptions and ensure he had all the medical equipment he needed. Then our conversations would turn to his personal life. He lamented his loneliness and boredom, explaining that he spent over 23 hours a day in bed with nothing to do. He told me about his daughter, who tragically died of cancer in her early 20s. His son was still living but he had distanced himself from Mr. Parker, only bringing the grandchildren to visit on rare occasions. His wife divorced him years ago. All that he had left was his brother, who was sickly himself.

Even Mr. Parker’s senses abandoned him. He relayed that cataracts were ravaging his vision, so he could no longer read. A prior COVID infection rendered him unable to taste or smell. He needed hearing aids that he couldn’t afford. His only remaining pleasure was loud music, his favorite being Southern rock. Otherwise all that he had to occupy his time was rumination on memories and regrets.

Now this poor man was in the local hospital with pneumonia, and I had a decision to make. I knew that if I didn’t visit him, no one else would. Yet being there with him would mean that I’d be exposed to his filth. I’d have to work hard to hide my disgust. And how would I extricate myself if he kept talking?

I knew what I had to do. I would never forgive myself if I let Mr. Parker languish so close to my office without ever stopping by. So I donned my mask and badge, then headed to the tiny community hospital, bracing myself for an assault on my senses. I glanced at the clear blue sky, hoping I’d make it home before dark.

When I walked into Mr. Parker’s room, I hardly recognized him, his long hair and beard obscuring most of his face. He looked at me wearily, expecting that I was just another white coat there to examine him, not realizing who I was. I announced, “Hi Mr. Parker. It’s me, Dr. O’Kane.” Immediately his grimace transformed into a grin. “Dr. O’Kane!” he exclaimed. “Please, have a seat.”

I sat at his bedside and we engaged in small talk. We discussed his health, the weather, current events. While we bantered back and forth, I felt an internal prompting to play music. Remembering that Lynyrd Skynyrd was his favorite band, I opened Spotify and shuffled Skynyrd songs. “Tuesday’s Gone” played first. He closed his eyes for a moment, murmuring the lyrics. I removed my mask and sang along, even making silly sounds to imitate the twangy guitar. We both laughed.

I asked if he had any musical requests. He listed several songs by Lynyrd Skynyrd, Allman Brothers, and George Jones. I played all of them, ultimately hunting for one Jones song with a title he couldn’t remember. While the music played, I noticed the pitiful state of Mr. Parker’s body, with bandages on his arms at failed IV sites and bruises indicating where well-meaning staff had repositioned him. A thought occurred to me: When was the last time anyone had intentionally, lovingly touched this man?

Suddenly I felt like Mother Teresa ministering to a leper. She healed by doing “small things with great love.” If I touched Mr. Parker, could that small act of compassion heal his soul, even as his body lay dying? I decided to ignore my reservations about exposing myself to the germy grime he exuded, hoping he wouldn’t make sexual comments to me like he had with others. I reached a hand over the bedrail and gently caressed his shoulder. He stared at me in disbelief. I continued singing, slowly moving my fingers down his crusty, scabbed-over arm. When I got close to his wrist, he took my hand in his and held it. Then he moved our hands to his chest, over his heart. As his heart beat steadily, he stroked my hand, reciprocating my tenderness. Tears streamed down his ruddy cheeks. We sat in silence for a while. “Thank you,” he whispered.

A nursing assistant entered the room and looked shocked to see a doctor holding hands with her patient, especially this particular patient. She checked Mr. Parker’s vitals and hurriedly exited the room. He and I chuckled at her discomfort. Then his eyes widened as he remembered the name of the song he wanted to hear. “Play ‘Uncloudy Day,’” he said.

I was taken aback. “Uncloudy Day” was the favorite song of one of my first and dearest hospice patients. I couldn’t find a version by George Jones. “Do you mean the one by Willie Nelson?” I asked. “Yes!” He cried. The same one that was my other patient’s anthem. Now tears flowed from both our eyes. We sang along as Nelson crooned:

   Oh, they tell me of a home far beyond the skies
   Oh, they tell me of a home far away
   Oh, they tell me of a home where no storm clouds rise
   Oh, they tell me of an unclouded day

That afternoon Mr. Parker and I created a home where the storm clouds of disease did not rise. Though we were in a hospital, we transported ourselves somewhere far away. Indeed, we shared a moment of humanity, unclouded by fear. Of course I took precautions, thoroughly scrubbing my hands afterward. But overall I was vulnerable. Sharing in my patient’s vulnerability enabled us both to experience a profound healing that overshadows any nostrum offered by modern medicine.

Mr. Parker died two weeks later. Although I was sorry that he lived such a short, difficult life, I felt at peace knowing that I did everything I could to help him. What an absolute privilege to have been his physician.

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