The Man That Scares Me and The Man I Love

There is a man. He is in my house. I don’t know where he came from. But he just came into my house. And now he is living there. And I am afraid of him. I do not know who he is. There is a man in my house. I am so scared. I don’t know why he came. But he is there. And he tells people he is my husband. And he is not! He is not! And no one believes me. Do you believe me? He is not my husband. I am so scared. Do you believe me? I am a good person. I have seven children. I am an honest person. There is something wrong. I know there is. I know there is.

 My patient. Age 68. She perseverates about this man. She is insistent. She was found wandering in the hospital parking lot. No one is with her. She wants to let out her fear in screams, but her voice is thin and frail. She is so frightened.

 They told me she has early onset Alzheimer’s dementia a year and a half ago. Last week I found her standing outside in the rain. A few days ago she had walked down to the neighbor’s house three doors down at 11 o’clock at night without a coat on. Today, she had an accident in the bathroom. She hollered for me to come to the bathroom and then hurried me away because she said she was going to clean it up. I went to check on her and she was gone. She had taken the car and left. She drove herself here.

 My patient’s husband. He is soft-spoken. His left hand tremors as he stands. His face is slightly glossy and his expressions are muted. I explain that she currently is confused. She thinks he is not who he is. She may be frightened to see him.

Sometimes she gets like that. She yells at me. “Get out! Get out! You don’t love me! You don’t love me! You son of a bitch! Get out!” It hurts my feelings. It does. It really hurts my feelings. And then sometimes she tells me she loves me. She thanks me for being her husband.

He speaks with a hollow, flat voice. He stares at me with foggy, pale blue eyes. His sadness and defeat lean into me. He tells me to wait for his son. His son is arranging for her to go to a center. He’ll have the details to tell me.

We’ve been married 44 years. We have seven children. And 16 grandchildren! She is my world. Can I go in?

 We stand outside her room, and his eyes fall on the closed door handle. I tell him that she seems frightened at the moment, but he knows best. If he thinks she will be comforted by the sight of him, he is more than welcome to go into her room. If he thinks it may make matters worse, he is welcome to wait in the waiting room. Whatever he thinks would be best for her.

Well. I think I’ll try, Doc. If she shouts and hollers and shoos me away, I’ll go outside. But if I go in quietly, sometimes I can talk to her and she is okay with me staying there. And then sometimes she warms up to me. I’m going to try.

 He is soft spoken but resolute. I peer through the crack he leaves in the door as he slowly inches in. He leans over the railing of the bed. He straightens her white crisp hospital sheet. She looks at him and I can’t hear their conversation, but that is relieving. He settles into the seat next to her side.

The next time I enter the room, the husband has left with family to rest and the patient’s son sits at the bedside. He loves his parents and he tells me that they are arranging for her to go to a memory care center.

He won’t be far behind her. He can barely take care of himself, let alone her. It’s just been too much for him, you know?

 The last ten days has been draining on their family. This seems like a quicksand downhill plunge. They have been in and out of hospitals. She was at her neurologist’s three days ago and there is nothing to do. Maybe these new medications will help. They will take time. In the mean time, they are chasing her in the rain.

I come back when the work-up is finished. I am relieved. She has a urinary tract infection. I am not relieved there is something wrong with her but I am relieved there is something fixable. You see, urinary tract infections can make you more confused than normal. Confusion can be the absolute only sign that you have an infection. And there it was. The last ten days of rapidly losing this adored wife, this beloved mom, this treasured grandmother, explained with a urinary tract infection. IV antibiotics were started and I admitted her to the hospital where she would not wander into the rain and she would get better.

I am not saying this is the end of their battle, that it won’t still be a declining slope, but I am saying that maybe they haven’t completely lost her the way they had thought.

I go back into the room to tell them. She is no longer tense and tearful. She is relaxed and loved and safe next to her son. I tell them about all the things I have done. Laboratory studies, CT scan, and that she has a urinary tract infection that is very treatable. She laughs out loud and all sense of that frightened woman I had met before seem to be drowned right out. She holds her hand up high in the air to give me a high-five.

