Feeling Well

It’s peaceful out here,

sitting at a picnic table,

the breeze over the water lifting my hair.

 

It’s quiet out here,

children’s voices as they play on a sandy beach,

flapping of grasshopper wings,

ducks honking at each other as they swim.

A dragonfly lands on my shoulder, and starts to walk up to my face

until I gently tap him away.

 

It’s joyful out here,

a father takes his son out in a canoe to fish, they wave and say hi,

continue on their way.

 

It’s pleasant out here,

waiting for my daughter to finish her day at pony camp,

sitting in sunshine with nothing to do but read and write.

 

Physician wellbeing, something we search for,

something so intangible much of the time.

Yet here it is:

I worked until midnight, went to bed around 1, up at 6 with my kids

and working again at 4

 – but I am sitting in peace by water and wind.

 

Wellness is this;

taking a moment,

a few stolen hours between responsibilities,

to do what makes one happy.

 

My summer feels as if a thief caught it by the tail

and yanked it out from under me.

Running, the burglar trails happiness away

and laughs when I reach out for it.

Sometimes, we have to steal back what is taken.

These brief minutes are just that;

leaning out further to snatch what seems gone.

 

Magic

Tonight we watched the space station fly over our house, with a sliver of yellow new moon shining nearby.  Wide-eyed the children listened to me describe the astronauts living inside, looking down at us from up high.  The wonder, the innocence of being so little and not knowing at all what the grown up next to you is telling you; imagining a reality you can’t even begin to perceive – it’s magical.

When I was a child, I believed in magic.  I trusted bees not to sting, carried ladybugs on my palms, sheltered worms in mud filled tupperwares in the backyard.  I thought the world moved around me, that somehow all was good and right.  When kids began to tease me at day camp and suddenly my world wasn’t safe and perfect, I still truly believed that if I was just nice, and kind, the boys wouldn’t push me off my bike at speed on the street.  If I was sweet, they wouldn’t hold my head under water at the pool until the lifeguard whistled.  If I asked them to stop, they wouldn’t spit on me or chase me down the street till I fell.

As I grew up those boys faded away; at eighteen I left for university and forgot them, left them behind.  They weren’t important, they were shadows in the past of a childhood that was light and air and sunshine around the corners of their nastiness.  I was a happy, free, innocent and playful kid with lots of other friends, so as I grew up the bullies occupied only the tiniest part of my memories.

But I never forgot their names.  Three, in particular, still sit at the tip of my tongue.  K., R., and J. were the meanest of the mean back then in those sun filled sticky summers, and every now and then I did wonder where they went.  Did they grow up good?  Did they end up in jail?  Who did they hurt after me?  Did they regret being the bullies they were?

Today, I learned what happened to one of them.

My day was somewhat remarkable at work; early in the day I encountered an old teacher of mine, from grade school.  A lovely lady, poised and elegant, always pleasant and warm in my memories, she accompanied her elderly husband for a relatively benign reason, to my emergency department.  Seeing them was a rose, a sweet moment in my day, lighting my morning with joy.

In the afternoon, a punch to the gut when I saw his name on the next chart to be seen.  No way, it can’t be, but I knew with a glance at his birthdate that it was.  The bully of my childhood, now a man, a troubled one, waiting to be assessed in the psychiatry back hallway.  He had been suffering for years with a psychiatric disorder, at times aggressive, at times psychotic; his disease made sense to the little girl inside me who suffered from blows and knocks off her bike.  A bad boy grew into a man with a mental illness; how long was his illness undiagnosed?  Was he sick when we were young? Is that why?

 

Prepared for anything I did what I always do when I go into the psych rooms: I removed my stethoscope from around my neck and placed it in a pocket, hid my pens in back pockets or underneath clothing, took all the precautions not to be injured by an errant patient.  My stomach in knots, doing back flips of nausea from recollections of pain, I pushed it all away and went to face my patient.

 

“Hi sir, my name is Dr. A., can we sit over here and talk about why you’re here?”

