She has the bluest eyes I've seen in years.........blonde hair and the face of a thirteen year old "girl next door". Her real age is twenty three. She is screaming at both her doctor and me to stop hurting her. We are trying to start an IV in her neck. In her neck because all the veins in her arms and legs are already destroyed by too many needles and syringes filled with heroin.
Her doctor finally gives up in disgust. "Why did you come to us if you didn't want us to help?" Her answer is the answer of a child. "I didn't know it would hurt like this. I wouldn't have come if I had known it was going to hurt." The intern has already been up all the previous day and through the night. She looks exhausted. The young woman starts screaming again. "I want to go home. You can't keep me here. Please........just let me go home."
The doctor looks old by intern standards. Maybe thirty five or forty years old. There are already streaks of grey in her hair. I wonder what road an Afro American woman has had to travel to reach an internship at her age. She stands back and begins the defining questions. "Do you know where you are? Do you know what the date is? What is your address?" Having determined that the young woman is mentally competant to make decisions, the intern tells her she can go home and die if she wants and leaves the room.
Those blue eyes follow me as I clean up the area around her bed. The sheet covers her body now. Only that little girl face, the blonde hair and her hands are showing. The hands have scabs on them where she has "Skin popped"....a last resort when addicts can no longer find a vein. She watches me as I pick up the remains of our attempts at starting an IV. "Am I really going to die?" I take this as an opening to talk. "Yes........if you go home without treatment, you WILL die." I wait for an answer. She just yawns and turns on her side. She goes to sleep without answering me.
Back at the nursing station, the doctor is writing orders in the chart. She looks angry as she slams the chart into the rack. "Don't forget to document what she said. If she goes home and dies, it's her fault......not ours." Her mouth is drawn in a tight line as she leaves the floor to answer another call to the emergency room. I suspect she is hoping the call is to help someone more deserving of life than is my patient.
Another of my patients this shift is gay. He is huge, at least six six and more than three hundred pounds. He has liver failure as a result of complications of AIDS. He comes to the nurse's station with an empty water pitcher. One nurse smiles and nudges another as they watch this hippo like man modestly hold his gown together with one hand and hold out his water pitcher with the other. He has a tiny voice for such a large man and........yes....he lisps. I take his pitcher and fill it with ice for him as he walks daintily back to his room.
Back in his room, he sits on his bed with his legs drawn up under him......as a young girl might. Perhaps this is the way he sees himself. I put the pitcher on his table and he thanks me. I am turning to leave the room when he speaks again. "My doctor says my liver is ruined.........." He lets the words hang there. He bites his lower lip. He looks like he might cry and I feel uncomfortable and don't know what to say. "Do you have a bible on this floor?" I nod yes and leave the room. When I get back to the nurse's station, a nurse sees me and begins to walk with an exaggerated, mincing walk. I ignore her. I find the bible and take it to his room.
I return from dinner to find several nurses looking out our fourth floor window. A young woman in a hospital gown and sweat pants is walking toward the bus stop on the corner. She has blonde hair. I call the intern on duty to report that my patient has left the hospital. The intern says "Good" and hangs up.
The shift is over and I'm home now. I sit here trying to make some sense out of this day. Maybe some common denomenator.........some lesson. I can't see one. I am writing this to salve my concience because I didn't have the words to stop that young woman from leaving.........nothing more.
Interns are newly graduated from medical school. Most have spent the past twenty years in school...... studying from books. Our interns write in their notes about patients "Abusing alcohol" because they admit to two to three beers a week. Many of my patients drink two to three quarts of vodka A DAY! Interns write notes about cigarette habits of sixty or more cigarettes a year. Most of my patients smoke that many A DAY. Interns write orders for mild analgesics to help patients sleep at night. Analgesics that might be appropriate for elderly men and women who drink a glass of sherry twice a year.
My patient with the "ruined liver" is crying quitely when I offer him his "sleeping pill" at 2100. He is scheduled for surgery in the morning. He tells me how he appreciates my giving him something to help him sleep because he has been having nightmares for the past two weeks. I look at this young woman in the body of a huge man and I feel shame for the many times over the years when I've made fun of "Queers". I go back to the nurse's station and call the intern on duty. I tell him that I will be calling him hourly during the night for additional meds if he doesn't give me an order for a stronger med to help my patient sleep now. He gives me the order I ask for. While I have him on the phone, I ask him to triple the dosage of Valium for the alcoholic in room 401. The man is already starting to hallucinate and is on the verge of full blown DTs.
I'm really tired tonight. I'll look at this attempt at understanding my day tomorrow. Maybe then I will feel differently. Right now though...........all I can do is wonder if maybe I have the answer. Maybe what I do is what someone has to do. I speak for these people who have no one else to speak for them. God help them..........maybe I am all they have.
The drug addicts, the patients with AIDS, the alcoholics, the gang members with bullets lodged in their spines..............these are my patients. If I don't speak up for them.........who will?
For those of you who see so clearly what is right and wrong........what is good and bad.......what is disgusting and what is "appropriate", all I can say is maybe you are like these young interns. Maybe you haven't sat with these people and seen their terror and confusion when they face death. When someone who could have been your son or daughter says "I didn't know it was going to hurt like this".
This isn't one of my stories. I will most likely delete this tomorrow. Whatever........it helps somehow just to put my feelings into words.
It's funny that it took me all these many decades to fully understand what those words meant that I learned as a child in Sunday school. "Judge not lest you BE judged."