Wow! Good job, Doctor!  So thorough! Thank you!  

She laughs joyously like I have just uncovered the eighth wonder of the world for her to see. I thank her for the first high-five of my day. We all chuckle together like old friends and it feels good.

There it was. A glimpse of her real self. All the charisma, all the spunk, all the warmth. There was the woman he has loved for 44 years. There is the woman that raised seven children with all the strength in the world. I see her now. I can see why this is so hard. To see her, then lose her, then see her. It would hurt my feelings too.

Hold close to those you love. Remember all you love about them. Tell them often. Let what you love imprint itself onto you, because you never know which way life may turn.

 

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Therapeutic Tears

Also published: https://www.kevinmd.com/blog/2018/05/a-doctor-cries-therapeutic-tears-with-her-patient.html

He wasn’t particularly likable on first encounter. He wasn’t apt to answer questions asked. He had a long pause and a long drawl and a tangential, winded story–and back story–all of which he was bound and determined to tell to its detailed completion. With an irregular heart rate in the 170’s and a respiratory rate in the 30’s, I tried to steer him in the direction of concise answers so I could obtain as much information as possible and do my job. This is an emergency. He is an emergency. An emergency who had waited until the last possible millisecond; we did not have the luxury of time.

But he was not to be rushed. My mind raced around his long pauses. My hands flitted around. Feeling his pulse, feeling his distended abdomen. Feeling the smoldering, red, hot cancer that took over his right thigh. I had never seen anything like it. It took my breath away and chilled me with impending fear of the extent of disease yet to be uncovered.

I tried to redirect him, but each interruption was met with a pause, and an indignant return to where he had left off in his storytelling.

It had been three years since he found out. Then, it was just a small bump. They told him it was cancer. It was easily covered up with clothing and easy to deny. He muffled it’s pervading presence with his stubbornness. He was indignant. This wasn’t happening. But it continued to happen. With or without his permission. It grew and grew and grew. And now, it was an undeniable monster. Growing on his thigh, in his liver, in his lungs. Filling up all his space, causing him to take staccato, labored breaths. Fighting to steal some room for oxygen every moment of his days.

His heart medications had gotten mixed up, confused, or refused. It was hard to completely tease out what had happened, as he wasn’t ready to be completely forthcoming. His stories took us farther away with every follow-up question asked. Now his heart worked in an overloaded chaotic state.

Infection had found its window of opportunity and seeped its way in to make sickness sicker—his organs on the cusp of failing.

His last name ended in an “-er”, like “Tyler” or “Kramer”. I brought the consent form for the procedure, he turned his head sharply towards me; we were practically nose to nose, as I had leaned in close so he could hear me in his good ear. “That’s not me. My name has no ‘S’” he said. I looked at the name I had written a top the consent form. I had mistakenly added an “S” to the end of the “-er”, like “Tylers” or “Kramers”. “You’re right”, I said. He gave me a gruff, indignant grunt.

We did what we could to stabilize him. I prepared for a procedure. “Have you done this before, Doc?” He looked suspicious. “No.” I said resolutely. “But I just looked it up on YouTube, and it looked really easy.” He was startled and appalled. I winked and smiled. “Oh, you got me. You got me good. That was good.” He let out a bellowing laugh like a man with all of his breath and strength. It filled the room. We both needed to share that.

I spent my time in Room 7 with him. Fluids, antibiotics, labs, imaging, procedures, talking. I softened. I grew to see his heart. His light. And I grew to like him very much.

I ultimately admitted him to the hospital. He may not have too much more time.

The next day was a day off clinical work, but I was at the hospital for meetings. My mind settled time and time again on Mr. “-er” with no “s”. I wandered between meetings up to his hospital room.

It took him a second to register who I was. My hair was down, and I wore normal clothes, not scrubs. “Oh hi Doc. Well, what are you doing here?” He asked breathlessly.