Calmly and quietly he joined me, meek, eyes cast downward, he spoke softly.

“I don’t feel right.  My heart feels weak.”

Slowly I drew out of him the story, learned he has been unstable, not well, needing help.

Stethoscope out, I touched my patient, one warm hand on his shoulder as I heard for the first time the beating of his heart.  The same heart, that beat when his fists hit me, so many years ago.  The same heart, that carried him from a troubled childhood to an even worse future.  A strong heart, a beautifully beating musical heart giving life to this tormented, beaten down, sad man seated with his health in my hands.  His heart knocked the breath from my own chest, and I planted my feet solidly so not to fall.

 

The magic of my childhood felt palpable in my fingers; the silvery string of time and fate shimmering between us as we spoke.

 

I wish I could feel like he deserves this life.

I wish I could feel vindicated.

I tried to feel like “karma’s a bitch”, I even said it to myself, but I couldn’t feel it.  I don’t feel it.

No one deserves to live a tortured life.  Mental illness, untreated likely in childhood, now eating him up inside – how devastating.

 

I walked out of that hallway feeling quite empty.  His sadness like acid in my mouth, his loneliness like stones in my belly.

So now I know where he went, when he dissolved to shadows in my frame of existence.  But knowing, and knowing what I know as a physician, only makes the memories even more sorrowful.  I wonder if anyone knew, when he was young, and if anyone could have helped.  It’s all speculation, hidden in the fabric of time, and I’ll never know.

 

Looking at the cosmos tonight with my children, watching their eyes sparkle in the moonlight, hearing their laughs and feeling the music of their souls, I made peace with that little boy in the past.  He sleeps quietly in my mind, and I pray for the same quiet in his all grown up soul, tonight and always.  If magic exists, I hope my hand on his arm passed some of it inside to heal him, in ways no medicine ever could.

Mortality

“Every time I see you, I feel like I’m lost, wandering around aimlessly” says the young, fresh faced new resident as we bump into each other for the umpteenth time on this night shift.

He is lost in this place, and I am lost as well.

Lost, because this year, for the first time, I feel old.

I turned forty, and suddenly mortality hit me in the gut like a linebacker on a football field. The sucker punch of age left me reeling, unable to catch my breath.

When I teach students these days I realize they could be my children. I am that old.

When I brush my hair, a thread of silver peeks out, laughing, from the most obvious part of my scalp, laying itself firmly in the sunshine for all to glimpse.

My hands, my face, showing weather and sun and the years of my life passing like the river that surrounds my city. The years pull away from me, stretched out behind like the shadow my son likes to make on the wall with my phone light at bedtime.  I play with my children and have to push myself back up to stand, partly due to obesity but also due to my old lady self.

Forty, I feel old, I feel sad, I see time speeding up and away and I don’t know how to slow it. And suddenly, this year, I no longer feel secure in what I always believed – that the end is comforting, present, that when we die our souls look down on family and friends and stay close. Out of nowhere I have started to doubt that anything truly exists when we die. Will the end just really be an end?

I watch his young back and unlined face as he strolls away down the hall, and I wish him many more years of youth and innocence and dark hair. I wish him joy and excitement and the wonder of discovery.
And I wish myself peace, as I kiss my own youth goodbye.

—————

Working a full moon night shift in a large academic tertiary care emergency department is an adventure.  The full moon brings out the worst in people, the crazy, the anxious, the sad. And those people bring all that to the EDs in cities across the continent, where people like me have to help them come to terms with and deal with what the moon brought out. Well, not the moon really, but that’s how it feels.

Doing what I do, I am confronted by mortality – my patients’ – but also my own – every shift.

Tonight, teaching young residents, I felt old. So old. I visited the darkness of age in my mind. Then a few minutes after composing an ode to my own angst while taking a bathroom break, I reassessed an older lady I have met multiple times in the ED. She, a strange cat, but kind, told me that every time she sees me here I grow better looking and get younger. Suddenly, my hair felt full, my face clear of wrinkles, my steps a bit lighter. In her own bizarre but sweet way of self she gave me a gift. Mortality moved further from me and quieted its steps on my soul.

