Sunday, February 6, 2011

On vulnerability

Don’t close the door, please! She pleads. I am clausterphobic.

The voice comes from the tiny blonde woman sitting in a corner of the room. Her soft wet eyes look up and meet mine. She seems to be shrinking before my eyes, like Alice in Wonderland or a wilting flower in one of those sped up films.

Two thoughts occur to me.

First is that I too don’t like closing doors, but for a different less generous reason. The second is that someone, somewhere along this woman’s life has messed her up. Now, she can’t even have the door to this room closed.

I ponder for a second the herculean task of our lives: to set straight what has happened to us, to work our way through it. And if we don’t or somehow can't, that mind of ours will do it for us. Panic attacks. Somatization. Clausterphobia. All kinds of unreasonable things.

I leave the door open.

I have already reviewed her chart. I do this to save time, inaccuracies, embarressment. In 2009 she was found to have a lung mass on xray. The CAT scan had diagnosed Bronchogenic carcinoma. She subsequently refused any further investigation or treatment.

She looks up at me. Quitely. There is something about her that at an earlier time in my life I would have called ‘mousy’, like a water rat coming up for air, scraggly and wet.

We talk about why she is here today.

Coughing - worse for the past week, but really it had been going on for weeks; associated with weight loss, but without fever. She adds that she hasn’t gone to work all of that week. For this woman, I imagine this is a big deal.

She is cachectic. Given her story, I know that this is really bad.

I sit next to her on the bed and gently help her lift her sweater. I notice her hair is a shiny highlighted blond. I will be doing an Xray so this feels like just going through the motions. My clinical skills are sadly going to extinction.

'I was afraid', is her answer. Why hadn’t she gone through with the bronchial washings 2 yrs ago?

She still smokes and I think I understand why.

‘Is it possible this is just a lung infection?’ she asks. This isn't suicide by neglect. She has the will to live.

Her right upper and lower lungs are filled with something that gives them a white appearance on the xray – it could be fluid or more likely infiltration by a mass or by infection, or both.

‘It is possible. It could be an infection.’. She's right, it could be. Perhaps, an infection over and above the underlying problem.

'I can admit you to hospital', I offer. ‘No. I want to go home.’ was the reply. I don't push.

‘Make sure you come back for the CAT scan tomorrow.’. We negotiate. It's the doughnut, not the tube. The doughnut is okay.

She's stoic, containing her grief with dignity. She is protecting a vulnerable child.

Saturday, February 5, 2011

I am a retired political science professor.

I had noticed him earlier, as he was walking into the Emergency department. He was different from the other Chinese patients. He was exhuberant, friendly, saying hi, without knowing who I was. I was wearing my pink scrub top so he may have thought I was the nurse. Another thing, his teeth were pearly white and perfect.

He was hurt. By that, I mean his pride had been wounded. This was his second visit to the Emergency department. He had been assaulted by a security guard in an electronics store and assessed for head injury and sent home, and he returns today because he noticed there was also a bruise on the left side of his chest wall right above his heart, and his left wrist which had been hurting on the first visit, was still hurting. He couldn’t bend the left wrist as far back the right.

I could tell that his pride had also been hurt.

“I am a retired political science professor from Hong Kong” he told me as I examined the yellowing bruise on his chest.

“what exactly happened?” I couldn’t resist. This man was unusual, and interesting. Excitable in a likeable way.

He recounted how he was taking a photo of a store display TV screen which was broadcasting some news with his phone when the security guard asked him to stop.

“I had stopped”, he said, like a hurt child. The security guard had wrestled him down and perhaps grabbed his left wrist roughly.

He looked comfortable. I didn’t think there was anything broken, and I asked him.

“Do you think there’s anything broken?”


I had already done the xrays before seeing him, and I confirmed that everything looked well.

I liked him. I believed his story, if only because his pride had been hurt.

“It was nice to meet you.”.

I say this to acknowledge that I believed him. That I knew his pride was hurt. That he was a nice person to meet.

He thanked me, flashing his pearly white teeth.