Mrs. B. was in love with the telephone operator at her nursing home. She would dial zero every night and tell him about her loneliness, its size and shape, and the poor perplexed man would listen a long time- maybe longer than was appropriate. Then he'd put in a call to her physician. When Mrs. B. was my patient on psychiatry, and she told me about her telephone operator, I wondered who this man was, how he'd felt each time the woman's call turned up on his switchboard. He was like me, I thought, and like my classmates in medicine: surprised and somewhat touched at the wide view we're granted of our patient's lives.
Over the past year, I've dwelled a lot on these signs of life, human drama in its ugliest or most exquisite presentation. I'd be lying if I said I don't worry that the world will end tomorrow, and I don't mean that in an apocalyptic way; I'm just repeating what I garner from the news, on the days when my temperamental TV actually gets reception. Meanwhile, my patients are human, and thus profound in the smallest ways. I take each life encountered as evidence that the world is still spinning, and phenomenal.
#1. Joanna is a four-year-old child referred to the pediatric cardio
logist
for evaluation of a heart murmur. Her cousin has a hole in his heart and
the whole family has been very worried that Joanna's diagnosis will be
the same. Her echocardiogram turns out to be normal, but Joanna cries
anyway, stressed out by the visit to the doctor and the long ultrasound
examination. "You have a perfect heart," I tell her, handing
over a freezeframe of her echo. "Just gorgeous."
She looks dubiously at the grainy image, fine yellow hair spilling over her shoulders, and continues to howl.
The cardiologist hands over his stethoscope. "Take a listen," he says to Joanna's sister. "Tell her what you hear."
The child, a year or two older than her sibling, clambers up next to her and listens closely. "It sounds like a bicycle," she says.
In my modest years of clinical training, I have never found this to be
the case.
Joanna giggles. "A racing bike?"
Her sister nods. "Like a washing machine. Like a big horse."
"Like a dragon?" She is laughing so hard, I am afraid she will
forget to breathe. Her mom shrugs.
We leave the girls alone with their hilarity, each one of us touched by that easy laughter. We come back later for the stethoscope.
#2. Mrs. Melvin is a 66-year-old woman admitted to the general medical service for an exacerbation of her emphysema. The slightest emotion sends her into paroxysmal coughing fits, leaving her red-faced and breathless. After a visit from her grandchildren, she becomes so excited that she decompensates entirely and is transferred down to the unit with a lung infection and a new diagnosis of reactive airway disease. Her course in the ICU is scary; she is intubated, sedated, and spends two days in-between the world of those who breathe and those who don't. Finally her infection clears; she is ready to go home. She's lost ten pounds and there is a crack in the side of her lip from the breathing tube, but Mrs. Melvin does not talk about the ICU or the fact that she very recently has almost died. She puts on her spectacles, sifts through the armament of her prescriptions and discharge instructions, and then she asks me when I think she will be able to play Bingo. It is her favorite game, she tells me, and when will she be able to play? She asks this question like her life depends upon the answer.
#3. As a rule, my patients lose less sleep over their nebulizers and heart medications than they do over the amount of time till they can wear high heels again, or hit the bowling alley. One patient pulls out her nasogastric tube overnight and tells me she won't have it replaced under any circumstance. The reason? She dreamt that she went to Barcelona with the handsome young doctor. "We were dancing together," she tells me. "I didn't want the tube."
"It was just a dream," I remind her. "You need that tube," but she shakes her head.
"I could have the same dream again," she says, as if this is the most obvious thing. "And I really hope that I do."
#4. "My daughter is so damn dizzy," says Mrs. Blefaro, "and
now I know how she feels." She throws her head down and vomits good-naturedly
into a pink basin.
"When did this dizziness begin?" I ask her. A good history and
physical demands that the student establish a timeline.
"You
don't get what I'm saying," she tells me. "I didn't feed my
family tonight. I was cooking up some pasta and I started feeling so dizzy!"
"What time were you cooking up the pasta?" It is now almost three in the morning.
"You're a teeny little thing," she tells me. "Don't you know how to cook?"
"I cook from time to time."
"Liar." Mrs. Blefaro wretches and heaves over the basin. Then she lifts her head. "I'm feeling so dizzy."
"When did that begin?"
"The most important thing about a sauce," she tells me, "is to get nice fresh vegetables. Once you figure out how to pick the good vegetables, you'll get a good husband."
"Mrs. Blefaro, does the room appear to be spinning, or are you spinning?"
"My daughter's dizzier than I am," she says. "Can't cook
a meal to save her life. You two would get along."
#5. "Dear God, what have I done to deserve so much pain?" In
his postop delirium, John X tells me exactly what he's done: he's cut
people, committed armed robbery, broken into houses for drug money. Still,
no person on earth deserves this sor
t
of pain, or the diabetic blindness and amputation that are his lot. John
X is also a poet and he likes to tell me the things he's written. He has
a poem about ice cream, which he came to regard with a sort of religious
sanctity during his time in prison. He can describe in detail the cash
economy of jail: a guy can earn $1 a day working down in the laundry,
spend $6.25 a week on smokes, and still put away 75 cents each week, so
that every two weeks he can afford an ice cream for $1.50. Every morning
when I round on him, Mr. X counts the birds that land on the rooftop across
from us and recites his ice cream poem. I'll always be a little bit afraid
of him.
#6. I hold the hand of a newborn in the neonatal intensive care unit. The childwas born at 24 weeks gestation, and her skin is purple, translucent beneath the warmer. The full weight of a stethoscope might stop her from breathing, so everybody listens carefully.
#7. On her first day as my patient, Mrs. Wing goes into a partial code. There is peppermint spray in her room to keep things fresh, and when people tumble into the room and I reach for a pair of gloves, I knock it over; the floor is covered in peppermint.
Through the rest of the code, and the rest of the day, it's all I smell. Before I leave for the night I stop by her room and she has pulled off her nasal cannula; she's praying over the prongs and thinking it's a rosary. "Honey," she tells me, "I'm about ready to go home."
"Today?"
"Yah," she says. "I'll go to the store and pick up a chicken; I'll cook it up for the girls downstairs.
"Today isn't the best day for a dinner party."
"It's the perfect day," she tells me. "I've got the shopping list right in my head."
__________________
At the end of it all, of course, I'm a medical student and I present my
patients in SOAP note form, certainly not as above. At 6:45 AM, in the
elevator of the Floating Hospital for Children, I suddenly realize I am
missing one of these SOAP notes. I rifle through my papers. I rifle through
again. Then I flip through my pockets.
The elevator opens and I step onto the floor. The corridor is a long
slender rib, and the light comes down through the high windows. In this
early light, each gesture is eloquent: the nurse who rocks a child on
her lap, the student writing vitals on a card, the resident who rubs her
eyes and starts the new day where the last left off. The mom who asks,
have you got a red crayon? Pink won't do. I find my SOAP note. It doesn't
begin to cover the things that I feel, but it's designed to make the patient
well, and what I feel is somewhere up over the windows, in the light that
comes down over us and makes each one of us a bit more whole.
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