I Dreamed a Dream
As a child, Christmas Eve used to be full of excitement, trying to fall asleep so the morning would come faster and trying to not hear mom and dad pattering past my bedroom to fill up the stockings or put the finishing touches on the bike or move the presents they’d stashed in their room out under the tree. This year, I glanced down at the right hand corner of the computer screen in the ER, “12:03,” and turned to the intern next to me who I barely knew, “Merry Christmas.” Most everyone else they schedule to work on Christmas is Jewish, so they didn’t care so much about the holiday, other than it meant that many patients come in because the holiday prevents them from going to their normal doctors.
One of the senior attendings tells me only the really sick or very lonely or crazy people come in on Christmas. I take to typing, “Happy Holidays,” at the end of the discharge summaries I write for the patients to take home. Of course some of them get admitted, which means that I have to convince my colleagues that the admission is valid—that the patient really does need to come in to the hospital. It’s tough to be a medicine resident in the emergency department world. The ED is the source of new admissions, some of which are very painful to deal with as inpatients.
I worked Christmas Eve, 7pm to 5am, but really didn’t leave until closer to 6:30 am, drove home in the dark, sat alone on the edge of my bed and opened the presents from my grandparents that I’d been saving, took a shower, put on my PJs as the sun rose, took klonapin and passed out. Bob awoke me several times around 10:30 by banging on my window wanting me to come have Christmas breakfast with him, Jane, Joseph, and Doug. He finally stopped when I stumbled out of bed, pulled an ear plug out and pushed back my black out eye cover and opened the door to tell him Merry Christmas and I’m sleeping and I work again at 7pm. I felt hung over. Christmas this year was a far cry from those I remember as a child.
Despite the sleep disturbances, I do find immense comfort in this place I live—in the people in it. Phillip and I had talked about his surfing career and my doctor career as he tanned by the pool. Jane and I spent Christmas Eve day riding our bikes along the beach (in the sand and through
the seaweed even!). I feel lucky to have crossed paths with these people who live in the nine studios around mine. I felt less isolated when I drove home Christmas morning and, though everyone’s lights were out, the Christmas lights we’d put up together were on; and some of my neighbors become friends were there, sleeping, or struggling with their own distances from their families or their dreams on Christmas morning. I wasn’t alone really, neither in space nor time nor sentiment. Because of that I didn’t cry until I woke up much later, and even then not for long before I remembered the joys of this life, and at “the root of the root and the bud of the bud,” how lucky and how loved I am. I woke up around 4pm, in time to watch the end of “Memoirs of a Geisha” with Jane, return to my place upstairs, cry a little over the stew I ate alone in my quiet kitchen and throw some scrubs back on as Joseph wandered in to say Merry Christmas and call me a humbug before I returned to work.
The first patient I signed up to see was an obese 24 year old woman with three young children whom she’d left with her sister while she lived at an alcohol rehab shelter; she returned to the ED for the third time that month with abdominal pain. She continued to have unprotected sex, but her last pelvic exam cultures from two days ago didn’t show anything growing, her abdominal CT didn’t show appendicitis or diverticulitis and her pregnancy test was negative. She may have irritable bowel syndrome, but she’ll see a primary care doctor to help her with that. She can get one after the holidays. Her family history of lupus stung me; it always shocks me a little back into remembering. I don’t think she noticed.
The new patients who need someone to see them pop up on the computer board in blue and what to my wondering eyes should appear, but Mr. Robinson, and triage notes of an another seizure! Again he’d broken his colostomy bag and I knew before I signed up for him that he would be covered in feces and probably drunk. I signed up; it would be easier than having someone new see him and I felt bad for the guy. He had most of his gut removed because of C. difficile colitis, which is somewhat similar to gangrene of your intestines, so now he had his bowel connecting to the outside of his body and supposed to drain into an attached colostomy bag, which he kept losing (this time he told me someone took it—I can only imagine that a used colostomy bag is quite a hot commodity on the streets). Plus he and I had a strange sort of understanding which would come in handy as the night progressed.
