I like to believe that words can be likened to sutures. That the turns of phrases that we use to deliver unfortunate diagnoses and prognoses can be restorative, healing. I like to believe that the moments we spend at the bedside to listen, to share, and to learn are important.
I don’t like the emergency department. I didn’t like it as a medical student as I weaved my way between residents and attendings who ran through the pods with ultrasound probes. I didn’t like it last month as a first year resident as I worked my way toward room 45. Per chart review: 13 year old presenting after a syncopal event. Per observation: she was wearing glasses that were pretty cool (which I told her) and a bulky sweatshirt. She was incredibly tall (which I told her was an amazing thing) and incredibly reticent.
Her (adopted) mother filled the room with her description of what had led to their arrival to the emergency room after midnight. “She has post traumatic stress disorder and I think her symptoms are just a manifestation of that. I know her. We’re close. At least we used to be close. I think she’s stressed about school – we switched schools you know – and it’s harder and her ego is shot. I think this is the cause of her anxiety and her stress and honestly everything. Am I right?”
She responded with the gesture universally understood as “so-so.” I asked her mother to leave the room and sat in silence with her until she began to speak. She had a voice that would serve her well on the radio. She described her recent stressors and her recent trauma; her eyes welled with tears; her voice quivered. We sat there in silence before I responded. “Have you told your mother?” She shook her head. “Do you think you can tell her?” She shook her head again. “Why can’t you tell her?” And she said: “I don’t want her to think less of me because of this.”
We talked a lot about how important (maybe even life-saving) it is to be intentional about the circles within which we spend our time. The people we let into our lives. The people we let stay in our lives. The things we say and the things we choose not to say. She squeezed my hand before I left the room to present her story to my attending. As I presented, I felt myself tearing up and he interrupted for a moment with “these situations are challenging for me too; it’s ok. I get it.” In that moment we went from intern and attending to two humans acutely aware of the emotional burden of this career.
Her mother worked her way to our work station and said: “I don’t know what you said to her but thank you for giving my daughter back to me.” I sat there stunned and mumbled something that was most likely self-deprecating because praise has always made me uncomfortable. “She told me everything. Absolutely everything. And she said she could tell you understood her.” .
She was discharged from the emergency department. Before she left, she gave me a hug and said: “thank you for being my doctor tonight.” There were no studies drawn; no imaging conducted; no consults made; no broad differential diagnosis required. Yet the encounter reminded me of what drew me to this field. So to the girl with the fresh glasses: thank you.