Unassuming Companion

2014
Tripodi, Deanna

There is something about night shifts that is different. With an almost palpable, primitive rhythm underlying the stillness of the night. There is a heightened viscosity to ones’ movements. A dark and mysterious quality to those encountered. An unrelenting undercurrent of static, if you will, like someone left the television on long after the last program had aired.

And so it was, that night, the older couple entered the Emergency Department seeking assistance. The door lapsed in time, suspended by the air caught momentarily between the invisible. Ajar just long enough for the Unassuming Companion to reach their side. Then the metal on metal of door against frame clanged shut behind them. The deep chill to the night seeped in, lingering long after the couple had been ushered away.

They walked arm in arm down the hall to the bed. Their strides matched in a way that only years of knowing between two can refine things to a demi-dance. The sound of her coughs blended into the baseline hum of the department. It was only the sound of leather shoes against a tiled floor that stood out from the rest.

The story was a simple one: Ten-day history of cough and fever. No worse tonight but no better either. A differential considered. Cough, shortness of breath and fatigue all noted.

Her husband sat closely to her right. Diligent. Respectful. Attentive. With a single glance, he translated her thoughts aloud. Rocking back and forth slightly in the chair as he spoke, the history of his wife’s onset and progression of symptoms unfolded. The Unassuming Companion stood silently at the head of the bed to her left, as if waiting patiently to tell his version of the story that had not yet unfolded. His stance was formal by comparison but relaxed enough to suggest a familiarity of the process already well underway. Labs were ordered. IVs started. The chest x-ray confirmed pneumonia. Perhaps she, too, had contracted the invasive strain of pneumococcal running rampant in the community. Internal Medicine consulted immediately for patient admission.

The trio was apprised of the results.

“Why? Why? Why didn’t the walk-in-clinic doctors do anything about this?” she demanded. “I went back THREE times-s-s,” she puffed, and by way of emphasis waved her three middle fingers in the space between us. Her oxygen mask hissed the ending to her last spoken word in a way that expressed a merging of her frailty, fatigue and frustration. There was not a reasonable explanation for this, and that, she was subsequently informed. The husband shared both her frustration and fatigue. He stood bravely to shake my hand. His eyes held a blend of appreciation and relief, with a slight hint of doubt noted as an afterthought. It was the latter that slowed time between us at the bedside. Those eyes. It was those haunting eyes framed by creases in the skin that hung like cobwebs made heavy by rain. They were the eyes of a wounded soldier looking into a future he no longer understood. The eyes of one man, a man who had fought with good intentions but who now stood lost in the world he found himself engulfed by. Uncertain of who the true enemy was, too exhausted by the process to fight.

She would get the assistance she needed, he repeated in his mind. Sufficiently reassured, he elected to return home to sleep for the few remaining hours before dawn. It was the Unassuming Companion who nodded in support of his decision. As if on guard, he remained standing to her left, while she slept comfortably for the first time in days.

But something sinister took place behind the carelessly drawn curtains surrounding Bed #5. It may have been a slow, seductive dance with the devil. Or perhaps the use of secret potions or covert negotiations. What is clear though is that as time passed, minute by minute, illusively so too did she.

Acute Respiratory Distress – Bed #5.

The patient was cleared for the trauma bay. Bodies clad in green and blue polyester scrubs, interspersed with white coats of varying lengths, created an undulating wave of movement. A magnetic pull redefined the gravitational centre of the department to the resuscitation room. The patient, now lethargic, was wheeled past the nursing station and down the hall. Nurses connecting tubes. Physicians calling out orders. Respiratory therapists pumping 100% oxygen with metronomic precision. Only the Unassuming Companion did not appear flustered. He walked briskly in line with the rest. His immaculately-pressed suit jacket flapped behind him as he kept pace. He remained at her bedside – head of the bed, to patient left. The silver hue to his dark suit momentarily shimmered as it caught the overhead lights. No one thought to escort him out. No one took notice of him at all. 

Suction! Suction.
Endotracheal tube! ET tube placement confirmed.
Central line. Central line in.
ABG stat! ABG drawn.
Dopamine. Dopamine running.
Chest compressions. Compressions started.
Pulse check, stop compressions. No pulse. No pulse.
Chest compressions - resume. Chest compressions resumed.
Pulse check, stop compressions. No pulse. No pulse.
Chest compressions - stop. Chest compressions stopped.
Code called: 04:27H.

It was then, and really only then, that I looked up. In that moment, the Unassuming Companion was as clear as clear could be. Our eyes did not meet for he stood unchanged in his stance, gazing down at the patient, knowing expression on his face. His job was done; as too was ours.  

Theme: Death and Dying | Décès et le mourir
Theme: Family | Famille
Theme: Health Care Delivery | Prestation des soins de santé
Theme: Patients | Patients
Theme: Physicians | Médecins
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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