“I was just thinking I wanted to see how you were doing.”

“You want an update? Well, I can’t says it’s looking good Doc.”

He recounted his last 24 hours.

“I think I waited too long, Doc. And now my wife, you know. She’s home. She needs someone to take care of her. So, you know. We have to figure out how to tell her. My son was here, you know. He slept here last night. You just missed him.”

We sat for a long time. I watched his monitor. An irregular fast heart rate still in the 140’s. I listened to the rapid jagged, sharp breaths he sucked in and out.

“This must be tough. You have to remove yourself. You can’t let yourself feel. You see terrible things. All the time. But you have to Do, not Feel. It must wear on you.” In a moment about him, he made it about me.

“Well,” I said. “I just want you to know you have touched my heart.”

We cried. That awful stifling cry where so much needs to come out of what feels like a pinhole. I gripped his forearm with its weathered, dry skin. My finger scraped the edge of the medical tape that held his IV in place. He patted my hand with his other hand until the blood pressure cycled and forced him to straighten it out.

“Oh Doc. Thank you. For your therapeutic tears. They are warming. You worked last night, and now here you are. Right next to me. What a doc you are. What a doc you are.”

He lay with his eyes closed. Tired. Silent. Just his labored breathing.

Mr. “-er”, no “-s”, you are on my mind. Know that I’ll be here. Right next to you.

How Was Your Shift?

Also published: https://www.kevinmd.com/blog/2018/03/emergency-physicians-shift-really-went.html

She is 61 and she can’t help but smack her lips together repetitively. She has no teeth and the curvature of her spine makes her a miniature version of what she once was. Her frizzy hair is a purple-gray tone, and there are dark particles of something in the knots alongside her left temple. Her clothes are too loose and there are food stains on her shirt. The ambulance arrived at her home and there were pills strewn all over her floor and scattered pill bottles. She tells me that it wasn’t her. That someone had been in her apartment. That they were putting different pills in those bottles that weren’t hers. That pills were showing up on her floor. She was being followed when she went places. Her lips smacked harder as her anxiety mounted. She had to flush all the pills down the toilet because they weren’t her pills and so she didn’t have her own to take.   I ask if there is family I may call.  She stares back at me with hollowed eyes and does not respond.  She had just been released from the hospital a week ago for paranoid thoughts, but it is clear she will need to come back in.

He is 70 and his anxiety is like a storm cloud exploding in the room. He is overwhelmed because he cannot pay the bills and someone has stolen his identity. His furnace is broken and he is afraid the pipes will explode. He is concerned there is a carbon monoxide leak in their home and they are all being poisoned. At times he cannot speak because he is so overcome with his panic. He stutters and spits and cannot get the words out. I hold his hand and rock it back and forth as if to relieve the tremors that riddle his body.  I tell him it is okay over and over as I hold on; at times he appears momentarily calmed and is again able to speak until the next wave of emotions takes prey over him. His family arrives, and there are tears of fear, pain and love filling their eyes. None of this is real. No one has stolen his identity.  There are no broken furnaces and no carbon monoxide leaks. He paces at home and cannot eat or sleep. They have even called the fire department to the house to prove to him that there is no carbon monoxide leak. But it has not helped. These delusions have become his reality.

He is 57 and drinks every day and lives on the streets. He comes in one to two times a week for pain. Sometimes, he says his pain is so bad he wants to shoot himself. He says he has guns at his son’s house. This time he said he fell and his hip hurts. I help him take his pants off and he smells of urine and stool. Where can he go to take a shower? There are no bruises, scrapes, or cuts, but I x-ray his hip and there are no fractures. He says he won’t actually shoot himself if he can have a sandwich and bus tokens to go. He asks for a sandwich and bus tokens with every visit. He says his pain is 10 out of 10 and immediately falls asleep. It is the warmest and quietest place he will sleep until he comes back next week.