He had a new satchel since the last time I’d seen him two days prior, one that looked like it had been sewn by a charity organization, with Christmas tree fabric and a festive handle. I imagine it was given out to some of the homeless in town. He also had a new yellow scarf that looked like part of the same donation gift. At least it didn’t have poop on it. When I asked him about his new possessions, he was nonchalant and seemed not to care much about his new possessions nor the fact that I’d noticed them. But later in the night, when he refused to go to x-ray I went to talk to him about it and discovered that he was afraid if they took him to radiology that someone would steal his stuff.
His life is hard. He served in the military, hated it, and threatened to kill himself unless they let him out. His wrists are covered in scars from where he cut himself to prove his point. He was discharged, apparently without benefits. And now he’s homeless and unable or unwilling care well for his colostomy bag. I understand why he needed the surgery, but it still seems like a bad long-term picture for him, especially coupled with his alcoholism and seizures. It bugged me as I thought about him throughout the night, so I called surgery on-call. As soon as I mentioned his name they got defensive, “Oh no! We’re not admitting him. There’s no surgical issue.”
“I know, I know.” I had to calm them down so I could ask what I really wanted to know, “I just want to know if his colostomy is reversible.” I knew patients had had reversals of ostomies once their acute infection was over. Their bowel movements were never the same, but at least it would come out the right hole. “Oh,” the surgery intern calmed down when she realized I actually had a valid question about patient care and needed help answering it, “Sure, he can probably be reversed eventually, but it will be at least four months and we will have to keep him in decent shape until then.” He had some hope. That made me feel better for him. He gave me the same probing skeptical look he always did when I told him the news, but I think it was like our discussion about his new Christmas bag: he’d remember and think about it later.
I told him he was being admitted (to the medicine service instead of surgery) and he quizzed me on which room would be his. “I don’t know; the charge nurse and the transport people will know when they take you upstairs.”
“A lot of help you are!” He yelled at me.
I looked at him and said, “I am a lot of help, actually. I’m trying to figure out what is best for you. And there’s no reason to yell.”
“I don’t have to do what you tell me to do,” he yelled again.
“That’s true. It’s always your choice. We make recommendations on what we think is in your best interest. There’s no reason to yell and be disrespectful.”
He calmed down and apologized, “I’m sorry, Doc. I’m hard of hearing so I talk loud. I’m sorry,” his voice softened considerably and he stared piercingly at me again.
“What’s with the look?” I asked.
“What look?”
“You’re looking at me like you have something more you’d like to say.”
He paused, “Why is your hair light and your eyebrows dark?” I knew he saw more than he let on. Somewhere in him, buried in some tortured past was a man who noticed things. He’d told me
on his last visit that his ex-wife had blond hair and green eyes.
“I don’t know,” I answered him about my eyebrows, “they’ve always been that way.”
“I like it.”
“Me too. They’re going to come get you for x-ray soon. We’ll close the door so no one takes your stuff.”
“Okay, Doc,” his voice had lost the hunted animal edge for the time being, “Could you please turn out the light when you go? The brightness gives me a headache.”
I walked out and switched the light off on my way. They took him upstairs soon after the x-ray.
A 22 year old man with diabetes got arrested for possession on Christmas night; his blood sugar was much too high when they checked it in prison, so the cops brought him to me. His personal guard hovered at his bedside all night asking when he could take him back to jail. When we’d finally given him enough fluid and insulin, I saw him walk back out in handcuffs and his jaunty brown fedora-type hat. It was a rough Christmas for him, too. The hospital where I work has the “jail contract” so if anyone gets sick in or on their way to jail, they come to us, with chains around their ankles and wrists and waist and cops always at their bedside.
In the wee hours of Christmas morning, I sewed up the eyebrow of a tough-looking convict who’d had a seizure in jail and hit his face on the cement floor as he fell while seizing. He needed a head CT so I waited until they’d taken him for that and he fretted over the little numbing needles I told him I would use. He wanted to be completely sedated for the suturing. He ended up having bones in his face fractured and a small head bleed. His cop escort asked me if his wounds were more consistent with a fist fight than a seizure. It’s possible, but with unwitnessed events we can’t know for sure.
