Jenny Blair: What You Should Not Forget

(courtesy of Mason,--got me thinking about how our perspectives shift throughout our journey in life (hours, daily, weekly, monthly, by year, decade/s, etc) and the influence of what we choose to remember and forget--how that shapes our understanding and meaning. The style/perspective of this essay seems to be influenced by Atul Gawande.)

What You Should Not Forget
By Jenny Blair, M.D.
Hartford Courant

“O, I have pass'd a miserable night, So full of ugly sights, of ghastly dreams…"
-- Shakespeare, "Richard III"

Drunk drivers crash, and come to you. They breathe in and they breathe out, and the reek of alcohol mingles with the sweetish smell of blood. They lie with eyes half-open, snoring, too drunk to know they are injured. Their clothes are strewn like trash around the room, filthy with blood and the rubbed-in dirt that a sot collects.

The nurse has spotted you in the hallway and asks you to come in and speak to the wife of your patient, one of those drunks who lost control in the middle of the night. Thirty hours later, she has found him, and she is frantic at the sight of his face, which is broken, swollen, barely recognizable. You would rather look at his face, though, than hers.

Some of the senior residents have grown coarse. The unrepeatable words they speak are at grave odds with their white coats. They guffaw about the hopelessness of people's injuries. They call each other by their last names and say, "Quit your whining" when one of the medical students confesses that she vomited yesterday during rounds.

Your pager chortles a different, more insistent tune. It's a code. You put aside your paperwork, shoulder your bag, and find the nearest stairwell; where like an iron filing you join the people from all directions moving straight to the patient whose heart has stopped. The patient lies there unconscious, a set of memories in a fading body that no longer has a right to modesty. Someone's at the groin trying to insert a venous line. Someone's at the head trying to push down a breathing tube. Someone's leaning broad-shouldered over the chest doing CPR. You glimpse a pair of flaky feet, a thin neck, an unresisting arm with its messily taped-on IVs. A heart monitor jaggedly registers every chest thrust, but nothing native in between. The room is full of people. You're unsure whether they - and you - are there to help, or just to watch.

A resident belittles one of the interns in front of four or five colleagues. Because 11 new traumas came into the ER last night, she has not completed a small task on one of the stable patients upstairs. Her hair is tangled; she hasn't had a moment's rest during her 24-hour shift, and she is angry. As you try to console her, you hear yourself calling that resident things you never say about other people. You feel sick.

A man comes in with terrible frostbite. He is homeless, a drunk, an illegal alien who hardly knows a word of English. Through an interpreter, he tells you that his friends took his shoes as a joke. Now he sits with his bleeding toes propped on a pillow and gestures mournfully at them every morning when you come in. While they heal, he will be there for months, as he has no place to go.

Some joke.

"From that time on she had known that beauty is a world betrayed. The only way we can encounter it is if its persecutors have overlooked it somewhere."
-- Milan Kundera, "The Unbearable Lightness of Being"

An elderly veteran with the AIDS virus shows you a gratitude so intense it seems to sanctify him, when all you've done is arrange a referral to another doctor. He holds your hand in both of his, looks you in the eye, and says, "Thank you for everything you've done, doctor." He says it over and over.

A friend has e-mailed you a few exquisite lines by a Spanish poet, followed by his own translation. You read it in the din of the emergency room. You print it out, fold it, and put it in your pocket, so you'll know it's there all day.

A nurse scolds you because you did not say "good morning" before you walked up and asked her something. You feel ashamed, and grateful for your shame.

Lunch today was packed by a sister who stayed up late to stir-fry it. You haven't seen her in two days, but she has rubbed cheese on a grater over the vegetables to make them taste better.

A rumor goes around among the nurses: Doctors Without Borders has announced that they have actually been given enough money for their tsunami relief effort.

You decide to buy the man with frostbite a newspaper in his own language.

The attending physician this week knows your name. He calls you by it, and he looks you in the eye. To every patient on rounds, he introduces you and every other resident and medical student in the group. He speaks to the patients as human beings, in sharp contrast to everyone around him. Somehow he has not been worn down. He touches each patient on the shoulder. He is unhurried. "How else can we help this lady?" he asks us earnestly, once he has named every strategy he can think of.

As he says it, a strange thought comes: If this doctor asked, you would do anything for him. You are unaccustomed to feeling that way. You didn't know you still could. You had forgotten that there can still be heroes.

Jenny Blair is a graduate of the Yale School of Medicine. She is now a resident in emergency medicine at the University of Chicago. All patients' stories are real, but their identities are concealed for confidentiality reasons.

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