He is 20 and he overdosed on heroin. He was not breathing when the ambulance arrived. They gave him medication and resuscitated him and now his heart is racing and he looks bewildered as if he is on fire with anger. He says he knows it is dangerous. He has seen his friend dead in a car from a heroin overdose with the needle still in his arm. Maybe this is his rock bottom. I ask him if he is ready for me to help him get help so he doesn’t die too. He was really close this time. He says he understands what I am saying and he appreciates it. He says he is ready to stop, but he just doesn’t need help today.

These were four people I met on my evening shift last night. There are endless more stories like theirs. I don’t know where they were before they got to here, but I know life has not handed them anything. Their days are constant, steep uphill climbs. It may be addiction. It may be mental illness. It may be violence. It may be homelessness. It clasps its grip around them and won’t let them go. Day to day it swallows them and pulls them back down deep. There is little voice that advocates for and represents them. There is endless judgment that looks down upon them.

Friends and family will ask me how my shift went. I often don’t know what to say. Sometimes I feel I can help and do great things. Sometimes it is a vat of endless hopeless stories in a system with limited resources that continually seems to fail in one way or another. We will keep showing up and keep doing what we can, but it certainly is not enough.

A Love Story

Most love stories we see in the movies begin with a young man, a young woman, a chance encounter, or these days—maybe a swipe right on an online profile. But the greatest love stories are those that go untold. And this love story—this is one of the greatest I have had the honor to witness, if only for a few hours of their story.

She started with her confusion four months ago. Initially, it started as small things that most would not have noticed. A misplaced purse. Forgetting where the car was parked. Forgetting to mix the eggs into the cake she was baking. Nothing any ordinary person hadn’t done. But soon it turned into something more, he explained.  Getting lost in their apartment. Realizing she had opened the closet door instead of the bathroom door and the shame that followed that he couldn’t shoulder for her. The full out heaves of tears he couldn’t calm when she couldn’t find the bathroom after all. The heart ache of watching her grab armfuls of clothes from the closet and place them on the floor with such purpose, knowing there was only a mass jumble of thoughts and hysteria behind her frantic actions. It was a test of stamina to care for her, to look after her, to help her find the way in this narrowing, dark tunnel of her mind. It tired her too. And she slept. She slept after breakfast, she slept after lunch, she slept after dinner. Her waking hours became so sparse, but when she was awake, it was so filled with hyperactive conviction and activities that were seemingly purposeless. He would spend her sleeping hours placing all her shirts, pants, and dresses back in the closet. Washing stains off her clothes that she had spilled soup on. Salvaging what he could out of the trash of the oranges he bought yesterday that she had thrown away.

And soon, she lost her ability to dress herself. And it angered her. With such frustration, she would pick a dress, throw it on the floor, not knowing how to put it on. She would pick something else out of the closet, throw it on the floor, acting as if it wasn’t that she didn’t know how to put it on, but that she no longer wanted to wear it. Yesterday, she settled after picking a towel, laying it neatly on the ground, and with a satisfied content look, declared that this towel was in fact the dress she had decided to wear that day. He told me this, then fell into silence; keeping his eyes locked on my reaction, as if he couldn’t believe his own words, as if he wanted me to tell him they were not true.

He shared most of these things with me in rapid succession, with the same low, quiet, monotonous voice. His eyes tired but gentle; he spoke with such tenderness and love for his wife. This was a love that had grown over 51 years of marriage. Four months of hardship was worthwhile so long as he still had her.

She lay in the hospital bed with her eyes closed. I talked to her softly as I examined her. He chuckled at me, “you know she is probably stone cold asleep, don’t you?” She awoke when I sat her up to listen to her lungs. “Marty?” She said, startled by my presence. “Yes, May? It’s okay. It’s just the doctor. She is just taking care of you.” “Hm.” she grunted as her shoulders relaxed.