Another of my patients slept on a gurney in the hallway most of the night while we evaluated her weakness and high blood sugars and dementia. She spoke no English and her caregiver had left her there hours before, saying she’d return soon. My patient used to be the nanny for the twenty-four year old girl who now cared for her. They didn’t know I spoke Spanish when they said, “La doctora? Muy joven.” Very young.
“Tengo veinte-nueve anos.” I told them I am 29. The young woman told me she is 24 and had a young son so she took time off from school to raise him. She seemed envious of my ability to dedicate time to a career instead of a family. The envy was conversely mutual. People often ask me how much school it takes to be a doctor. The factual answer is four years of med school after college and then residency length varies depending on specialty. The real answer is: your whole life. One of my residents in medical school told me that once you become a doctor, it’s not something you can separate out from the rest of your life. I think you can sometimes. I think you have to. Otherwise you go crazy yourself.
“I dreamed a dream my life would be, so different from this hell I’m living.” I’m reading “Le Mes”, Fantine has just left her beautiful daughter Cosette with the mean inn-keeper’s wife because her cad of a boyfriend deserted her and she has to work to support herself and her daughter. I dreamed I’d have my own child now, a someone with whom to celebrate Christmas, some time, no pill boxes or “past medical history” of my own. But just because it’s different, doesn’t make it bad. Hard sometimes—and lonely—but not a “hell I’m living.” As I told Joseph when I left for Spain, this life gives me space to take such adventures. It was a different Christmas; perhaps working in the Emergency Department is the best way to help—in the true spirit of the season.
One of the senior attendings tells me only the really sick or very lonely or crazy people come in on Christmas. I take to typing, “Happy Holidays,” at the end of the discharge summaries I write for the patients to take home. Of course some of them get admitted, which means that I have to convince my colleagues that the admission is valid—that the patient really does need to come in to the hospital. It’s tough to be a medicine resident in the emergency department world. The ED is the source of new admissions, some of which are very painful to deal with as inpatients.
I worked Christmas Eve, 7pm to 5am, but really didn’t leave until closer to 6:30 am, drove home in the dark, sat alone on the edge of my bed and opened the presents from my grandparents that I’d been saving, took a shower, put on my PJs as the sun rose, took klonapin and passed out. Bob awoke me several times around 10:30 by banging on my window wanting me to come have Christmas breakfast with him, Jane, Joseph, and Doug. He finally stopped when I stumbled out of bed, pulled an ear plug out and pushed back my black out eye cover and opened the door to tell him Merry Christmas and I’m sleeping and I work again at 7pm. I felt hung over. Christmas this year was a far cry from those I remember as a child.
Despite the sleep disturbances, I do find immense comfort in this place I live—in the people in it. Phillip and I had talked about his surfing career and my doctor career as he tanned by the pool. Jane and I spent Christmas Eve day riding our bikes along the beach (in the sand and through
the seaweed even!). I feel lucky to have crossed paths with these people who live in the nine studios around mine. I felt less isolated when I drove home Christmas morning and, though everyone’s lights were out, the Christmas lights we’d put up together were on; and some of my neighbors become friends were there, sleeping, or struggling with their own distances from their families or their dreams on Christmas morning. I wasn’t alone really, neither in space nor time nor sentiment. Because of that I didn’t cry until I woke up much later, and even then not for long before I remembered the joys of this life, and at “the root of the root and the bud of the bud,” how lucky and how loved I am. I woke up around 4pm, in time to watch the end of “Memoirs of a Geisha” with Jane, return to my place upstairs, cry a little over the stew I ate alone in my quiet kitchen and throw some scrubs back on as Joseph wandered in to say Merry Christmas and call me a humbug before I returned to work.The first patient I signed up to see was an obese 24 year old woman with three young children whom she’d left with her sister while she lived at an alcohol rehab shelter; she returned to the ED for the third time that month with abdominal pain. She continued to have unprotected sex, but her last pelvic exam cultures from two days ago didn’t show anything growing, her abdominal CT didn’t show appendicitis or diverticulitis and her pregnancy test was negative. She may have irritable bowel syndrome, but she’ll see a primary care doctor to help her with that. She can get one after the holidays. Her family history of lupus stung me; it always shocks me a little back into remembering. I don’t think she noticed.