Ruthlessly however the spectre returned later in the long night, when a psychotic, angry, awful man began screaming obscenities at me from his locked room. As he called me unrepeatable names and told me to get on a treadmill, I forced myself to type my notes and keep my cool.

When he yelled “I’ll remember your face”, and threatened to harm me, the knot in my gut twisted. Fear returned, took hold, solidly placed its’ teeth in my belly. This man and many like him walk our streets. We don’t know who they are. Tomorrow, he could be next to me in a cafe, or behind me on the street.  Him, or someone like him. Maybe he will remember my face, maybe he will just see a woman and want to hurt her. This man, and others like him, are the reason I fear. And I see them, every day. They come to me, where I work, and they demand to be acknowledged. Maybe they are sick, maybe they are just mean, maybe they should be in prison. But I, and those like me, must treat them with respect, kindness, like any patient who comes through the door. So I do, and I pay the price by hearing his abuse echo in my ears. I carry a “screamer” on my ID tag, an alarm that emits a high decibel siren if I pull it; it’s sad to think I as a doctor feel at risk enough to carry such a device. But just last week, a health care worker in my department was attacked in a horrific way, out of nowhere. So I take no chances.

Mortality. Death. I know it, I walk with it. I recognize it. I fear it.

Delightful

When you tell me your story I often resist making you stop.

I hold myself back from truncating your words.  I stand by you or sit on the bed and I listen, as you say so much and yet so little.

Usually I get only a hint of what I need to know, as your physician, to heal your wounds (the physical ones).  But through your narrative I learn you; what drives you, how you think, where you come from, why you are really here.

If I stay silent long enough you will tell me of your uncle who died last year of brain cancer, and now I have a better idea of why you are here in my emerg at 4 a.m. with a mild headache.

Though I may stay with you longer than perhaps I should, for the sake of efficiency, I don’t sacrifice these moments because I am truly delighted to be someone you can trust, to tell me your story.

I will take your words and write them down, first in your chart and then in my heart, as I learn what it is to have fear.

 

Written at a wellness conference for Canadian women physicians.

Home

Home is the heartbeat of my patient as they roll off the ambulance; rapid, pressured like the speech of the lady in the psych back hallway.

Home is chaos, a tumult of sea-salt smelling air rushing off the ocean as we arrive at the coast.

Home is warmth, a hot chocolate after a long ski day when the kids’ cheeks are apples and my hands are frozen meat.

Home is delicious, spicy, sweet all at once like moroccan salmon cooked by my husband after a long shift, the taste of my son’s cheek in bed in the morning.

Home smells like my daughter’s breath as she sings pop songs off key with such joy and lack of self-consciousness.

Home is pinks, oranges, greens of orchids and lettuce we planted last night, watermelon fresh cut dripping sticky juice on just washed counter.

Home is all of it, and when I stick out my tongue in the backyard to catch snow with my children, home is the hearts we have woven together that I can hear beating in the quiet of night bringing peace to my mind and joy to my heart.

Home is knowing, just knowing, that all is safe and right.

 

Written at a wellness conference for Canadian women physicians.

Sunshine and truth

I want to write.  It’s a sunny day and the world is bright, there are kids cheering at a school across the street, the sidewalks are filled with people dressed like spring and with a spring in their steps.  I have the day off, which doesn’t happen very much lately, and so far I’ve used it to my advantage.  This morning I woke up at 6 as usual, with my cozy, sweet smelling four year old boy snuggling me and his dad still quietly sleeping nearby.  My beautiful, growing, pre-tween nine year old girl joined us a few minutes later, and the peace and joy in my heart almost made my inner balloon burst.  Lots of hugs and kisses and laughter later, with some loss of temper sprinkled in as per usual, the kids were fed, dressed, hair and teeth brushed, shoes on and out the door with their dad to start their days at school and daycare.  After waving goodbye, I closed the door softly on the chaos and fled back upstairs to my still warm, undemanding, restful bed.

