From the Bedside

Thursday, April 24, 2014

One hour into my first ED shift, my attending suggested, “go in there, examine your first patient and tell me what you find.”

Instead of performing a physical exam, I listened to what Alejandra said:

“I hate hospitals, and the doctors that come along with them.

‘I have an appointment available January of next year,’ said the receptionists.

‘Next year I’ll be dead,’ I should have responded.

I take the appointment and attempt to go as a walk-in the next day. I can’t walk a block without stopping, holding on to any rails I find, and waiting for my lungs to catch up. I have a drain placed on the left side of my back, but fluid keeps leaking out. I just want someone to take a look at it. The pain in my right thigh and knee doesn’t help either. No, I don’t know what brings it on, no, I didn’t have trauma to it, and no, nothing makes the pain go away. Stop asking me these same questions. I just want someone to tell me I’ll be ok. I’m only 24, but my grandmother can outpace me. I’m on my third round of chemo with five more to go. My 25lb stage 4 ovarian mass went unnoticed, not sure how. And the metastasis to my lungs were treated as a UTI, not sure how.

I get my prescription, and with my cane I shuffle down the stairs to the pharmacy. It’s 5:15pm, I’m the last one to get there, and the doors are half locked before they finish assisting me.

‘Your medications were not entered in the computer.’

I just finished seeing Dr. G, so my pain meds should have been in. With the little strength I had left, I caught the elevator back to the second floor, but already doors were locked, lights were dimmed, and providers slowly trickled away. I knocked, I yelled, I even kicked that damn door. People don’t get sick only from 8-5pm.

Have you ever dived into the bottom of a 20ft pool, looked up from its floor with the last few seconds of air left inside you. You know you’ll eventually surface and are unlikely to drown with so many people around you. I thought this was true, until last night.

My mother wheeled me into the ED. I was quickly placed in a room, changed into one of those hospital gowns that hundreds before me have worn, and had two different IV needles in each arm. I have no idea what was going into my body. Initially, doctors came in and out, mumbling all kinds of jargon, examining my lungs, examining my chest tube, and examining my naked body stuffed in that cigarette box room. I even saw Dr. G. She went straight to the computer and talked to another physician in the room. Didn’t acknowledge me or my mother, didn’t ask how my pain was, and assumed those prescriptions went through. I hated her. I looked over my shoulder, my mother with tears drowning her eyes, wanted to fight back. An apology would have been more therapeutic than narcotics filling the IV. Neither of us had strength left, so we remained quiet.

I visited Alejandra multiple times, even after she was no longer my patient. Each time I found her mother leaning over her baby, an aunt demanding answers to questions I didn’t have, her sisters reminiscing over baking sessions long gone. I followed her as she was switched from room to room, and I read each nurse, physican, dietician, and chaplain note documented.

One night, after my shift, I headed towards room 643 and approached a group of people pacing in front of a locked double door. They were here for Alejandra. I fumbled with a leaking pen in my coat pocket to distract myself from their anxious faces. I hated my white coat then, hated the false hope it gave them for their dying niece, granddaughter, and cousin. All the skills I’d accumulated these past three years in medical school were useless.

I found her mother in a corner of the room. No progress was made from the ED visit, only regression. Alejandra was slouched in the bed, head tilted down, and oxygen slowly seeped through her nostrils. A blue Hello Kitty tattoo peaked out from the drooping shoulder of her gown. The narcotics and anxiolytics were doing their job, and the stage 4 was making its final act.

I gently shook her leg and asked, “Do you remember me? I met you in the Emergency Room.”

Her eyes sluggishly opened and a smile slowly drew across her face.