Trying not to feel
I held it together until I got to my car. But away from other doctors and nurses and the harsh fluorescent lighting and aseptic corridors I cried. They were harsh, ugly tears. It was not because I had a bad day - I survived plenty of those. It was not for the rejection I continue to face each day or this year long consults rotation without weekends or holidays. What finally got me was a young lady who died before her time.
I met her a week earlier in the ICU, where she was admitted for fever, pancytopenia, acute renal injury and liver failure. Without disclosing too much history, I can say she was an immunosuppressed patient and I was called to evaluate her for atypical infections. Despite how sick she was in the chart, I found her in good spirits. Her mother stood as a sentinel at her bedside, swooping in to expand on symptoms when the patient tried to minimize.
“How long have you felt ill?” I inquired.
“The past few weeks…”
“Well for several months she has had mysterious symptoms,” her mother interjected.
The interview proceeded in this manner, the story unfolding as an amalgam from the patient and her mother. But as the puzzle came together I realized this was not an infection - her symptoms fit better with a rare autoimmune blood disorder. Despite this I continued to follow, interested in the case overall.
As I typically do, I tried to learn about who my patient was, the context of her beyond her illness. She had recently moved across the country to live with a family member, which seemed like a new start of sorts. She was an aspiring artist, currently working on commission. We bonded over video games and movies. She reminded me so much of my sister, another young woman trying to find her place in the world.
She declined quickly. I returned from a day off to find her encephalopathic and unresponsive. Her liver could not keep up and her kidneys failed to the point of requiring dialysis. Her porcelain skin had grown yellowed and jaundiced. Her breathing was agonal and labored. Despite broad antibiotics, steroids for her presumed autoimmune disorder and vasopressors, she teetered on the edge between life and death.
After a few days of this tension - the balancing act of machines and medications supporting her physiology - her family began to face harsh realities. Ultimately her family decided to withhold further aggressive care. She passed very quickly.
Each day I am confronted with death. I can typically handle this with mental acrobatics, compartmentalizing the bad and reiterating the good. A regular dose of alcohol also helps to sterilize the emotions. But this one hurt - perhaps because she was so young, perhaps because I saw so much of my sister in her, or perhaps because as medical providers we had so little to offer. Regardless of the reason, she remained constantly on my mind in the days to follow, like an anchor holding me to the emotions I try so hard to quell.
Following her death I cried alone in my car. In the days that followed I tried to talk to other fellows and to attendings, but everyone was too busy fighting their own mental battles, rushing each day in the hopes of making it home at a reasonable hour. With enough distance I was able to again compartmentalize, shoving the sadness deep down. Maybe with a little more time I will stop wondering about all the art she did not produce; all the video games she did not play. Maybe eventually I will be able to stop wondering who this woman would have been if she had found her way.