 

A nap, then a cleansing, thought filled shower carried me to a lunch date with a best friend.  Lunch with a friend is underrated in the technological hullabaloo of this world; many of us have forgotten the quick ease of conversation and the value of a venting session with someone who knows us well.  I have not neglected the worth of good friends.  Though my life is packed and full, I make time like this in order to make space for calm in my soul.

 

Now here I sit, giving myself the gift of sunshine and a clear mind.  When I write, I open myself.  I reflect, I build rooms in my memory that get filled with words, accessible for a lifetime or more.  I take the stories around me and translate them from biochemical connections in my brain into tangible things that I can share.

 

For instance, today is a good time to digest the story of a young woman I met recently, who is not unlike many women I meet in the Emergency Department.  She came to see a physician because in her 6th week of a very wanted pregnancy, after years of trying, she was bleeding.  The evening before, she had first presented to the hospital, and after an initial evaluation she was asked to return in the morning for a pelvic ultrasound.  Therefore, when I met her it was in the context of giving results.

 

In these moments, I often reflect before and after the visit, on the fact that the power I wield as a physician is astounding.  And not necessarily in a good way.  I can walk into a room, and change someone’s life profoundly.  When I entered this woman’s room, we had never met.  I was a stranger with all the knowledge and the answers; she was an anxious woman waiting for what would prove to be a harsh sentence.  I stepped into her world and ruined her life, shattered her dreams, brought tears and bitterness with my words.  Her pregnancy was an ectopic; the egg and sperm had joined in unity and created the spark of a new life, but that potential new baby had settled outside the uterus and alongside an ovary.  By getting lost in this way, the collection of cells though formed into a gestational sac and beginning to divide into a new world, would not have a chance to continue it’s growth.  An ectopic pregnancy if left to develop, could very possibly result in the death of both fetus and mother.  It is a leading cause of death in women in the first trimester of pregnancy, as it can cause rupture of the pelvic organs and massive bleeding.  Therefore, when I opened the door to her room, I closed the door on her dreams.

 

The responsibility I carry as a physician is not lost on me; every day I feel this acutely.  It is at once a burden on my soul and a blessing; I help, I heal, but I hurt as well.  However, I find myself often having to remind my heart that I am not the cause of a patient’s illness.  I am not the reason this cluster of sperm and egg took a wrong turn.  I did not choose to harm.  I am the messenger, and one whose face she may remember forever for the truth I had to tell.

 

So, writing out her story, I find my way to forgiveness.  I learn about why I feel so tired, so drained, when I finish a day at work.  I remind myself that the power I hold is not to be considered lightly.  I reflect and find insight, and I heal myself.

 

The sunshine outside shines too on my patient; I hope she finds her own way to heal, and to forgive herself and her body for the mistake she had no power to fix, and medicine had no power to change.

Burnout

There’s always so much to write about, and there’s never any time.  I work too much; it’s become evident recently that I need to cut down.  I have started noticing that things affect me much more than they ever did; there are days I hide my tears, and days I show my tears, when before the tears would have waited for the occasional (yes, occasional) shower.  This is a function of my level of exhaustion; if I were to plot it out on a bar graph like the kind my daughter is learning to understand in third grade, the intersection between the extremes of “time at work” on the x axis and “lack of me time” on the y axis would be the way I feel right now.  Burnt out.

 

Burnout: a small word we use a lot recently, to describe a very complex situation.  Physicians (and I can only speak for this category of person as I am one) are suffering.  Many of us won’t mention it, won’t give it breath to solidify itself in our lives.  If we say it, we make it real, when it’s often easier to just push it away and deny it’s existence.  Burnout.  There, I said it again.  To be honest, I’m not always sure this is where I am; but I’d like to learn how to prevent getting there.

