Another repost from a few months ago as I recover from jet lag…
It was 2:30AM my eyes were so dry from lack of sleep that my eyelids seemed glued to my eyeballs.
The pager had convulsed again. I had it on vibrate attached to my scrubs so it would not wake my husband. I pulled it up to my face and the green light display flashed the ER’s number. Damn. Not again. Please don’t be an admit. Please don’t be an admit.
Somehow I knew it would be, though. I had skipped church on Sunday and my lucky socks were dirty. I was doomed.
I dialed the number and waited for a couple of minutes while the nurse tracked down the ER doctor.
“Yeeeaaaahhhh….I’ve got Rose here (not her real name, of course). She says she has a headache. She wants to start treatment again for the crypto.”
“You can’t be serious.”
“Deadly serious. She says she won’t leave. I tried for two hours. Sorry.”
The policy was that in your third year of residency, if you were on call for this hospital (we covered two) you could take call from home. If you had to admit someone, you had to physically go up there and see the patient, dictating the history and physical within the hour.
I screamed at God in the car on the way there. I railed against him. The fatigue was really getting to me. Why do you torture me? Was it skipping church?
I had never met this person before but she was well known. She had AIDS and cryptococcal meningitis. She would start treatment, take it for a few weeks, then fall off the wagon and disappear.
When I entered her curtained cubical at the ER, she was staring blankly at the ceiling, emotionless. I had resolved to go in there with guns blazing and beat her down for playing these games. Some residents just admitted people like this and crawled back into their beds. I liked to make a big deal out of it. I’ll teach you for getting me up. I have a full day of clinic tomorrow. You will suffer as I suffer.
“Why are you here?” I asked matter of factly. “You don’t really want treatment do you?”
She started crying. Damn. I always made people cry. But it also told me there was something else going on. I softened.
“What do you need?”
“My family found out I have HIV. I can’t live with them anymore.”
“You need a place to stay?”
She nodded. “I need a good nights sleep.” She was silent for a minute. “And some food.” She hazarded a grin.
All this time she was struggling to survive in a way none of us could comprehend. She did not want treatment. She wanted to know that she mattered to someone. When she just got too desperate, she knew her medical condition could get her an extended stay in our hotel for “treatment” of her cryptococcal meningitis while she sorted things out. So she did exactly what I or anyone else would have done.
We had a long chat. I hugged her. I admitted her overnight so we could get a social worker involved. We made plans to get her a place to stay. She also did not have a primary care doctor she could trust so I agreed to take her into my patient panel. Why do you always do this? You will probably regret it.
In the next few weeks, she continued to refuse treatment. She was not depressed, she insisted. She just did not see any point in going on like this. She agreed to hospice and eventually died. Peacefully. In a bed. With food. And she was not alone.
So in the car that night on the way to the ER, I had felt a voice inside say I want you to learn something. And I pushed that thought out of my head as I continued to let my anger and frustration boil over. But I did need that reminder of what a privilege it is to be in this profession, to have the opportunity to provide peace and comfort, even if it does not involve medicine.
I am not special. I am not a perfect person. I still struggle with some of my difficult patients, finding the capacity to care to the degree that I should. In the end, we are all human. We all have value. Some day that could be me. Or you. It could be a different disease, different circumstances, but I hope that there will be someone there to listen or to hold my hand. In the end.