Last night had frightened him. “It scared me the way she was acting.” For the first time, he had seemed to slip from her mind. It had been different when it was the location of her purse, the location of the bathroom, or even how to put on her pants. Last night, she couldn’t remember him. She had asked for her pain medication, and when he gave her only one tablet as prescribed, she had become upset. Looking straight at him, she had said, “I don’t know why Marty wouldn’t give me the whole bottle so I could take what I want. He would only give me one tablet! ONE tablet! Can you believe him?” she had shouted at Marty. She proceeded to ask him to call the police, as there was a man in their home. She tried to leave the apartment without her shoes on with the car keys in hand. “And she doesn’t drive. She’s never been like this. It scared me.”

They met 60 years ago in fifth grade. They spent much of their adolescent years getting to know one another, and at the age of 20, they married. They spent the next 51 years married, 20 of those years married with multiple sclerosis grabbing a hold of her and settling into their marriage with them—an unwanted, dreaded third wheel. There have been good days and bad days, early on the good days outnumbering the bad days and making them tolerable.   These days, the bad days like a storm cloud ravaging all their days. There are days with falls. There are days with anger. There are days with forgetfulness. And every day that slides by, he tenderly holds onto the girl he met all those years ago. His one love.

I walked into room 14 of our emergency department, 4 hours into their visit. I found him sitting still next to her bed holding her hand in silence. The TV off, her eyes closed, the lights dimmed. Her presence—even in these dark days that have consumed them, even when he is losing his ability to care for her in the way he has for 51 years—her presence still his greatest comfort.

Where they go outside of the doors of our emergency department will be a new chapter in their lives. Their story is one of the great love stories that deserves to be told. A love that knows no end.

Beyond The Final Breath

Republished at:  https://www.washingtonpost.com/national/health-science/we-didnt-save-his-life-but-we-didnt-disrespect-him-either/2017/02/03/74612afe-d1f6-11e6-9cb0-54ab630851e8_story.html?utm_term=.9e665c02ec43

Republished at:  http://www.kevinmd.com/blog/2016/12/didnt-save-life-better.html

“Well?  Did you save him?” “No. We did better than that.”

He came in pulseless. The machine performing chest compressions with the rhythmic thud, thwack, thump. His ribs heaving under the force of the compressor, keeping his heart artificially beating. The plastic tube secured in his airway forcing puffs of air to inflate his lungs.  His skin slightly purple-gray, on that narrow brink between life and death. His eyes like speckled round pieces of glass, with fixed pupils, staring nowhere.

Our team was assembled, prepared, ready. We worked deftly with experienced hands, our focus and determination fueled by adrenaline, a synchronized team, we worked side by side; this was our life to save and we were going to do everything.

But his glassy, fixed eyes spoke to me. As we regained a heartbeat, and we halted the chest compressions, and our adrenaline settled–here he lay, not out of the woods, but heart back from a standstill. His glassy eyes told me his heart was back, but his life of living was gone. The life that laughed, that smiled, that held his wife’s hand–there was no amount of life saving measures that could bring that part of him back.  We didn’t know how long ago he had stopped breathing. But it was long enough to have robbed him of his mind, his memory, of everything that made him that man his family loved.

His wife and only daughter arrived. I left him in my able teams’ hands and sat down with them. I looked them in the eyes. I told them the story of his final hour of life, from the perspective of his fighting, beating heart.

His heart was here with us, but his  brain had gone too long without oxygen before we could reach him. He would never walk out of this hospital. They listened to my words.  Words spinning and exploding beyond comprehension. They nodded their heads, as if to ask me to keep talking.  So long as I was talking, we didn’t have to move.  Tears were inevitable. It was so sudden. How could they be asked to make a decision of whether to continue with the resuscitation or to just let life walk its final march.

Yes, this was about them, but this was ultimately about him. What would he want? It is true it was sudden. It is true it is the toughest decision anyone will make.  But with the return of his heartbeat, the decision to continue resuscitation is as big, as active a decision as it is to stop all aggressive measures and let him be comfortable. These are both big decisions with big paths for us to travel down.  I needed them to understand that this wasn’t their decision to shoulder. It was their time to respect–in the most selfless of ways–the man they loved.  To step outside themselves, slip into his shoes and honor his wishes in the greatest way possible.  What would he have wanted if he saw himself in this moment?  Representing him in this way is a responsibility no one cares to bear, but this final act is the biggest, most giving way they could love and honor him.

