no. 7: unexpected.

i cried at work last night. that's right, i shed actual tears. it started with sadness and tears welling up inside me, and i'm sure i had that look of one about to cry--you all know what it is, perhaps a quivering lip, as well as well as glassy eyes with a stream of tears just waiting to fly forth. i got to that level, and then just beyond. i let 3 icy drops fall from my eyes. and i was not able to hide them. i was kneeling when this happened, and when i arose, it was as if a crowd had gather around, and they were all looking right at my giant tears. i'll never live this down.

You see, i had forgotten than the woman to whom i was talking was nearly deaf, so i was essentially screaming, which allowed everyone within 50 feet to hear what i was saying. the woman to whom i was speaking was a cute little 95 year old who had been sent in from an nursing home with complaint of chest pain. she had a host of medical problems, including heart disease, afib, an ICD, diabetes, etc. in addition, she was 95, but she looked good for 95. i initially told her that she would likely be staying in the hospital, and she was not thrilled. she basically told me that she wanted to die. she wasn't happy, she said, "what do i have to live for?" was something she repeated at least 6 times. i explained what the casue of her chest pain could be and what could happen if we didn't know for certain what was going on inside her. i received an emphatic "no" when asked if she wanted to get better. at this point i became evasive, as i often do in this situation--which is fairly common--i told her that we would wait for her lab results and then make a final decision at that point. This given the patient some hope of avoiding an admission and gives them time to think about the pros and cons of coming in. this is taking a bit of a gamble since you don't know what their lab work will show, but there is a good chance that something will be far enough out of whack that i can use that one factor as a reason necessitating admission, and i was sure this lady was no different. after all, she was 95!

but i was wrong. her labs looked great. nothing going on with her heart, kidneys, or liver. my last hope was the urine--sweet, sweet, urine--often so filled biwth bacteria in old folks. but alas, hers was pristine (except for for blood, the result of spending a fair amount of time searching for her urethra with a catheter); not a bacteria in sight!

at this point i thought i had good news for her: she wouldn't have to stay. i passed along the joyous message with a grin on my face; one that was quickly erased by her replies. to distill what she replied down to it's true meaning: i'm 95, i shit myself. almost all of my friends are dead. i live in a place that smells like urine, and the people who work there to take care of us don't care at all what happens. sometimes i don't get to eat for more than a day. sometimes my diaper gets changed only once a day. i don't want to live like this, not anymore. i thought if i stayed in the hospital i'd get sick and they'd pull the plug (her phrase, not mine) and save me from all this. she even asked me to pull the plug. i laughed and told her there was no machine, at least not right then. she told me she had nothing to live for. i responded that i was happy she had come in on that night, since it gave me the opportunity to meet her and make me smile. i got down on my knees next to her bed as i said this, and i continued by telling her that i don't always see the greatest people in the ED at night, that i am often surrounded by the dregs of society, by heinous actions, one after another, on people hurting others, and that that has made me sad, and angry, and hard. but then i got to meet her, and after working christmas eve, chirstmas day, and spending the first christmas of my life away from my family, i felt sad and disconnected from humanity. but in less than 5 minutes of talking to her, i felt restored. it was strange--i actually cared about one of my patients again, i was empathetic. i don't know when that last reared it's ugly head--probably sometime in med school.

as i told her that i wished there was something i could do to help her, the ambulance crew arrived to take her back to her nursing home. as i stood up, i realized there were tears in my eyes, and that everyone from the department was crowded around because they could hear me conducting this conversation at an insane volume. basically everyone saw me--the three other residents working that night, the attending, the nurses, the techs, even the security guards. there goes my street cred. i had to walk away quickly, as she was loaded onto the ambulance stretcher, for i couldn't bear to see her face as they took her away. fortunately, since everyone was still crowded around her, they did not see the copious stream of tears running down my cheeks as i headed for the desolate back hallway of the department to collect myself.

i told her that i wouldn't forget her, so i have committed her story to words, hoping that myself and others will not forget her.