It is one of those nondescript 7 a.m. work days when you feel as if everyone around you is still waking up. Still with half of their first cup of coffee to drink; the caffeine not quite kick-starting their day just yet.
Yesterday’s loose documents still being filed. Nurses amidst their morning hand-offs at change of shift. Morning huddle circles just starting to materialize.
The ambulance phone rings, piercing this morning hum. 78-year-old-man with dizziness. Vital signs stable. ETA less than 5 minutes.
He arrives. He is vague about what brought him to our emergency department ambulance bay, but he is certain of his diagnosis. This dizziness–just like the vertigo that brought him here 2 years ago. This left arm pain–just like the pain from the left arm surgery 6 years ago. This heart burn pain.
“Well, sir, what does your heart burn pain feel like?” He tells me it is a pressure. A heaviness sitting on the middle of his chest. I ask him about the left arm pain. It is an ache that has made a resurgence after 6 years of not having pain since his left arm surgery. He describes it as an ache that has become progressively more prominent since its arrival three days ago.
The lackadaisical air of this morning quickly lifts, and I swiftly start undressing my patient. “EKG. I need an EKG.” And the EKG confirms it. “Well, sir, I am glad you decided to come in today. You are having a heart attack.”
His wife is now sitting in a chair next to him. They both look at me, bewildered. The patient looks as if I have popped out of the closest shrub and startled him, “I am?” His wife is overcome by an immediate shadow of grief and panic that settles onto her shoulders, gripping her with a paralyzing tremor, the way a strong, unexpected gust of wind shakes a trembling leaf holding tightly onto its last life-line branch. Tears storm into her eyes, as her breaths become shallow and uneven.
I explain to them next steps. I describe the commotion that will quickly envelop them, about the events that will unfold before their eyes quicker than it takes to process each and every one. I assure them that they are in the right place.
They nod. I linger. I am confident it will be okay; I want them to feel my confidence.
Minutes fly like hummingbird wings. Orders are written. Medications are given, and my patient is ready to be taken to the cardiac suite. I have no doubt this transfer will happen swiftly and seamlessly.
The emergency department is starting to fill with other patients: The patient with foot pain in room 6. The patient with a headache in room 8. The driver involved in a car accident in room 12. The patient with nausea and vomiting in room 11.
Between every patient encounter, as I walk from room to room, I finish reviewing the plan of the person I have just seen. I think about what they just told me, what I felt with my hands, what I observed with my eyes, what I smelled, what I heard, about how their family or friends reacted at the bedside. I think about every single part and stop between rooms to finalize my orders for that patient. Then I blink. I reset. I introduce my mind to the patient I am now going to see. I think about the one word descriptor that pops up as to why they are here, I recite his or her name in my mind, I note his or her age; a laundry list of possibilities of what may be going on starts to populate in my mind. I momentarily let go of the person I have just seen. It is a quick, brisk walk from room to room, but it is the time I have. I blink. I reset.
The man four rooms down having a heart attack will not alter the attention I pay to the woman here who has had foot pain for a year. The frustration my patient with foot pain relays who has felt bounced from specialist to specialist turns to impatience and anger when I say I cannot guarantee I will find her answers today. I will not allow this interaction to affect my patience and compassion for my next patient with a headache in room 8. The severe pain of the patient with the headache will not make me think less of the neck pain my stoic patient in room 12 reports whose car was T-boned by an SUV going at highway speeds. The stoicism of my patient in room 12 will not affect my sensitivity for the first time pregnant mom, tearful about her struggle to provide nutrition to her growing baby through her crippling morning sickness.
So, between rooms, I blink. I reset.
As I move swiftly from my first patient having a heart attack to my patient with foot pain, I see out of the periphery of my vision my patient’s wife. She is standing as close to the wall as possible as her husband is being transferred to a different bed. She looks small. Her eyes brimming with worry.
In that moment, I am transported back to my 17-year-old self. My dad is back inside from a half-mowed lawn. He is sweating cold sweat, pale, labored in his breathing. “Call 911” he tells me. “Call 911”, says the man who, in my 17 years of life had never complained about an achy joint. “Call 911”, says the man who, when a cement brick fell on his left big toe, had unceremoniously poured betadine on it, wrapped it with a gauze, and returned to pushing a wheelbarrow full of bricks.
In a blur, the ambulance arrives, and is takes away my dad, lights and sirens.
My mom, our family matriarch, my pillar of strength, is left limp, helpless, frightened, sobbing.
I see my mom in my patient’s wife. She carries herself differently, but I know there is panic, there is fear of the unknown. So, this time, I don’t blink. I don’t reset. I pause.
“He is in the best of hands. I know it.” I hug her. My stethoscope digs into my collar-bone, and likely hers too. But we hold the embrace, we both squeeze a little tighter, and when we let go, she is still heavy-hearted, but there is something lighter in her eyes. She looks less small.
He made it. He’s alive. He’s okay. I checked in later in the day after his cardiac catheterization to re-open the blocked arteries around his heart. He’s okay, and so is she.
I have to blink. I have to reset. But before I do, I want you to know, I am here for you. And only you. As long as you need me. If you are the one waiting in the next room, please know, I’ll be there as soon as I can be, for as long as you need me too.
At the end of the day, no matter how many times I blink and reset, I’ll gather you all up, and carry you all home with me. Because at the end of the day, it’s all of you that has made an impact on me.