Little Things Matter

2013
Kmet, Alexander

Winner, AMS–Mimi Divinsky Award for History and Narrative in Family Medicine for a story from a family medicine resident or medical student.

“Is there anything else you need tonight?” I asked her from the doorway to her emergency room.  The dark inside her room was betrayed by a stream of light edging around the parted cloth shades held apart by my hand.  I held the barrier open, connecting her world to that of the recently stilled department.  The light cast aside few shadows but I could see enough to emphasize the meagerness of her frame and the gaunt lines of her memorably gentle face.

I edged towards her bed and sat in a depression amongst the ruffled blankets.  The space was still warm from the heat left by her recently departed husband.  I remember thinking that he looked tired.  The night had been long and its events were familiar; this was not the first time we had seen each other, and surely it wouldn’t be the last.  I watched him leave with lines of worry on his face, lost in a mix of fear and hope after saying his loving farewells for the night.  I imagine that he was resigning himself to a night of helpless rest before returning, as he always did, early in the morning.  I know that he had to hold his wife’s hand again.

“I’m heading home for the night and wanted to make sure that you had what you needed before I left.”  I said the words as her fevered hand lay upon mine.  “Like the last time we saw each other, your chemotherapy has made you vulnerable to infection and we’re treating you for your fever.  Now we let the medicine take its course and we’ll keep you comfortable until you’re ready to go home.”

Her heavy-lidded eyes peered unwaveringly into mine from her sunken orbits. I remember her gaze being remarkably soft, betraying no hint of worry.  Her pale face spoke nothing of tragedy despite the skeletal exaggeration of her ongoing wasting.  She was a picture of calm.  As a young medical student, no face had yet to become as etched into my experience as hers already had; I suppose that’s what happens when you travel on a journey together for a while.

“This tag I have on my wrist,” she said as she nodded to the yellow plastic snake constricting itself about her limb.  “The end of it is poking me.  It hurts.” 

“Then we’ll fix it,” I said as I stood from the bed.  I gave her soft hand a quick squeeze and set off in search of the ridiculously well hidden department scissors.

While hunting for my metal prey, I quickly revisited the night with her in a practiced routine of obsessive indulgence.  A 66-year-old lady with Multiple Myeloma whose last dose of chemotherapy was 3 days ago developed a fever today.  Her neutrophil count is 0.1.  Labs, xray and cultures… Check.  Antibiotics… Check.  Home medications… Check.  I’ll see her in the morning and she’ll be feeling better… Check.  What am I doing?  Scissors.  Ah, yes!  Scissors…

I walked back into the room, catching her in the midst of dozing off to a contented sleep.  Like her husband, she also looked exhausted.  Her illness was mechanically making headway despite our continued attempts otherwise. 

Months of time had rapidly passed since we’d first met under strikingly similar circumstances, and though her body bore the evident burden her unforgiving illness, I swear that her smile nonetheless grew brighter.  Or, at least that’s what I told myself.  It was easier to for me to see it that way.

I quietly crept to the edge of her bed, avidly hoping to avoid waking her.  I gingerly reached down to grasp the protruding tail of her yellow allergy bracelet and brought the scissors close.  Snip.  The disconnected end of the serpent’s poisonous coil fell to the floor.

“Thank you,” the words were spoken beside me.  Two faint words, scarcely heard through their tender tone.  Two faint words, said in sincerity for an act hardly worth notice.  I looked up.  Her head hadn’t moved, but her eyes shone bright.  The same eyes that I first saw worried months ago now spoke of nothing but grace as they saw into mine.

“You’re welcome,” I said.  “I hope you have a good night of rest and I’ll see you in the morning.”  One last gentle squeeze of her heated hand and I turned to go.

I reached the doorway and turned around to offer her a few last words goodnight.  I never made it past the silence; she was already sleeping.  A stream of light snuck around the curtain that my hand was holding aside, revealing her shrunken form lying quiet in slumber.  The blankets rose and fell in the soft rhythm of her breath and I knew that the night’s work was done.

The next morning my hurried boots echoed off the walls of the hallway to the beat of a dramatic military march.  I always walked that way in the mornings, figuring that there were things to be done.  I came to the desk on the ward, wondering how she fared through the night.  I looked for her chart in the rack but couldn’t find it.  It’s supposed to be right there.  Instead, an empty space leered at me.

“She died in the night,’ her nurse said knowingly from behind me.  She must have walked up while I was lost in search.  I turned to look at her as her mouth reflexively voiced the phrase “I’m sorry.”  I heard every word.

5 months of memories flooded my mind.  A journey of laughter, tears, smiles and fear displayed itself in a torturous image of sudden clarity.  My first patient had died.  My patient.  Every look given, every smile shared and every word uttered ran amok through my mind, leaving me alone.  I came this morning to create another moment with her.  I came this morning to find her gone.

I was left standing, shocked, with memories of her gentle grace and my own guilt.  I was left standing with two faint words shouting, ringing in the empty silence of my despair.  Two faint words…

“Thank you,” she had said.  It had made all of the difference to her, cutting that nefarious yellow tag.  That one little thing had made her comfortable.  I thought it was unimportant, but that last little thing is what I left her with.

“Thank you.”  It’s what mattered in the end.

Theme: Death and Dying | Décès et le mourir
Theme: Patients | Patients
Theme: Relationships | Relations

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.

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