Medical Narrative - Autumn 2008

By Pandora
8 January 2009





Haedynn

I have thirteen minutes to write. I thought it would be more this morning, but I’ll take what I can get. Death Cab is serenading me. Yesterday morning at JP’s I found Ecclesiastes open on his coffee table. He was still asleep and I was glad for some time before we had to discuss the previous week’s miscommunication. I read a few chapters. I drank in the reassurance that God has set eternity in the hearts of men, and that He has made everything beautiful in its time.

And a few verses after that I thought of Baby Haedynn whom I met Friday. “I saw the tears of the oppressed – and they have no comforter; power was on the side of their oppressors – and they have no comforter. And I declared that the dead who had already died are happier than the living who are still alive. But better than both is he who has not yet been, who has not seen the evil under the sun.” (4:1-3) I never understood this hopelessness so well, wondered about it so practically.

There is a pressure monitor sticking out of the hole drilled into Haedynn’s skull. The tape wrapped around its base is stained in brown-red blood. The nurse watches the stump of the monitor like a hawk when I look in Haedynn’s dilated pupils, afraid I’ll knock it out of place. The china-thin skull wouldn’t offer much resistance. Indeed, it didn’t offer much resistance when a mysterious force crushed or slammed it Wednesday afternoon. Haedynn has huge transverse and axial fractures, and her brain has swollen to neurologically devastating degrees. She is eight weeks old.

The hospital ethics committee was consulted regarding how much intervention should be given. The child abuse specialist talked me through the CT scans today: “there is absolutely no question that this was inflicted.” Now he and the ethicist and the resident are standing outside the sliding glass doors, discussing what the medical examiner would like done pre-mortem and whether organ donation is acceptable. And little baby Haedynn’s pale fingers are curled around a teddy bear. There’s a bright quilt at her feet; there’s a prayer written by her mother above her bed – junior high girl script penciled on notebook paper.

There was a dent in the ceiling of the apartment, and Haedynn’s father, Roy, who was taking care of her Wednesday, is quite tall. Roy is not allowed to see his three year old any more because of charges of abuse, and he himself was a product of the foster care system after physical and sexual abuse. I want to believe in redemption, in people’s capacity to change. But it seems unacceptable that this man was allowed to care for that perfect child.

Prayers keep trying to rise up from within me, and I just can’t quite breathe them yet. How dare I try to beg grace into this horror? How, especially, when it exists so ubiquitously? Better than both is he who as not yet been. I see that it is possibly true.




Growing

I find myself wondering at these funny privileges of medicine: the “singular intimacies” Danielle Ofri described. We get to do and discuss so many things that are, in any other setting, entirely inappropriate. But the constructs exist that make them appropriate, so that although a patient doesn’t know me from Eve, when I sit on the rolling stool and she on the exam table, when I don a stethoscope and she a jonny, the mysterious social rules we so innately follow dissipate. It’s not only appropriate, but also expected, that I ask for every detail of bowel movements and palpate all the sacred parts (“palpate” – even the words change in this context). I love this privilege. I want to participate with people in life very thoroughly; I feel honored to share the delightful and the terrifying, the proud and the shameful, and to be near even in the intensely solitary process of death. But what a funny, strange profession! A personhood, really. Already I see the fast-moving waters of medicine smoothing my edges as they see fit – what about when I step back out into the sunlight, cement, living room carpet that is life apart from this? How does my evolving shape fit?

I lost my uncle Bob last year – my dad’s eldest brother, my favorite cousin’s father. I skipped Hematology lectures to show up at the hospital armed with hugs and cookies after Uncle Bob had his seizure. But also, to my surprise, armed with this scary new part of me: when I looked at the MRI, the physician’s “we just need to do more tests” became hollow. Irregular borders, bigger than a grapefruit, crossing the midline, growing toward the frontal lobe. Uncle Bob’s tight grip on the bed rail became spasm, not nervousness; instead of listening to his voice I listened for abnormal speech patterns. But fuck, lying there, trying to smile, he looked so much like my dad.

It’s a precious thing to participate in the process of dying. I don’t regret a single visit or long drive or late phone call over the ensuing months. But it’s a funny thing to learn with one foot in each of these worlds: family is who I am and where I come from, and who I “get to share with like-it-or-not” (Momma would point out) – and this beautiful, sharp, art of medicine is somehow also where I belong. I haven’t yet learned to straddle the gulf; in losing Uncle Bob I mostly dove and skidded from one side to another – child one moment, scientific interpreter the next.

Now, more than any time since I’ve started medical school, I feel like this is where I’m supposed to be. I’m twenty-five and transient, so whole wheat or rye is as significant a commitment as I feel capable of in life lately – yet somehow, my desire to be a doctor lives in a different realm: it is certain and steady. Vocation, perhaps, chooses you more than you choose it. In spite of this rare sense of certainty, I am really terrified. I feel this thing has gotten hold of me, this river cutting away the edges, and I don’t know what will come out the other side. It moves very fast, takes away much of my space for contemplation and evaluation. So when I do pause for a gulp of non-medical air, I find myself wondering: when all’s said and done, will I like who I’ve become?




