|NARRATIVE MEDICINE SYMPOSIUM ON COVID-19: INDIVIDUAL CONTRIBUTIONS
|Year : 2020 | Volume
| Issue : 2 | Page : 136-138
Diksha Mishra, Manish Garg
New York Presbyterian Hospital/Weill Cornell Medical Center; Columbia Irving Medical Center, New York City, New York, USA
|Date of Submission||28-Apr-2020|
|Date of Acceptance||04-Jun-2020|
|Date of Web Publication||29-Jun-2020|
Dr. Diksha Mishra
241 E. 86th St. NYC, NY 10028, 412-251-8509, New York
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mishra D, Garg M. Being human. Int J Acad Med 2020;6:136-8
A family of four run past me at the subway station. I stumble slightly as the little girl's purple skirt brushes against my leg, my arms filled with grocery bags. I really shouldn't have bought those two extra boxes of cereal. Oh well. “New Yorkers never do stop running,” I think to myself. Even COVID can't keep them from getting where they need to go.
We don't run in the Emergency Department. Patients tend to not like this. Their appendixes deserve at least a jog one would say. But, those extra three seconds seldom change a patient's outcome. Regardless of the acuity, the speed of my stride has always remained constant as I move to take control of whatever situation arises in my emergency department.
Recently, however, I have had more of an urge to run, to hurry over to my hypoxic patients – honestly, to do anything out of the ordinary to save my patients' lives – because clearly what I have been doing for this long has not been working. I have never seen anything like this before.
First patient: Breathing comfortably, pulse ox says he should be dead. Second patient: Young and healthy 2 weeks ago, now with lung, kidney, and heart failure. Third patient: Came in talking to me, leaving in a body bag. I see the fear in my patients' eyes, I hear them gasping for air; I weigh who “deserves” a vent and who does not; I watch people die. Is there nothing I can do?
I'm tired. I continue walking up the stairs of the station towards the exit. I overhear a man talking on his phone a few feet away, something about selling shares. It's refreshing. I wish those could be my conversations at work.
”Why would you want to revoke your husband's do-not-resuscitate (DNR)/do-not-intubate (DNI) orders ma'am”? I asked my patient's wife earlier that day. Her husband, after all, suffered from dementia, couldn't pick up so much as a spoon, and was only a shell of his past self.
She started crying. “I never thought about what those orders really meant until I realized he may leave me. I know he doesn't recognize anyone, but he knows me. I know he can't do much, but he holds my hand every day,” she sobs. “He holds me. I can't lose that, doctor. Not without a fight.”
What is this fight that everyone talks about with death? That last epic battle against fate. Why must it be a fight?
I am unaccepting of death myself. I hate it. Physicians are known to encourage DNR/DNIs for others because we see the complications of resuscitations and machines; we see people die, have violent compressions done; be brought back to just a shadow of a life; only to be placed on a machine. However, when our own time comes, we are slow to lay down to rest peacefully, the way we recommend. We fight too. Why do we do that?
I explain the high rate of complications from breathing tubes to her and the fact that he may never get off a ventilator once he is on one. “Your husband will most likely not benefit from a breathing machine,” I tell her over the phone.
It pains me to say that. If her life revolves around him holding her hand-maybe I could give that to her. Maybe the ventilator would make a difference; maybe I could buy him another few months. True, the chance of complications is higher. But maybe he'll be lucky. Why am I trying to tell her otherwise? Who am I to tell him to move on? When did I start to play God?
You're sounding like your patients, I realize. I shake my head, confused at who I am and what I'm doing. I picture my husband in 50 years. I panic. I have to keep him alive. We have to do everything. I'm frantic. I'm.crying? Am I just not thinking clearly anymore? I don't want him to die. I don't want anyone to die. I do want to play God. I can play God. I'd make a great God. In my world, all would love, all would smile, all would rejoice. There would be enough ventilators and personal protective equipment for all.
But I am not God. I am human – with it coming the hardship and limitations of my reality. And in this reality, resuscitation is not a benign act. Though my heart bleeds with her, I know I have to give her the facts.
As an emergency physician I am very aware of the horrors that tomorrow can bring. Of how life can change so drastically in a single moment. Two months ago, I would have never thought about what I'd do in the center of a pandemic. yet here we are. I respect the unknown. I am at the mercy of chance, of destiny, of the Gods. I cry with my patients and their families. After someone's parents die in the emergency department, I call my mother, sobbing, and tell her I love her. I tell her to stay safe.
How do I not spend my life in a constant state of panic? How do I respect the uncertainty without being devoured by the sheer horror of it? How do I not spend every moment playing and replaying the constant thought of my own parents' unexpected death?
A bag falls out of my hand and I hear a clatter. I'm back to the present. I sure do hope that wasn't the glass bottle with the pasta sauce. I'm really looking forward to that tonight. I check to see if it's intact-it was just a can of beans. All is well.
I wonder if I'll be able to go through the big door. Will I have to put all my bags down on the grimy subway floor to open it? Probably. I may not get COVID in the hospital surrounded by my hundreds of COVID patients but I certainly will get COVID in this subway station today.
Before I can finish my thoughts I see the family of four staring at me with smiles. They had opened the door. for me? My pace gets quicker as I walk towards their generosity.
”Thank you so much!” I say.
”No, thank YOU Doc!” says the taller of the two men. “We're so grateful for everything you do.” He proceeded to salute me and his children followed suit.
”You're our hero, doctor!” the littlest one says, jumping up and down in earnest.
My immediate reaction was to see if my Emergency Department ID tag gave away that I was a physician. Typically, a petite, 5-foot tall, tan colored female in scrubs elicits a “nurse” or “tech” in response. I'm asked for a sandwich before I'm asked for advice on a sprained ankle. But, this family got it. I wasn't wearing my ID. They knew who I was and they appreciated… me?
COVID has brought out our appreciation as a society. Whether we clap for our essential workers at 7 pm or donate money to our farmers, we have taken the time to slow our lives down and realize how much we appreciate what has been around us all along. What I'm doing right now is no different from what I have been doing for the past few years. The hospitals were always open and serving everyone. The farmers were always struggling to provide us with food. The delivery workers were always squeezing by on minimal pay and maximal work. Our janitors were always cleaning behind us with zero claps. And, they and we will continue to do the same even after this is over. Once everyone starts running through Penn Station again-will we remember? Will we still appreciate? Will we find a moment in our busy days to say thank you?
I don't have the answers. It never was about the burden of the heavy grocery bags, but the burden of my day, of my stories, of my difficult moments in the hospital. That's the burden the family helped uplift when they held that door for me. And, that's what I can do when I see my patients. I can do whatever I can-big or small-to make their days better, to help them carry their burdens, to help create happy memories for them. I may not have all the answers as they don't. I may fear death as they do. I may be human as they are. I may not save them. But I will do my best. I will run to every door and hold it open for them.
Before I could cry or attempt to give the family all hugs (you can't help but forget about social distancing in moments like these), they were running off to hold the next door for me. I laughed, yelling thank you after them, excited to see them at the next door.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Ethical conduct of research
The authors of this manuscript declare that this scholarly work complies with reporting quality, formatting, and reproducibility guidelines set forth by the EQUATOR Network (http://www.equator-network.org). Within the broader context of narrative medicine, this article discusses individual stories and patient encounters as integral aspects of the lived experience of health and illness.