“Don’t leave me alone,” I heard her say from behind the oxygen mask. I turned around in the doorway and she stared at me longingly. She was afraid she was going to die; I could see it in her eyes. She held on to the bars of the stretcher with a white-knuckled grip. The oxygen was flowing as fast as it could come through the tubing and out into the clear plastic mask pressed tightly against her face. She was alone in this small cubicle of the emergency department. I had no where else to be and nothing else to do at that moment, so I stepped back from the doorway and approached the stretcher.
I was scared. It was less than an hour ago that I spoke with this woman casually, relaxed, and with no immediate concern that something was wrong. She came in because she wasn’t feeling well and she was having difficulty urinating. Her bloodwork revealed that her sodium was dangerously low and my job was to figure out if there was an obvious cause for her hyponatremia. I asked my gammat of questions with a slight elevation in the volume of my voice. She was a little hard of hearing, but she generally answered the questions well. I sat patiently as she tangentially went between pertinent points of her history and the superfluous pieces of information that only an 86 year old woman would feel the need to tell me. She was cute and charming, in an endearing sort of way. I imagined her sitting in a rocking chair with an afghan over her shoulders while knitting a sweater or a scarf. She smiled proudly at me, and asked me multiple times if I was a medical student. “You are doing a fine job my dear. Your parents must be proud.”
Yes, ma’am, I hope they are proud.
And now I stood there watching her fight to breathe. Just moments before we were called urgently back to her room. I was in shock, as was the resident. “Has this happened to you before?” The resident asked. She nodded her head. “Is this the reason you came to the hospital today?” She nodded again, this time averting her eyes with a telling level of shame. I’m not sure why she didn’t tell me about her difficulty breathing, especially since I know it’s one of the questions I always ask about. It wasn’t important in that moment, however. We stood there for what seemed like forever as we thought about what to do. We listened to her chest and found nothing out of the ordinary. Her heart rate was fast, but her oxygen was pristine. Despite what the monitor said, she sat there gasping for air. The resident rattled off a list of stat tests and walked out of the room. I turned to follow, but then I heard her call out to me.
I stood next to her with my arms crossed against my chest. I didn’t know what to say to this poor lady as she literally held on for her life. I was scared for her and all I wanted to was to make it easier for her to breathe. I was scared for myself. What if she died, right there? Right then? Right in front of me? In this small room inside the emergency department? With only me beside her? I tried to think back to my brief ACLS training. I looked out the open doorway and was confident that help was right there, not out of reach – but that didn’t make me feel better. I was scared because I imagined that this might be the moment in my medical career where I witness someone die – for the first time. And, not just someone, but this sweet, cute, little old lady with whom I just had a very real and normal conversation with less than an hour before. In that moment I felt selfish for worrying about me. This poor lady was fearing for her life…
Her heart rate was slowly creeping up. Now it was over 100… 110… 115… She hadn’t taken her medications yet that day and it was starting to show as her frail body became more and more challenged. “She needs to take her meds!” I called out to the nurse from inside the room. Her and the resident came back into the room to confirm whether or not she had actually taken them. The patient shook her head with a worried look on her face, as if she feared she was making this whole situation worse for herself. The nurse quickly came back with a little plastic cup holding a mixture of 6 small tablets.
She didn’t want to take the pills because it meant she needed to remove her oxygen mask. She was fearful, as if the mask was the only thing keeping her alive at that moment. “You have to take the white ones first, because if you can only swallow a few, those are the ones that will slow your heart rate down.”
The beeping monitor continued to speed up, we were almost at 130 now. She was getting more and more anxious as her real fear of death became more urgent in her mind. Suddenly, I realized that I could do more than just stand there, uselessly, hoping that she wouldn’t die in front of me. I grabbed the plastic cup of pills and poured them into my hand. With the other hand I carefully lifted the oxygen mask off of her face and brought one of the small white pills to her mouth. She began to realize that the momentary removal of her mask was not going to hurt her. She tentatively stuck her dry tongue out of her mouth and accepted my placement of the small pill. I grabbed a cup of water and positioned the straw in her mouth for her to sip and swallow her pill. The mask was back on her face quickly and she gasped for air. Her eyes pleaded with me to give her another minute to breath before we repeated the task again. Slowly, over 5 minutes, I placed her pills, one by one into her mouth, brought the straw to her lips, and waited until she was ready for the next one. When we were done, she smiled at me from behind her mask.
I smiled back at her and grasped her hand for reassurance. She squeezed it tightly and I knew, in that moment, that she was thankful for my presence. We shared a moment of friendly silence before the resident came back into the room and called me away. “She’s scared to be alone here,” I told him. He walked up to her and kindly told her that I was needed somewhere else and that there were many people close by to help her. She slowly and tentatively let go of my hand, then placed her own over her oxygen mask. She was doing better. She wasn’t struggling to breathe as much. I assured her that she would be okay and that I’d check on her again later; she relaxed back against her bed a little.
I never made it back to see her that night, but I know that she was okay. I was at the hospital again two days later and I went to visit her in her new room. I walked in the door and she recognized me instantly. Her eyes opened wide and her smile spread across her face like that of a small child on Christmas morning. This time her family was with her and she was eager to introduce them to me. “This is the fine doctor who was with me in the emergency room the other day. I’m sorry, dear, I don’t remember your name, but you are just the most wonderful little lady I have ever met. Please be sure to visit me everyday. I will never forget you.”