The computer said she was an 88-year-old female with a chief complaint of fatigue. From experience, I knew fatigue in an older person could be caused by almost anything. So … was it a heart attack? Depression? Cancer? An infection somewhere? Or was she just … fatigued?
The real reason she was there never crossed my mind.
The tiny woman had positioned herself precisely in the centre of the gurney. Her white tennis shoes sat under the chair with a thick, flesh-coloured knee-high stocking tucked inside each one. On the seat of the chair was a neatly folded yellow cardigan atop an equally neatly folded brown dress.
She wore her hospital gown like a jacket, open to the front, and her knobby hand clutched it closed over her cross-your-heart bra and waist-high white cotton panties. A Catholic cloth scapular with an image of the Virgin Mary hung on a string around her neck, and a tiny gold cross on a fine gold chain nestled in the hollow at the base of her neck.
“Hola. Mi nombre es Doctora Birnbaumer. Como se llama?” I said to her.
“Hola, Doctora. Mi nombre es Maria,” she replied.
Her eyes sparkled, and she sat up straighter, her posture that of someone who found life interesting. I checked her armband and offered to cover her with the sheet folded at her feet. She nodded.
I asked her how she was feeling. Fine, she told me. Was anything bothering her? No, she said. Any pain? No. Any shortness of breath, chest pain, headache? No, no and no. I went through my list and she denied anything being amiss.
Maria’s only encounters with the medical system had been for the births of her many children, several of whom she had outlived. She had been widowed over two decades before. She lived alone, with family nearby. She wasn’t working but had spent most of her life as a housekeeper. No meds, no allergies, no surgeries.
I asked if I could examine her, and she nodded. From head to toe, she was remarkably fit. Her bright, curious eyes nestled in a sea of soft skin and were bracketed by deep crow’s feet sculpted by years of smiling. The rest of her head and neck exam were normal. A tiny bit of curvature of the spine. Clear lungs, a strong, steady heartbeat with no abnormal sounds. Abdomen, extremities, neuro exam... all normal.
I was flummoxed. She watched me expectantly.
“So, are you sure nothing is bothering you today?” I asked.
She shrugged and raised her hands in a “what can you do?” gesture.
I was getting nowhere. Time for a different tactic.
I asked her why she was in the emergency room. She said she didn’t know.
Dead end.
New angle: “How did you get here today?”
Her face blossomed into a smile. Her daughter, granddaughter and great-grandson had come by her home, picked her up and brought her to the emergency department.
Finally. Maybe an answer.
With Maria’s permission, I sought out her family members in the waiting room. They were easy to find, all three resembling the petite woman on that gurney. The same dark eyes stared at me as I approached them, but while hers were bright and inquisitive, theirs were red-rimmed, and their eyelids were swollen.
As we entered the “family room” to talk, the two women deferred to the teenage boy, who acted as spokesman. He remained standing as the women and I sat.
They all turned to me, waiting. I cleared my throat.
“So, I was wondering, why did you bring Maria to the hospital today?”
Instantly all three sets of eyes filled with tears. The oldest woman nodded to the boy, and he spoke, dropping his gaze to the floor.
“My cousin. He died. The police came to my aunt’s house and told her he got shot.”
“Oh! I’m so sorry.” Now I understood the tears.
We sat for a few more moments in silence. No one moved. And I still didn’t know why Maria was there. I ventured, “So, is there something wrong with your great-grandmother?”
The boy answered. “My cousin. He is... was... Abuelita’s favorite. Everyone in the family knows it.” The boy’s voice was pleading, but I still didn’t understand. “We want you to tell her he’s dead,” he blurted.
And there it was.
I wish I could deny it, but my first reaction was irritation. Really? There was nothing medically wrong with her? The emergency room was packed with people, some were really sick, and I just spent 15 precious minutes on this? Did people really think the emergency room fixed everything?
Then the three of them started talking at once. They feared she’d have a heart attack or a stroke when she found out. They were terrified the news might kill her. They didn’t want to tell her. They wanted someone else to do it, and she needed to be somewhere that, if something terrible happened, she’d be taken care of.