The new patients who need someone to see them pop up on the computer board in blue and what to my wondering eyes should appear, but Mr. Robinson, and triage notes of an another seizure! Again he’d broken his colostomy bag and I knew before I signed up for him that he would be covered in feces and probably drunk. I signed up; it would be easier than having someone new see him and I felt bad for the guy. He had most of his gut removed because of C. difficile colitis, which is somewhat similar to gangrene of your intestines, so now he had his bowel connecting to the outside of his body and supposed to drain into an attached colostomy bag, which he kept losing (this time he told me someone took it—I can only imagine that a used colostomy bag is quite a hot commodity on the streets). Plus he and I had a strange sort of understanding which would come in handy as the night progressed.
He had a new satchel since the last time I’d seen him two days prior, one that looked like it had been sewn by a charity organization, with Christmas tree fabric and a festive handle. I imagine it was given out to some of the homeless in town. He also had a new yellow scarf that looked like part of the same donation gift. At least it didn’t have poop on it. When I asked him about his new possessions, he was nonchalant and seemed not to care much about his new possessions nor the fact that I’d noticed them. But later in the night, when he refused to go to x-ray I went to talk to him about it and discovered that he was afraid if they took him to radiology that someone would steal his stuff.
His life is hard. He served in the military, hated it, and threatened to kill himself unless they let him out. His wrists are covered in scars from where he cut himself to prove his point. He was discharged, apparently without benefits. And now he’s homeless and unable or unwilling care well for his colostomy bag. I understand why he needed the surgery, but it still seems like a bad long-term picture for him, especially coupled with his alcoholism and seizures. It bugged me as I thought about him throughout the night, so I called surgery on-call. As soon as I mentioned his name they got defensive, “Oh no! We’re not admitting him. There’s no surgical issue.”
“I know, I know.” I had to calm them down so I could ask what I really wanted to know, “I just want to know if his colostomy is reversible.” I knew patients had had reversals of ostomies once their acute infection was over. Their bowel movements were never the same, but at least it would come out the right hole. “Oh,” the surgery intern calmed down when she realized I actually had a valid question about patient care and needed help answering it, “Sure, he can probably be reversed eventually, but it will be at least four months and we will have to keep him in decent shape until then.” He had some hope. That made me feel better for him. He gave me the same probing skeptical look he always did when I told him the news, but I think it was like our discussion about his new Christmas bag: he’d remember and think about it later.
I told him he was being admitted (to the medicine service instead of surgery) and he quizzed me on which room would be his. “I don’t know; the charge nurse and the transport people will know when they take you upstairs.”
“A lot of help you are!” He yelled at me.
I looked at him and said, “I am a lot of help, actually. I’m trying to figure out what is best for you. And there’s no reason to yell.”
“I don’t have to do what you tell me to do,” he yelled again.
“That’s true. It’s always your choice. We make recommendations on what we think is in your best interest. There’s no reason to yell and be disrespectful.”
He calmed down and apologized, “I’m sorry, Doc. I’m hard of hearing so I talk loud. I’m sorry,” his voice softened considerably and he stared piercingly at me again.
“What’s with the look?” I asked.
“What look?”
“You’re looking at me like you have something more you’d like to say.”
He paused, “Why is your hair light and your eyebrows dark?” I knew he saw more than he let on. Somewhere in him, buried in some tortured past was a man who noticed things. He’d told me
on his last visit that his ex-wife had blond hair and green eyes.“I don’t know,” I answered him about my eyebrows, “they’ve always been that way.”
“I like it.”
“Me too. They’re going to come get you for x-ray soon. We’ll close the door so no one takes your stuff.”