 

Physician wellbeing is another catchphrase, like “wellness”, that is getting a lot of air time these days in conversation and at conferences.  This is something I can hang my hat on, that I want to be a part of.  In my little corner of existence I am going to step up and start working on improving my, and my colleagues’, wellbeing.  How?  Well, I have plenty of ideas.  Whether I can bring them to fruition is a good question, but I’m ready to try.

 

How can you help?  Can you help?  Can anyone?  I think so.  Here’s an idea.

Next time you’re in the emergency department, or your family doctor’s office, or visiting a specialist in clinic, try to think about how hard those individuals are working for your benefit.

Put yourselves in our shoes, for a moment, and see through our eyes.  See the way we have to hide our own emotions in order to help you get through yours.  See how we stay late to take care of your children, while our own children miss us at home.  See the glassy look in our eyes when we try not to cry as we tell your mom she will die within the year of a cancer we discovered by accident when we did a CT scan for kidney stones.  Look at my hands clasped tight, white, before me as I break the news that your brother did not make it after I worked for hours to the best of my ability, to save his life.

Look at all of us, stretched far beyond what we ever thought we signed up for, in a system where more and more sick people come to our door but we can’t hire more physicians to help see all of you faster.  When you have waited six hours and it’s 4 AM, and I finally walk into the room with an exhausted look on my face and a droop in my shoulders, but I put on a smile and say “hi, I’m Dr. A., how can I help you today” – please don’t crush me with your anger and your frustration.  Please understand we do our best and work our hardest to navigate fear, exhaustion, panic, sorrow; that we search to balance these with moments of joy at a new pregnancy diagnosis, or a hard fought save in the resuscitation room.  We try so hard to give you good news, or break the bad news with empathy; to see you faster, more efficiently, without skimping on the care we give to each of you.

Please, look at me and see my heart, see my humanity, treat me as you would like me to treat you, with kindness.  Just because I am a doctor, wearing scrubs and a stethoscope and a messy ponytail with pens sticking out from all pockets and phones ringing every few minutes, just because of this garb I put on when I come to work, don’t decide I am any less of a person than you.  I feel what you feel.  I hurt as you hurt.  I bring your stories and your pain home and I feel it over and over with you as you lie in the stretcher where I left you, and feel it yourself.  We feel this together.  You are not alone.  But when I go home, I am alone; no one knows your stories, no one sees the tears you cried when I told you the awful things I had to tell you.  Those moments we had together, that changed your life, don’t think they haven’t changed mine.  They have.  I am changed, by you, and you by me.  And it hurts.

 

So please, be kind to your doctor.  We need it.  We need kindness, and compassion.  From you, from each other, from ourselves.  Help us heal, the way we try to heal you.

The monster inside

I met such a brave woman the other day, and a brave family.

Fully aware of her disease, my patient told me calmly of the death sentence handed down to her by a higher court than human justice. Nothing just about it, this too young woman had not one but many ways to die all sitting and waiting within her like bombs ticking relentlessly.

She had come to the Emerg that day for a new pain, a different pain from her every day suffering. After clearly telling me that she no longer wished any extraordinary measures, including resuscitation or surgery, she allowed that she would like to know the diagnosis for this new agony. I treated her pain with analgesics, and ordered a scan.

The images were astounding. My lovely, sick, profound patient had a monster inside of her. A creature already known to be laying in wait, it had now grown into a true threat putting my patient’s life in imminent danger.

I came back into the room, met by my patient and her wife, who wanted to take her home to die in her own bed. In the most compassionate yet direct way, I explained what I had seen on the scan. I told them the story of her impending demise. I illustrated in colour the beast she was facing, because to do anything less, to hide the truth, would have been cruel and the wrong thing to do for this family.

I can barely express in words the way I, as a doctor and as a person, feel, when having to break bad news to patients and their families. To look good people in the eyes and tell them they are soon going to be separated from each other in the most permanent way, is heartrending. To explicitly tell a patient that he or she will die very soon, is harder than one can imagine.

And this death. This death would be agony. Of the four bombs set to detonate in this woman’s body, the growing goblin on the scan would certainly be the most painful and frightening way to go, for both the patient and her family.

