Nurses and technicians suction to the walls as we pour from of our corner in a flurry of coffee, papers, pagers, and white coat tails. We stand outside patient rooms in a methodic ceremony of speedily reciting dates, numbers, and medications encompassing the sleeping patient behind the door. Our huddle exchanges less than a hundred words to dictate which orders to write and which direction to turn from here. A brisk walk inside, possibly a handshake or an introduction or two, regurgitation of plans, glob of sanitizer, swarm out. The entire process takes about twenty minutes.
When I first heard her case, I knew it wasn’t an infection. As a 3rd year medical student, I just get patted on the head with a taste of “oh, little medical student, you’ll learn to stop reading into these silly small things”. They slapped antibiotics on her chart with a note to “reassess in the AM”. Days passed. Fevers kept spiking. Her creatinine kept climbing. 80% of her kidney function was gone by the time they ordered the kidney biopsy.
When results came back, they looked at me as if I had been cheating the system.
I remember the staff would groan at the mention of her name. But I secretly loved how she would take out her notebook each time we entered and scribble down every word we said. Inside, I completely understood her demand to be heard and pleas to not be dismissed. They had called her “a crazy narcissist who loves playing the sick role”. After the biopsy results, I spent hours carefully printing articles about her condition, highlighting the answers she had begged us to answer. I scoured her chart until I traced the inciting event back to a single telephone note documenting a course of antibiotics for a dental procedure and emphasized the importance of her avoiding this drug class in the future. Her greatest fear was being treated, for the side effects it might entail. She cried and told me about her son with a rare genetic disease. For her, the possibility of psychosis as an adverse effect was not just inconvenient or frightening. It was her son’s life on the line. It meant risking a lapse in time where she couldn’t adjust the dose for him right away, or tell the babysitter what to do when his blood sugar plummets spontaneously, or help him clear his secretions plugging his airway.
“I knew from the minute you all walked in the door, you were the only one who still had their eyes open. You were the only one listening to me.”