On Gluttony

Dr. Brodsky is a specialist, a scientist, cold. For most of the patient encounter he is pecking new med orders into the computer. This is boring, and I’m glad it’s Friday. Brodsky stands for the cursory physical exam and I stand too, eager to participate at all. In a quick check of Dennis’ heart and lungs there seems to be quite a thrill in the anterior chest wall. I take the stethescope off and ask if I can undo another button, then tuck my fingertips down his shirt. I hold my breath a moment with the realization that I can palpate almost the entire front of the heart. It’s big, and it’s pumping away beneath just a soft layer of tissue. Brodsky’s chill on the room breaks: this is fascinating. I flip quickly through a mental catalogue of reasons I would possibly be feeling what I’m feeling. It turns out Dennis had his sternum cut open for a heart surgery years earlier and developed an infection, and eventually they took the whole sternum out. We talk about this briefly and Dennis seems amused by my awe. Apparently the surgeons pulled up his rectus abdominus to cover the gap between the ribs. I ask a few more questions to stall because I don’t want to take my hand away from his chest – so much can be felt there of the sacred organ, usually shrouded from fingertip evaluation by a firm bony cage. God, it’s beautiful.

Driving to Portland after work I’m thinking about Dennis’ heart, trying to remember the details of how it felt. The week’s other interactions swirl in and out of my thoughts as well, then the whole mess blends into a stark realization: I am a total glutton for intimacy. (Actually, “whore for intimacy” came to mind first, but it quickly becomes a mixed metaphor.) Earlier in the week I had exchanged long letters with a dear friend again, one with whom this happens every few weeks: we cut each other profoundly and know it, fear it, regret it, forgive it, and somehow feel closer afterward. I also had some nice long drives and a couple of funny adventures with a new friend, an open, cavernous individual whose colorful stories bear strange similarities to my own. He didn’t seem to mind when I pressed for more details about his life than our history merited, and I drank in the time thirstily. Then there were a dozen late-night conversations with my boyfriend, trying to hold on tight as our little tops both spin quickly in different worlds. And now I’m off to see four of my college roommates, to stay up late drinking wine on the roof, and to talk about pasts and futures and boys and dreams.

This gluttony drove me into medicine, I think, and it is desperately necessary to keep me from being consumed by medicine. It’s worth navigating the EMR to feel Dennis’ chest wall a second longer. It’s worth losing sleep to fly to an island with friends. I have this visceral need to glimpse the little pinpricks of light in a dark world, to find some awe, to revere something - and it’s fulfilled by my gluttony. This longing for truth and beauty is an addiction: I feel like I shrivel and whither without it. The chance to tap down into a person, to touch beneath the surface, to reach the hallowed and hidden, is irresistible for me. If you can chip away a bit of the protective cage, amazing things lie beneath. Things that make you hold your breath, and grin when you remember them hours and days later.




55 Word Stories:

“Just a quick listen and you’ll be on your way.”
Palpable thrill.
“May I undo one more button?”
Hand on chest: identifiable beating chambers. I freeze. Palpable thrill.
He chuckles: “Just my belly muscles there – they took the whole friggin breastbone out.”
Protective cage gone – I felt his fucking heart. Gross, raw intimacy overwhelms me.


Anxious crew cut cradling his asthmatic cherub son. Babies, both. Three months at the shelter. Psychiatrist, Case worker, Parenting classes. “His mom ain’t around. We’re goin to court next week.” Fully custody. Overfull, flooding, torrential custody. I want to hug him. I want to cry. Instead a handshake, and weak words: “You’re doing great, John.”


“Pshhh.” The portable oxygen.
“Another pill, Dad?” The red-haired daughter hesitates, rubs her temples.
Bill raises his brown, draws a tired breath, and trusts. “Pshhhhh.”
Twenty-some years of demigod status makes Doctor Gray comfortable with the authority, with decision.
In the corner, I wonder if I’ll ever be. If I want to be.




Jacob

Jacob’s sclerae are faintly blue. He tracks faces beautifully and he’s aggressive with a pacifier. His chart refers to increased flexor tone – but it looks like he’s trying to cover his ears with those impossibly thin fingers, as though he doesn’t want to hear something. His fontanel isn’t sunken now, but femoral pulses still bound visibly with no fat to hide them. Jacob’s mom says she has to take the Seroquel at night “or put people in the hospital” with her anger. This keeps her from waking up to feed him. If she bothers to warm a bottle during the day it’s with annoyance and threats. So Jacob is out here in his basinet at the nurses’ station, uncomplaining, watching, still below birth weight at eight weeks old. In between laboring patients I pull the warm little bundle to my chest and pace with him, or rock in the office chair. We’re both in need of a little human touch, Jacob and I. We’re both pretty wide-eyed and quiet here on A5. I’m begging little blessings onto this frail fighter – and even though it’s already 9 pm, he’s the first person today to remind me to take a deep breath and say a prayer. I choke with wanting hope and health for Jacob, and I’ll participate in his care any way I am able. But somehow it’s becoming evident that he’s the one healing me.