I explained this. In quiet words, simple, straightforward. I asked, do you want to stay here, where we can make you comfortable, take away your pain as you pass? I told them I would leave the room and give them time to decide as a family. I involved the palliative care team to assist. By an hour later, the decision was made to allow the family and the patient to go home, armed with medications to take when the pain will become too much to bear.

Saying goodbye to my brave, kind, doomed patient with the grizzly bear in her belly tore my heart out. They thanked me for coming back in the room. I almost hadn’t, I had almost let them leave without going to say goodbye. But I couldn’t. This woman, her family and her story touched me, and I needed to look once more in their eyes. I knew I would never forgive myself if I didn’t say goodbye before she died. I needed to close the door that I had opened in my heart. But how do you do that? How do you express to a person you just met, that you’re heartbroken that they will very shortly die? How can such a strong connection be formed in such a short timeframe, within one encounter in a busy emergency department? Well, those bonds form and break every day in my world. I am grateful for this, because it teaches me humanity and grounds me on this earth. It makes me appreciate health and my family’s health. My patients’ suffering and deaths make my life somehow so much more worth living, if that makes any sense. Their pain and loss opens my eyes to appreciate the state of comfort and joy I experience in my own life.

So I said goodbye, I put my hand on her arm, I looked her in the eyes, and I wished her the best. And then they left, and I left, and our lives will never be the same.

Rest Day

Today I get to sit in a café and write for an hour.

Yesterday I sat at my desk in the ED and wrote for hours, but in a very different way.

I get asked a lot why I don’t take advantage of the ease of using a scribe when I work.  Scribes in the ED are young men and women who are interested in medicine, who are trained and paid to follow an emerg doc around with a COW (computer on wheels) and type the notes for the physician.  In this way the doctor saves a lot of time that would otherwise be spent dictating or typing notes into the medical record. While many of my colleagues (in fact the majority) at my emerg use scribes and thus leave relatively quickly at the end of their shifts, I often find myself sitting at my desk for two hours after the clinical work ends.

Why?  Because, as you can see, I love to write.

My notes, like this blog, tell stories.  They open a window into the life and ills of each patient I see.  Though I write them in point form, and as concisely as possible, I still manage to convey so much in them that I could never trust a scribe to do for me.  By writing my own notes, I allow myself the space to storytell all day long.  It soothes me, calms my mind, and helps me consider all the possibilities regarding diagnosis and management of each case.  Writing makes my physician vision clear; I can see through my fingertips.  It also helps me process, as you will see now.

 

Yesterday was my third day in a row in the acute area of our emergency department.  This time of year is full of flu, flu and more flu, punctuated by pneumonia and cardiac disease.  The place is so full and so busy one can hardly sit for a moment, and I think maybe I got to pee once in the ten hours I spent there each shift.  The days blend into each other, and the algorithms of medicine kick in so that each case is managed pretty much by rote.  But sometimes, the day is broken up by the purple resus light over every room, which flashes when an extremely ill patient has arrives in our resuscitation area.  This light beckons the physician, calls to me, tells me to hurry my little feet over to a room where I may truly save a life – or lose one.

 

“Code blue, resus 5”; I hear the call overhead and drop everything and go.  Purple lights galore as I rush into the room, and find a nurse doing CPR on an unresponsive patient.  I stop, breathe, and ask whose patient this is.  Turns out she is admitted to the medicine service, and it’s my colleague’s name on her case as the responsible ED physician.  But neither he nor I know this patient, as she has been under the care of another team for the whole day.  Never mind, we jump in together to try and save her, until we are told that the family and patient had decided on a do not resuscitate order.  We step back, stop compressions, and watch the monitor to see if she will recover.  Her heart tries feebly to pump under the probe of the ultrasound we place on her chest, but no pulse can be felt and the heart gradually slows to a place where it will soon stop.  We take the mask off, fold her hands over her belly, cover her body with a blanket and prepare to let the family know that she will not recover from this.

