Class of 2018
I notice him several times as I hurry past, wondering to myself what his story could be. He’s quite an old man, at least in his 80s. From a distance, I see two bulging black eyes, his face a mess of dripping blood. He’s observing the hustle of the ER with the expression of an accidental spectator at a cricket match: curious, but evidently a bit lost. I read the chart as I stride towards him: tripped and fell forward onto his face. Lives alone in a retirement home. On blood thinners.
I introduce myself as I approach. Hi Jan, I’m a first year medical student. I’m here to ask you a few questions about what brings you in today. As I get a closer look at him, I take in the dismal condition of his face: bright red blood is leaking from multiple scrapes on his nose and forehead, caking the crevices of his deep wrinkles and spilling onto his neck. He’s having trouble opening his eyes due to the prominent puffy purple bruises that surround them. The blood thinners he’s on are responsible for the rather dramatic result of a not-so traumatic fall; his face is almost caricature-like from the injuries. He’s very pleasant, with a thick Polish accent that instantly warms my heart, bringing to mind my own beloved grandfather. He recounts tripping over a curb and falling onto his face, in the kind of voice that suggests he finds this whole affair quite comical.
He’s the last patient I need to see and I take my time with him. As I ask more personal questions the flow of the conversation shifts, and soon I’m just listening. The same man who had trouble remembering the series of today’s events is now deep in the art of story-telling. His Polish accent is as comforting to me as a favourite sweater. He tells me about his childhood, displaying a wry grin.
But then his tone changes. He talks about his beloved son whom he lost to cancer. He tells me of his late wife that he continues to mourn, how the loss is as tangible and ever-present as a missing limb. He speaks of his father who died of a heart attack the night he elected to attend a party instead of helping with farm chores. He tells of the loneliness he often feels. There’s a young couple that sometimes visits and will take him out for dinner once in a while, but he admits he loans them money in return. As he speaks, tears leak out the corners of his eyes, and I alternate between dabbing blood away from his nose with one hand and soaking up tears with the other. Every once in a while he’ll pause and sigh. Thanks for listening. I just nod, my heart squeezing with a deep sorrow at the immensity of his grief.
His words, his tears and his blood begin to slow. He tires. I finish the bandaging, thank him for offering me such a privileged glance into his world, and wish him a good night. I walk back to the main desk to debrief with my preceptor. She recognizes my distress and, being the wise doctor she is, leads me to the Quiet Room in the hallway, closing the door gently as she leaves.
Feeling grateful, I sit down in the corner and lean forward. I squeeze my eyes shut and let the tears drip steadily. I feel the warm drops on my legs as they soak into my sea foam green scrubs. With my eyes shut, I see the faces of my patients from the past few weeks: the 37-year-old Aboriginal woman with diabetes experiencing multiple end-stage organ disease. The 27-year-old woman with a chronic pain flare up, who, only after extensive questioning let on that the onset coincided with being stalked by an abusive ex-partner. The 90-year-old man who came in with a heart rate of 22, his eyes wide and terrified, who held my hand so desperately when I offered it. And Jan, his puffy raccoon eyes and blood-soaked face. While I had spent the first few weeks in the ER riding high on the excitement, the challenge, the constant learning, I found myself now facing the other constants of this work: the pain, the fear, the desperation—as well as the limitations of pills and procedures when it comes to addressing human suffering.
I let myself sit in the Quiet Room, the safe haven for patients and healthcare workers alike from the stress and grief of the ER. I imagine all the tears that had been shed within its calming, nursery-yellow walls. It is just the beginning of my medical career, and I wonder about the long-term toll of genuine empathy. I think of an article I read recently about how to keep loving someone: when the lust and the excitement die down, when there are bills to pay and never enough hours in a day. It occurs to me how relevant this is to my chosen profession. How do I continue to care—ultimately an act of love—with all the pressure, the to-do’s, the seemingly endless well of need? I see the various ways the ER doctors and nurses cope—some in healthy ways, others with the same dangerous vices we warn our patients against. Some with one hand on the doorknob and both eyes on their watch.
So how will I continue to care? The article offered this advice: “To keep loving someone is an art. The start is the easiest part. To keep loving someone, you have to suspend the present moment in your mind and remember why you decided to love this person in those first glittery months of newness” (1). This idea resonates: I need to remember myself as this open-hearted, wide-eyed student with a deep love for people and a potent belief in the healing potential of medicine. Moreover, I need to continuously refine the art of caring: a balance of being present and genuine, yet able to set boundaries. Of taking time to nurture myself before I attempt to nourish others. Of finding time to feel, to process.
I change out of my tear-stained scrubs back into my day clothes, grateful to have a 30-minute drive on smooth, empty road ahead of me.