His daughter immediately said, “oh, he would want none of this. He would want you to stop.”

They stood by his bedside. We withdrew all aggressive cares. We turned off the beeping monitors, we stopped artificially putting oxygen in his lungs, we turned off all pumps, we covered him with warm blankets, we let him be comfortable with his wife holding his hand for his final minutes, and his daughter stroking his hair.

And that’s how he left us.

Did we save his life?  No we did not.  Not today.  We did better than that. We upheld our promise to continue to respect his wishes beyond his final breath.

About A Boy

8 years old. Blond hair, neatly cut. Fair skin with flushed cheeks. Curious, trusting, clear blue eyes. Rosy, red lips in a perfectly content, relaxed grin. Wearing a plain red cotton t-shirt and blue jeans with the elastic waist and Velcro sneakers. I meet you in your wheelchair. I asked your dad what was the best way to get you onto the hospital bed to examine you. He picked you up easily in a bear hug, and your lanky, skinny arms wrapped around him, as your tight, contracted legs held their bent position as he plopped you gingerly on the bed. I listened to your heart and lungs, I pressed on your soft tummy, I noted the pull-up you wore with Buzz Light Year printed on the front. You never took those calm, trusting eyes off of me. You never smiled, but your whole face smiled at me. You never spoke, but your whole being spoke to me.

This was maybe two weeks ago, but my visit with you still pops into my mind frequently. It’s unpredictable which patients stay with us. We see patient after patient, and some just settle into our hearts and mind, lingering in our thoughts, reminding us that after they leave our care, they are still here.

What I remember about you is how sweet and happy you are. How you didn’t have to say a thing to let me know you trusted me. You trusted your dad. You trusted this world that you live in. On this day when you weren’t feeling well, you still smiled with your whole face.

What I remember is how well cared for you are. Your styled hair. Your clean clothes and newly changed pull-up. Your new Velcro sneakers and socks without holes.

What I remember about you is how much you are like my own son. Your lanky arms, your lanky legs, your fair skin with flushed cheeks. Your big, curious eyes, trusting me.

You came in for nausea and vomiting.  While this is something that has plagued you in the past, this time, it was just a stomach bug rippling through your daycare.  Your dad relayed this in sighs of relief.  Because this was something common. This was something other kids were going through. This was a “just-like-everyone-else” problem and not a “just-unique-to-you” phenomenon.

See, there are milestones that you and your family have not experienced. Your first word. Your first steps. Your first laugh. But there are milestones that are like gold. Those first hugs. Those first nods of understanding and communication. The realization that you are taking it all in, and those eyes are your window to experiencing and memorizing this whole world around you.

I cannot begin to comprehend how hard this life is for you, for your parents, for the three brothers that came before you. I also cannot speak for the immense beauty and happiness in your life.  But the one thing that I do know is that you are loved. You are enriching and touching the lives of your family, of those like me that have had the honor of meeting you. This I have experienced first hand.  You are louder than you could ever be in your steadfast ways.

You didn’t have to say a word, but you have touched me. I see you the way I see my son. A wonderful boy that is filled with love and that is loved.

Life is hard. It is hard in different ways for different people. But it is these moments of strong, quiet beauty that keep it tender and keep it worth our hardest work.

The Best Friend You Never Wanted

This moment has been rolling around and around in my head. I sat down on the stool. I turned to my patient. He was intoxicated. I realized I had seen him here in my emergency department just six days ago. “Hey.” I said gently. “What happened?” Tears welled in his eyes. He went into the story of his past six days. I had seen him six days ago, and he had begged to go to rehab. As he had innumerable times in the past. He really wanted help. He needed help. But it never helped. He had gone to a Detoxification Center and had stayed there three days where they ensured he went through withdrawals safely. Then he went home. And he started drinking again. And here he was. Back again. “Please. I need help.”