 

My phone rings, and my husband tells me he and my daughter are outside the emerg with hot soup and lunch for me.

 

I take a last look at the scene before me, the peaceful body of the life we did not save, and I step out into the clamour of triage.  Washing my hands multiple times I leave the chaos for a moment.  Outside the emergency the air is cold, so much colder than when I arrived hours ago, with a chill arctic wind blowing snow in my face.  Suddenly I see the sweet faces of my man and my little girl, and I practically dive into the back seat of the car and shove my face into her warm waiting arms.  Happily surprised, she folds me in and caresses my hair as I kiss her face over and over, bury my not quite there yet tears in her hair and smell her fresh clean healthy little person smell.  Smiling and giggling she hands me my lunch, I kiss her again with such love and thank my husband for coming and giving me this moment, this gift, in my otherwise turbulent day.  I step back, close the door, watch them drive away and remember how cold the air is when I breathe.  I breathe deeper until my lungs ache, cleansing themselves of the death I could not prevent, and walk back into the world where I may face it all over again minutes from now.

 

This life.  It’s not what I signed up for.  The contrasts, the passions, the terrible sorrows, the incredible highs.  I didn’t know.  Would I choose it again if I did?  Probably.  But it still makes me ache and bleed inside every day, as I enter my patients’ worlds and lives and take it all into my own heart.  Thankfully at home I have two beautiful sweet smelling comfy feeling tiny humans who comfort me, and a man who helps me heal.  I didn’t know, I didn’t know why I felt such a need to find a partner and start a family when I started residency.  But now I know, and inside my soul back then I must have realized that without these loves to guide and heal me, I could never ever do what I do.  To help others, I need my family to help me.

Trying my hand at “fiction”

Looking through some of my older writing today, I found a piece that I wrote in 2007.  I am terrible at writing fiction, and when I do try it always feels forced and sounds silly when I read it back to myself.  But this piece that I wrote back then isn’t all that bad, so I figured I would share it here.  The medical details are all true, woven together from different patient experiences I had on the medical ward as a third year student.  Enjoy.

______________________

The sun was shining, she could see it as she entered the room.  Mrs. Johns lay as she always did, a lumpy potato sack on the bed sprouting limbs like toxic green shoots when the rot is near.  Megan could hear the rasping breath she was called to assess; even without the stethoscope the wheezes were audible. For the umpteenth time that month the respiratory therapist would have to be called, and the comatose sack would breathe easy once more.  That is what Megan was thinking as she auscultated the chest.  Only months later would she remember the patch of sun lying gentle as a caress on Mrs. Johns withered cheek.  Then, the quiet beat of her patient’s heart would blend with the birdsong outside the window and the radio next door, into an orchestra of meaning that Megan would recall over a breakfast of runny eggs and soggy toast, made soggier by the surprise of salty tears.

 

But that afternoon, as the Internal Medicine student on-call, all she wanted to do was watch American Idol – it was on in a few hours, and like usual she and the nurses would try to get in a few minutes of what she liked to call “brainfritz”.  Punctuated by snores, coughs, farts, the beeping of monitors and kinked IV lines, the singing would at least drown out the quietest of the hospital’s cacophony of night noises.  As she performed a silent rectal exam on Mr. Crenshaw (who after days of constipation had managed to poop out a whole wad of blackish stool) she mused about what Thai specialty she could order for dinner.  Of course, there was no real question, vegetarian Pad Thai was her favourite with it’s peanuty goodness, but then again tofu in red curry had an edge to it…

 

Abruptly, the shriek of the call pager jolted her out of her Thai reverie; the stool on her gloved finger tested positive for blood as a disembodied voice called “Code Blue, E south” over the intercom.  She hurried out of the room to find the ward a sudden frenzy of nurses, all propelling her down the hall and into Mrs. Jones room.  The nurse taking Mrs. Johns vitals had noticed that suddenly her oxygen saturation was 80% and the wheezing was much worse, and had called a “pre-code”, to perhaps stave off the inevitable.

