Don’t Say Goodbye

This is a reflection on an experience I had some time ago in its raw, non-edited form. It shows a bit of what the student life is and the little joys we get from it.

There was a smile on the mother’s face as we left the room. I had been in there with my fellow second year student as part of our pediatric session for the Patient-Doctor experience (PD) and he had happened to be the last patient we saw that day.

I must first admit that I have been on e of the many students that have smirked in disdain as our preceptors tried again and again to justify the saying of catch phrases like “that must have been hard for you” to patients. I understood the need for empathy towards the patient but I also knew the patient’s primary goal was to get treated. And as a second year, my aim was to learn the ropes for survival during third year and that involved learning about diseases, procedures and doctor preferences.

The morning was rather slow this Wednesday and we saw about two patients, one very quiet and needing little persuasion to consent to procedures, the other hyper-excitable and having more fun in a hospital than I had ever seen anyone have. In both rooms, I played the game of peek-a-boo while the physician and or resident got what they needed for diagnosis from child and mother alike. In the room of the third patient, we morphed from clowns into strong men holding down a child as a venous line was placed in her vein to hydrate and nourish her. I was learning. My day was getting productive but not as productive as it would in the next few hours.

My colleague and I had been discussing how best to get out early from the rather quiet ED (emergency department) to study for the STEP I exams when the cardiac monitor started screaming in protest. The beeps got louder and the rush of footsteps past the staff room indicated a major event was happening. Before we could rush into the room, the door was closed and we were left to rue a missed opportunity.

SVT, I heard them say. And with that I went to the still complaining monitors to conduct my personal consult. It was no SVT since there was no sinus rhythm but there was tarchycardia alright, 240 beats per minute in a child and all I could think of was what a unique opportunity this was to see theory in practice. The loud cries coming from Room 3 blended into one with the beeping of the monitor in front of me and both played in sync with the ups and downs of the EKG baseline and the cluttering and smoothening of the rhythm strip as I stood intently looking for the P wave before the QRS complex and arguing with my colleague about whether the initial upstroke was the P or whether there was a bundle branch block.

Finally, we got our chance or let me say, I got my chance when the cardiologist was brought down for adenosine therapy and my colleague volunteered to interpret the Arabic that the mother spoke. I saw a little boy in obvious pain with his face buried in his mother’s bosom and the hand he could use digging into the winter coat that she apparently was oblivious to the fact she was still wearing. And in the eyes of the mother, I saw not just pain and despair, but confusion—confusion about what was going on and probably confusion from being listening to what was being discussed around her and not understanding a single word of it.

We took our positions in the far corner of the room out of the way of the hurried masses and looked on silently while the professionals went about their work. I attempted my game of peek-a-boo again but where it held the first patients attention throughout our visit to her room, it caught this one’s only for a second. I watched my colleague communicate the findings and plans to the mother and repeat her questions and consents to the attending. I did not comprehend what they said to each other but from her mannerism, she seemed to trust in what the doctors were doing and only wanted her son to be free from suffering. First, a bolus of Midazolam was administered to calm the still remonstrating child and then preparations were made to administer adenosine in the hopes of getting him out of his arrhythmia. With each dose, he looked on first in calm and then as the medicine made its way to his heart he would writhe in pain and attempt to reach for his mother who stood holding his hands and brushing his hair with the other while tears run from both eyes. I turned and whispered to my friend to tell her everything would be okay, to “do what we are told to do in PD” but he was an interpreter. Was it really his place to do that? I was of course still jesting and I was still wracking my brains on what the mechanisms of action of adenosine and midazolam were but there was something else dawning on me that many hours in my PD lectures had not convinced me about—these two people were concerned not only about the treatment being administered. They wanted hope against hope that everything would be fine.

The adenosine intervention ultimately failed and the patient had to be transferred to the surgical intensive care unit. While preparations were being made for this and an ultrasound was sought to observe heart structure and function, there was a temporary lull in affairs and I went over to hold the boy’s hand. He held my finger tightly while I said to him that he was going to be fine without knowing whether he understood me and praying that he would be alright. We stood there silently watching each other and saying nothing more but understanding that a connection had being made that was essential to the humanity of both of us. The ultrasound came and left without him letting go of my finger and another cardiologist who could speak Arabic came and left and he would still not let go of my finger. Finally, at 5:30pm, 30 minutes past our check out time and with every thought of studying for the upcoming boards out of my mind and concerns about p-waves and inverted t-waves nowhere near the forefront of my consciousness, I was able to extricate my hand and mumble a good luck to the mother. At the door, I turned and waved. Bye S., I said. With the IV lines still in place and the EKG leads hanging off his chest, he turned to look at me, raised his hand slightly off the bed, and waved in return. At that moment, a lightness descended on me and for the first time that late afternoon, I saw a smile in the mother’s eyes and about her lips. Then I realized I was smiling as well.

On my way out of the ED, I could hear the cardiac monitor still shouting its revelations to anyone that would listen. But in Room 3, a silence had descended; a brief respite from what would most likely be another frantic few hours.

Prime

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This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
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