I leaned in. I listened. I nodded. I felt his sadness. He suddenly stopped talking abruptly. And he just stared at me. “Why do you care so much?”

The question startled me. Took me off guard. No one had ever asked me that. And trust me. I have been asked some fairly awkward questions. Why do I care. How do I even answer that question? Isn’t it just a fundamental part of what I do?   At the time, I had no eloquent answer.  I just stared back.  And dumbly said, “I just DO. I care because I know you need me to.”  At the time, I thought, I care because you are hurting. I care because you are human and everyone makes mistakes. And I believe you. You need help. This is your hellish cycle: You get help. It fails you, or maybe you slipped back away yourself.  Or maybe it is a combination of both.  It doesn’t matter. Then you need help again. I don’t know. The system is broken. It is so broken. And for you, something is failing, time and time again.  I do care. I don’t know. I can’t explain it, really.

But when he asked that question, I felt it knock the wind out of me. All of the caring I had bottled and neatly packaged into some crevice of my chest resurfaced into this avalanche of emotions. Yesterday, I saved a life. I brought his heart back from a standstill just as my daughter and son’s kindergarten open house was starting. I missed the open house waiting for his brother to arrive so I could talk to him. But I got there (mostly) in time for the kindergarten meeting. I sprinted up the walkway to the elementary school entrance, out of breath, just in time to see my daughter’s face light up when she saw me.  I mouthed an apologetic “sorry” to my son’s kindergarten teacher who was in the middle of addressing all the on-time parents as I slipped into a seat in the back of her classroom.

Before I walked into this room, I delivered a 16-week-old baby that the mother had spontaneously miscarried. I left her to grieve in private with her husband. And her baby girl. Tiny fingers. Tiny toes. Lifeless. Limp. Wrapped in a warm blanket. I’ll remember my heart-broken patient’s face. Stunned, sweaty, strong, brave. So many questions. So many fears. So much loss.

I care because it is all so much bigger than me. It is about lives. It is about families. It is about death. It is about surviving. It is about hopes.  It is about milestones. And I don’t know how to make sense of it all, how it all strings together and falls into place. Sometimes, I don’t know what else to do but care. To be present. To listen. It seems so very, very surreal that I can grieve the return-to-life of someone that I am not sure will make it to tomorrow as I race in the door, breathless, to my son and daughter’s kindergarten meeting.

I care because I am the best friend you never wanted.  You come into my space and tell me your most personal thoughts.  You tell me how this was unexpected.  How this is a horrible day.  How you had so many exciting hopes and daydreams for this growing baby in your womb.  How ecstatic you were to be a cozy family of three.  You tell me that my dying patient is your brother and you are the only family he has and how you wished he and his daughter had made amends.  You tell me you have been in and out of 14 different rehabs and you just want help.  You just want help.  Is there anything else I can do?  These are all the things you want to tell your best friend.  The best friend that you haven’t had a chance to call yet as you were rushing to the hospital.  The best friend you never had but wished you did.  The best friend that has given up on you because you have had one too many chances.  But here we are, just you and me, staring at one another.  So, you tell me your story.  It is about your hopes, your fallen dreams, your gut-wrenching day of heartbreak.  And it is all so real and I can’t help but feel fallen with you.

This is what we do. My colleagues and I. We care. We care more than you know. We don’t know the best way to express it all the time, but we do. We wonder if you have already started setting up the nursery that you will now have to let sit empty.  And we secretly hope you have not, as we can’t imagine the heartache of deciding whether to leave it as is or take it down.  We wonder if you will live to walk out of the hospital.  We wonder if this time, maybe this time, you will get the help you need.

We are far from your best friends.  But today, we will be who you need us to be in your life.  We will time and again–without question–put our lives on hold for yours. We will grapple with the balance between life at home with lives at work. But we know what is important. I can’t explain it better than to say, our hearts are with you.