 

“ICU is on their way!”

“Want to intubate her?”

“Which meds would you like?”

“Should I call the family?”

 

The nurses all peppered Megan with questions as the patient’s respiratory distress worsened.  It should have been simple – try drugs, intubate, stabilize, send to ICU – but Megan’s gut revolted at the thought of putting this months-unresponsive woman through all of that.  She should have had some sort of back-up besides the ICU, but call at Santa Maria Hospital’s Medicine ward as a third year medical student meant she had no resident or attending physician in-house.  Aside from the nurses, RTs, one emerg doc, the ICU attending and a few other medical students on other services, she was the sole person responsible for preventing the deaths of all the patients in the entire freakin’ hospital.  Shrugging the angst aside, she quickly moved for the phone and before the ICU team arrived, she had managed to get the RT back in the room.  After another course of inhalations Mrs. Johns’ saturation perked up to 95%.

 

Crisis averted (at least temporarily), the ward quieted down again and she finally got time for a pee break.  Hospital toilets being what they are, the nurses on E-south had taken pity on Megan and given her the code to their personal throne.  Squatting with her stethoscope hanging on the doorknob and her white coat pulled up out of reach of the wet depths below, the scene replayed itself in crisp detail in her mind.  Had she acted correctly?  Should she have anticipated the emergency before it occurred?  Would Mrs. Johns do this again later, before night’s end?  What would she have done if the meds hadn’t worked and the ICU team was busy with their own patients?  Would she survive the rest of this night, let alone the rest of her career, if patients were always trying to die on her?

 

The night wore on, and she ordered her veggie Pad Thai along with a chicken one for the ortho student upstairs.  Someone sang a terrible song on American Idol, and a demented patient pulled out their catheter, leaving a pool of blood on the floor and calling for his wife to cook the chicken.  Mr. Romano harangued his 99-year old roommate for snoring, Mrs. Cordoza fell out of bed, Mr. Jenkins tried to jump out the window, and Mrs. French found scissors and tried to cut her hair off.  The family of Mrs. Johns showed up at ten p.m. and wanted a family conference, a nurse fell ill with vomiting and had to go home, the fire alarm went off about ten times, and strong winds blew out a window in the conference room.

 

Meanwhile Mrs. Greenspan wandered down the hall in her open gown, 85 year old behind flashing its’ sagging self as she passed the nursing station on her way to the elevators and wished freedom before the nurses reined her in.  Cantankerous and special, her temporal lobe seizures (that Megan had diagnosed!) caused her to become intermittently violent and abusive, which made her the least-loved patient on the ward.  Having admitted her from the emerg and pushed for her initial EEG when the attendings were convinced it was just dementia, Megan felt a bond of sorts with this maligned lady and always kept an eye on her.  After Mrs. Greenspan was man-handled back into bed, Megan went in to make sure she was all right.

 

“Time for bed, Elsie”, the young almost-physician said as she stood by the bed.

 

“Sit down, girl!  I’m not tired yet, and I want you to sit with me.”  Proud and feisty tonight, her patient commanded and was not to be ignored.  Megan sat on the chair by the window, facing the bed, elbows on her knees and hands cupping her chin.  “Did I ever tell you about my husband?”

 

For the next few minutes Mrs. Greenspan relived a trip to Israel with her family, illuminating beaches and markets, archaeological digs in desert sunshine and the walls of the Old City.  Megan sat, fascinated, sleepy, privy to the internal wanderings of this woman’s wise mind in the moments before sleep, when doors thought closed are opened a crack and the subconscious peers out.

 

Silence.  “Would you like me to go so you can sleep now?”

Pleading, vulnerable, – “Stay with me while I fall asleep, won’t you?”

 

A shaft of moonlight cuts the blanket, landing on a gnarled hand, the band of gold and a diamond glittering brilliantly in the night.  Soon, the soft slowness of breath a lullabye, arms braced on the bed railing and head cradled above, Megan’s eyes close and for a few minutes she finds peace in the darkness of her patient’s room.