I sat with what they told me for a moment. I recalled how I felt when my dad called me with the news that his thigh pain was from a tumour that had spread from a mass in his lung. I remembered how much I wanted someone to tell me it would be OK, that we would all survive this, that the world, now horrifyingly askew, would somehow right itself.
The healing that eventually happened didn’t result from any discussions with a doctor but grew from the love and support we gave each other as a family, from the times we would lean together, our hands and heads touching, creating an edifice, a steeple from which we could all draw strength.
Through these memories, my path forward became clear.
I took a breath and leaned forward to look each of them in the eyes. I made sure they heard me when I told them I was there for them, all of them... including Maria. I said I would be there with them, in the room, and around for hours to watch Maria if she needed anything and to make sure she was safe and taken care of. I told them I had their backs, but that the news needed to come from them.
They searched each other’s faces, and then they all nodded.
As we all walked into Maria’s room, her bright smile faded when she saw our faces. They moved to her bedside. I slid a box of tissues onto the table near Maria and stepped away.
Maria was now surrounded by the three generations of her progeny. They spoke to her in Spanish in hushed tones, and I watched as four lives — four generations — confronted the dreadful news.
Maria listened quietly. Her straight posture sagged the tiniest bit, her smile disappeared, and her face aged decades in moments. She reached one hand, spotted with age and deformed by years of labor, out to her family, and they all joined hands. With her other hand, she clutched her scapular, pulling gently on the string that attached it around her neck.
I eased out of the room, leaned against the wall in the hallway and remembered.
I remembered being a young woman deeply invested in caring for others and deciding my future was in medicine. I happily took on the years of schooling and training and debt required to become a doctor. I recalled the thrill of learning about the human body, how it works and what to do when it doesn’t.
I remembered cringing when I learned to start an IV and the patient gasped in pain. My heart broke the first time I told a patient they had a terminal disease. I cried myself to sleep the night when, as a third-year medical student, the man I assured would do fine during his coronary bypass surgery died on the operating table.
But I couldn’t remember exactly when my empathy started to slip away.
I knew that when I started my shifts, I walked through an ambulance bay packed with paramedics, gurneys and patients. I knew that no matter how hard or how fast I worked, the waiting room would never be empty. Patients came to the emergency department when they were injured and ill, but also when they could not get in to see their own physicians or when they lost their insurance or because after-hours was the only time they had off between jobs. Police brought in patients who had nowhere to go or had behavioural problems or whose addictions had consumed their lives.
There were never enough beds, patients waited for hours, and everyone — patients and staff alike — was understandably tired and angry. There was no way to do a good job — at least not as good a job as I had been trained to do. Despite that, administrative bean counters reduced my performance to counting how many patients I saw per hour and how many tests I ordered.
When I became an emergency physician, I had been all in on taking on the hard work and the erratic schedule, the difficult decisions and the busy shifts that went with the job. Over time, though, I had let the demands of a changing, overstressed and broken system knock me off course.
Standing in that hallway, listening to the soft murmurs of Maria and her family, I remembered why I was there — why I chose this profession, why I worked these crazy hours, why I did this job.
I pulled away from the wall and headed off to care for the next patient waiting to be seen.
Maria didn’t have a heart attack or a stroke. An hour later, she sent her great-grandson to find me to tell me she wanted to leave. Her family helped her into her clothing and gathered her things as I prepared what was needed to send her home. At the door to her room, I hugged each of them in turn, Maria last, knowing her visit to the emergency room was exactly what she and her family needed.
Apparently, it was exactly what I needed, too.
Note: Some names and identifying details have been changed to protect the privacy of individuals mentioned in this essay.
Diane Birnbaumer is an emergency physician and writer living in Los Angeles. Her poems and essays have appeared in Intima: A Journal of Narrative Medicine and the medical journals Annals of Emergency Medicine and Annals of Internal Medicine, as well as the anthology “The Things They Wrote: A Writing/Healing Project,” published by Room: A Sketchbook for Analytic Action. She is an ambassador for The OpEd Project and attends The Writers’ Program at UCLA Extension.