“Okay, Doc,” his voice had lost the hunted animal edge for the time being, “Could you please turn out the light when you go? The brightness gives me a headache.”
I walked out and switched the light off on my way. They took him upstairs soon after the x-ray.
A 22 year old man with diabetes got arrested for possession on Christmas night; his blood sugar was much too high when they checked it in prison, so the cops brought him to me. His personal guard hovered at his bedside all night asking when he could take him back to jail. When we’d finally given him enough fluid and insulin, I saw him walk back out in handcuffs and his jaunty brown fedora-type hat. It was a rough Christmas for him, too. The hospital where I work has the “jail contract” so if anyone gets sick in or on their way to jail, they come to us, with chains around their ankles and wrists and waist and cops always at their bedside.
In the wee hours of Christmas morning, I sewed up the eyebrow of a tough-looking convict who’d had a seizure in jail and hit his face on the cement floor as he fell while seizing. He needed a head CT so I waited until they’d taken him for that and he fretted over the little numbing needles I told him I would use. He wanted to be completely sedated for the suturing. He ended up having bones in his face fractured and a small head bleed. His cop escort asked me if his wounds were more consistent with a fist fight than a seizure. It’s possible, but with unwitnessed events we can’t know for sure.
Another of my patients slept on a gurney in the hallway most of the night while we evaluated her weakness and high blood sugars and dementia. She spoke no English and her caregiver had left her there hours before, saying she’d return soon. My patient used to be the nanny for the twenty-four year old girl who now cared for her. They didn’t know I spoke Spanish when they said, “La doctora? Muy joven.” Very young.
“Tengo veinte-nueve anos.” I told them I am 29. The young woman told me she is 24 and had a young son so she took time off from school to raise him. She seemed envious of my ability to dedicate time to a career instead of a family. The envy was conversely mutual. People often ask me how much school it takes to be a doctor. The factual answer is four years of med school after college and then residency length varies depending on specialty. The real answer is: your whole life. One of my residents in medical school told me that once you become a doctor, it’s not something you can separate out from the rest of your life. I think you can sometimes. I think you have to. Otherwise you go crazy yourself.
“I dreamed a dream my life would be, so different from this hell I’m living.” I’m reading “Le Mes”, Fantine has just left her beautiful daughter Cosette with the mean inn-keeper’s wife because her cad of a boyfriend deserted her and she has to work to support herself and her daughter. I dreamed I’d have my own child now, a someone with whom to celebrate Christmas, some time, no pill boxes or “past medical history” of my own. But just because it’s different, doesn’t make it bad. Hard sometimes—and lonely—but not a “hell I’m living.” As I told Joseph when I left for Spain, this life gives me space to take such adventures. It was a different Christmas; perhaps working in the Emergency Department is the best way to help—in the true spirit of the season.
The New Colossus
Not like the brazen giant of Greek fame,
With conquering limbs astride from land to land;
Here at our sea-washed, sunset gates shall stand
A mighty woman with a torch, whose flame
Is the imprisoned lightning, and her name
Mother of Exiles. From her beacon-hand
Glows world-wide welcome; her mild eyes command
The air-bridged harbor that twin cities frame.
"Keep, ancient lands, your storied pomp!" cries she
With silent lips. "Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!"
Emma Lazarus, 1883
With conquering limbs astride from land to land;
Here at our sea-washed, sunset gates shall stand
A mighty woman with a torch, whose flame
Is the imprisoned lightning, and her name
Mother of Exiles. From her beacon-hand
Glows world-wide welcome; her mild eyes command
The air-bridged harbor that twin cities frame.
"Keep, ancient lands, your storied pomp!" cries she
With silent lips. "Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!"
Emma Lazarus, 1883
posted by S. at 10:10 PM
2 Comments:
thanks for your comment on my blog :)
Happy Holidays to you too, S.
It has been a trying time for me, this year.
I hope you are doing well. I find I connect with you on some level. Especially your view on gratitude. The 'gratitude attitude' is what fails me at times and those are the hardest days.
Having said that, today so far I have been grateful for my perfect cup of coffee and a compliment I received at work.
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