46. The Survivor

Cole Ferguson was 19 years old when we met. He was a frequent flyer at Brooklyn Hospital. I would see him multiple times throughout my residency years. And he was the only patient Jax and I shared.         Cole had cystic fibrosis ever since he could remember. He had grown up in downtown Brooklyn and his mother took very good care of him. He started his visits to Brooklyn Hospital when he was only 6 years old, so you can imagine that almost every person in the Hospital knew him.         I got his admission chart on a Monday morning. A 19-year-old boy with CF coming in with another respiratory infection. His last admission had been a couple of months before. I tried to quickly review his previous records before going to see him but there was simply an absurd amount of information. It was the longest chart I had ever seen. So I settled for a quick glance before heading to his room.         Before going in, I could hear a familiar laugh coming from inside the room. To my surprise, the first person I saw inside was Jax, the one laughing, sitting beside Mr. Ferguson.         ‘Oh, Lisa!’ Jax got up smiling. ‘You are in good hands, Cole, trust me.’ He winked to the sick-looking boy in the bed and excused himself to the hallway.         ‘Nice to meet you, Mr. Ferguson.’ I started. ‘I’ll be right back.’ And left behind Jax.         ‘Hey!’ I said and Jax turned to see me.         ‘What’s up, Liz?’         ‘You tell me! Do you know Mr. Ferguson?’         ‘Yeah!’ Jax said happily. ‘But don’t call him that. He prefers Cole. He was a peds patient for ages until he turned 19 last month. I can’t believe you’ll be the one seeing him! Small hospital.’         ‘So true. Any tips?’         He thought for a second. ‘Enjoy it.’ He smiled. ‘He is a great kid.’         ‘Noted. Anything else? I’ve never had a CF patient before.’         ‘Right!’ He laughed. ‘You basically have a Peds patient. His antibiotics are adequate and Cole usually responds well to therapy. I can go through some of his nuances with you later. But if you need anything before that, you can call me.’         ‘Good morning, Cole.’ I started again going back into the room. ‘Sorry about that, I am Dr. Lisa Diaz. How are you holding up?’         ‘I am okay, Dr. Diaz.’ He said in a weak voice and sat up. ‘You know, I’m used to it. I am happy to know you are friends with Jackson though.’ He smiled.         ‘Ever since we were little, would you believe it?’ I smiled back.         For the next 15 minutes, we talked about his symptoms. He started getting more shortness of breath in the week before, his cough worsened and then he spiked a fever.         ‘Just like the other times.’ He explained. ‘So I just took my sick bag and came in.’         ‘Sick bag?’         ‘Yes.’ He laughed and pointed to his backpack on the chair. ‘I keep it prepared for whenever I need to stop by the ER.’         I went to his physical. Cole was a very thin kid and had a true symphony in his lungs. Wheezes, rales, rhonchi, everything. He was tachypneic and his O2 sat was 92% with oxygen in the nasal cannula. I thanked him and left for rounds.         On the way there, I reviewed what had already been done for him in the ER. They started him on antibiotics and ordered an x-ray. He was also prescribed his usual home meds, including the pancreatic enzymes he took because CF broke his pancreas too. It’s crazy to think how a small defect in a chloride channel can make such a mess. From those thick secretions that make the lungs great for infections to significant gland dysfunction in the pancreas.         Cole was already in line for a lung transplant for years and he had a record-breaking number of hospital admissions during this time. I presented him on rounds and we made a plan to treat him as fast as we could so that he could go home soon.         I kept seeing him for the next couple of days and Jax was right. He was a great kid. He was always receptive and had an infectious energy. It was only when I met his mother that I knew who he got that from. Mrs. Ferguson was incredibly upbeat. She made Cole have fun in the Hospital, she brought him things that would make him feel at home, and she would ask me every day what was our plan for him and how soon he could be discharged.         Lucy also became friends with them. Actually everybody. There was always someone in Cole’s room when I stopped by to see him. Jax, a nurse from Peds, his respiratory therapist, even a patient-friend, which honestly I wasn’t sure it was allowed. He kept getting better and better.         Two weeks later he was all set to be discharged. His antibiotics improved his respiratory symptoms and we also supplemented fat-soluble vitamins he was lacking due to his malabsorption. I went to his room to say goodbye and found his mother singing while folding his shirts.         ‘Oh, hi Dr. Diaz.’ She said when she noticed my presence. ‘Cole is taking a shower.’         ‘That’s okay. I just came to wish him well.’         ‘Thank you so much!’ She said with a big smile. ‘For everything.’         I was turning to leave but I couldn’t help it.         ‘Mrs. Ferguson, can I ask you something?’         ‘Sure, dear.’         ‘How come you’re so joyful? I mean, Cole is a survivor. But do you ever get scared?’         ‘Scared of what?’         ‘Well, you know… that Cole…’         ‘Dies?’ She completed before me. ‘Dr. Diaz.’ She put her hand over mine. ‘Cole is my survivor. But we are all going to die someday.’ She went back to folding Cole’s shirts. ‘The only thing I’m scared of is that Cole doesn’t live until that day comes. I don’t want him to just survive.’

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AR: autosomal recessive; Chrom: chromosome; FTT: failure to thrive; Dx: diagnosis.

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