SPACE CADET | Adnan Askari
I met him in the PACU on the first day of my third year of medical school.
He looked to be in his late sixties, maybe early seventies — silver hair thinning at the temples, skin slack along the jawline, soft lines at the corners of his eyes.
He had just come out of surgery — a resection for head and neck cancer — and a fresh tracheostomy sat at the base of his neck, secured with white ties that looked too clean against the warm, red skin around them. The room smelled faintly of antiseptic and something metallic. He was awake, though not fully, and restless in a way that made the bed rails seem insufficient.
I introduced myself and opened my pre-templated H&P notebook. He tried to answer my questions, but the words had nowhere to go, air moving instead through the opening in his neck with a soft, wet sound. He gestured — impatient, urgent — and I nodded as if I understood.
Then he coughed.
It was sudden and forceful, his shoulders and chest lurching forward. Blood came up in a thin spray and landed across the page of my notebook, small red droplets soaking into the fibers between “social history” and “review of systems.” I froze for a moment, pen still in my hand, before closing the notebook. He looked at me, eyes sharp with something between anger and humiliation.
I moved on with my questions, though I wasn’t sure what to ask anymore.
***
The next morning, I tried to pre-round on him.
I asked about his pain, his medications, things I had read about in his chart the night before, reciting them in the order I had written down. The questions came out a little too uncertain.
He watched me for a moment, then reached for a piece of paper.
He began to write, gripping the pen tightly, each letter forced onto the page. When he finished, he slid the paper toward me and tapped it once with the pen.
I looked down.
I could not decipher the text. Perhaps it was the generic name of a medication, one I didn’t recognize. The letters were uneven, collapsing into one another. I tried to sound it out silently, tracing the shapes with my eyes, hoping it would resolve into something familiar.
It didn’t.
I hesitated, then asked him to repeat it.
He held my gaze for a second longer than before, then began to write again, quicker this time, the pen scratching harder against the page. He pushed the paper back toward me.
I still couldn’t understand.
Something shifted in his face. He crumpled the paper tightly and threw it — not at me, exactly, but in my direction. It landed somewhere between the bed and the wall.
For a second, neither of us moved.
Then I picked it up.
“Next time,” I said, crumpling the ball tighter in my hands, “you’ve got to aim for the trash can.”
The words came out before I could think about whether they were appropriate. I gestured toward the bin in the corner of the room, light blue plastic, half-full of gauze and wrappers.
He paused, watching me.
I tossed the paper ball gently toward the bin; it bounced off the rim and fell to the floor.
His shoulders lifted slightly, something like a breath, or maybe a laugh that couldn’t quite become one. He took another piece of paper, crumpled it with deliberate care, and threw it. It arced higher this time, landing just short.
We went back and forth like that for a minute or two, a quiet rhythm.
Eventually, he stopped and reached for the pen again.
This time, he wrote more slowly. He slid the paper toward me and waited.
Two words, clearer now.
Space cadet.
He looked up and pointed at me.
I looked up the term that afternoon. It meant someone absent-minded, not quite all there. Incompetent, maybe, but in a way that feels almost endearing. It felt fitting.
***
I continued to see him in the mornings and afternoons.
Each day, he seemed to reclaim a small piece of himself. He learned to cover the opening of his tracheostomy with a finger, redirecting air through his vocal cords. At first, it was just a breathy sound, then fragments of words, and eventually something closer to speech. By then, I had learned that understanding might come in pieces, or not at all.
Some mornings, we would crumple up stray sheets of paper and take turns aiming for the bin in the corner of the room. Other days, he wasn’t in the mood. I would ask my questions, less halting now, reaching for the H&P notebook a little less.
On his last morning in the hospital, I found him already sitting up in bed. The tray table had been cleared, pushed slightly to the side. Lined up in two neat rows were eight sheets of paper, each one carefully folded into a tight ball.
He looked at me, then at the tray, and lifted his eyebrows — an invitation.
I smiled and picked one up.
We took turns again. He was better than me now. One of his shots dropped cleanly through, and he held a finger over his tracheostomy, managing a short, breathy taunt.
Between turns, he reached for the pen. He wrote slowly, then slid the paper towards me.
Getting better.
Adnan Askari is a fourth-year medical student at the University of Chicago Pritzker School of Medicine. His career interests include narrative medicine, hematology/oncology, and healthcare disparities. He hails from Eagan, Minnesota.