The computer indicated she was an 88-year-old woman with a primary complaint of fatigue. Based on my experience, fatigue in an older person could stem from nearly any cause. Was it a heart attack? Depression? Cancer? An infection? Or was she simply tired? The actual reason for her visit never occurred to me.
The petite woman had positioned herself precisely in the center of the gurney. Her white tennis shoes rested under a chair, each containing a thick, flesh-colored knee-high stocking. On the chair seat lay a neatly folded yellow cardigan atop an equally neatly folded brown dress. She wore her hospital gown like a jacket, open in front, her knobby hand clutching it closed over her cross-your-heart bra and waist-high white cotton panties. A Catholic cloth scapular bearing the Virgin Mary's image hung around her neck, and a tiny gold cross on a fine chain nestled in the hollow at the base of her neck.
I greeted her in Spanish, introducing myself as Doctora Birnbaumer. She responded warmly, her eyes sparkling. She sat up straighter, her posture reflecting someone who found life interesting. I checked her armband and offered to cover her with the sheet folded at her feet. She nodded.
When I asked how she felt, she said fine. Was anything bothering her? No. Any pain? No. Shortness of breath, chest pain, headache? No, no, and no. I went through my list, and she denied any issues.
Maria's only previous medical encounters were for the births of her many children, several of whom she had outlived. She had been widowed for over twenty years, lived alone with family nearby, and had spent most of her life as a housekeeper. She took no medications, had no allergies, and had never undergone surgery.
With her permission, I examined her. From head to toe, she was remarkably fit. Her bright, curious eyes were set in a sea of soft skin, framed by deep crow's feet sculpted by years of smiling. The rest of her head and neck exam was normal. She had a slight spinal curvature, clear lungs, a strong, steady heartbeat with no abnormal sounds. Her abdomen, extremities, and neurological exam were all normal.
I was perplexed. She watched me expectantly. I asked again if anything was bothering her. She shrugged and raised her hands in a gesture of resignation. I was getting nowhere. Time for a different approach.
I asked why she was in the emergency room. She said she didn't know. Dead end. I tried a new angle: how did she get here? Her face lit up. Her daughter, granddaughter, and great-grandson had picked her up and brought her in.
Finally, a possible answer. With Maria's permission, I found her family in the waiting room. They were easy to spot, all three resembling the petite woman on the gurney. The same dark eyes stared at me, but while hers were bright and inquisitive, theirs were red-rimmed and swollen.
We entered the family room. The two women deferred to the teenage boy, who acted as spokesman. He remained standing. I asked why they had brought Maria to the hospital. Instantly, all three sets of eyes filled with tears. The oldest woman nodded to the boy, who spoke, dropping his gaze to the floor. His cousin had died, shot by police. I expressed my condolences. Now I understood the tears.
But I still didn't know why Maria was there. I asked if something was wrong with her. The boy answered that his cousin was Maria's favorite grandchild. They wanted me to tell her he was dead. And there it was.
I admit my first reaction was irritation. Really? Nothing medically wrong? The ER was packed with truly sick patients, and I had spent 15 precious minutes on this? Did people think the ER fixed everything? Then they all spoke at once. They feared she would have a heart attack or stroke upon hearing the news. They were terrified the news might kill her. They didn't want to tell her; they wanted someone else to do it, in a place where she could be cared for if something went wrong.
I sat with their words. I recalled how I felt when my dad called to say his thigh pain was from a tumor that had spread from his lung. I remembered wanting someone to tell me it would be okay, that we would survive, that the world would right itself. The healing that eventually happened came not from doctors but from the love and support we gave each other as a family, from leaning together, hands and heads touching, creating a steeple of strength.
Through these memories, my path became clear. I took a breath and leaned forward to look each of them in the eyes. I assured them I was there for all of them, including Maria. I would be in the room, available for hours to watch Maria if needed, and ensure she was safe. I told them I had their backs, but the news needed to come from them. They searched each other's faces, then nodded.
As we entered Maria's room, her bright smile faded when she saw our faces. They moved to her bedside. I placed a box of tissues nearby and stepped away. Maria was surrounded by three generations of her family. They spoke to her in hushed Spanish, and I watched as four lives confronted the dreadful news. Maria listened quietly. Her straight posture sagged slightly, her smile disappeared, and her face aged decades in moments. She reached one age-spotted, labor-deformed hand to her family, and they joined hands. With her other hand, she clutched her scapular.
I eased out of the room, leaned against the hallway wall, and remembered. I recalled being a young woman deeply invested in caring for others, deciding my future was in medicine. I remembered the thrill of learning about the human body and how to heal it. I remembered cringing when I started an IV and the patient gasped. My heart broke the first time I told a patient they had a terminal disease. I cried myself to sleep the night a patient died on the operating table after I assured him he would do fine.
But I couldn't remember when my empathy began to slip away. I knew that when I started shifts, I walked through an ambulance bay packed with paramedics and patients. No matter how hard I worked, the waiting room was never empty. Patients came for injuries and illnesses, but also because they couldn't see their own doctors, lost insurance, or only had time after work. Police brought patients with nowhere to go, behavioral issues, or addictions. There were never enough beds, patients waited hours, and everyone was tired and angry. There was no way to do the job as well as I had been trained. Administrative bean counters reduced my performance to patient-per-hour counts and test orders.
When I became an emergency physician, I was all in for the hard work, erratic schedule, and difficult decisions. Over time, I let the demands of a broken system knock me off course. Standing in that hallway, listening to Maria and her family, I remembered why I chose this profession.
I pulled away and headed to care for the next patient. Maria did not have a heart attack or stroke. An hour later, she sent her great-grandson to find me, saying she wanted to leave. Her family helped her dress and gathered her things as I prepared discharge papers. At the door, I hugged each of them, Maria last, knowing her ER visit was exactly what she and her family needed. Apparently, it was exactly what I needed too.
Note: Some names and identifying details have been changed to protect privacy.
