Tuesday, August 3, 2010

Savoring The Moment

I had been running late on another busy summer day. The type of day where you gain one step and lose two. Meetings and paperwork had filled up another summer morning. Baseball games, swimming practices, and soccer scrimmages had filled up another summer afternoon. And for this particular summer evening, I was scheduled to work an odd emergency room shift from eight p.m. to four a.m.

While driving to work, I had gotten stuck in a construction zone that had taken much longer than usual to get through. And, like Murphy's Laws would dictate, I had gotten stopped at several intersection lights that took forever to rotate back to giving me the green go-ahead. So, after finally arriving to the hospital and parking my car, I hurried into the emergency department, hopeful that all would be quiet.


The waiting room was jammed. The sounds of chaos hit me immediately, several TVs competing for dominance (Maury Povich vs. Headline News) while multiple conversations in multiple languages lingered heavily in the air. I had to step around several waiting patients while I dodged angry glares. "Excuse me," I said repeatedly, stepping around one patient with a bandaged, bleeding scalp and another sitting in a wheelchair, holding a vomiting bin, before finally making it to the double-doors that connected the triage station and waiting room area to the emergency department's active hallways.

I held my electronic ID badge up to the monitor and deeply exhaled as the double doors opened wide for me, taunting me to step forward into more mayhem. "Come, Jim," they spoke, willing to remain open until I took that first step through, "we've been waiting for you."

I walked into the ER's hallways as the doors clicked shut behind me. Locking me in. A good thing, too, since the hallways were lined with more wheelchairs and multiple cots, all filled with patients waiting to be placed into treatment rooms. The overhead fluorescent lights had been dimmed to create a warmer atmosphere, but failed miserably. Patients were writhing in their cots, holding their aching body parts while the wheel-chaired patients' bodies were slovenly tipping to one side or the other, like wilting flowers in the sunshine, obviously tired from maintaining an upright posture.

For a few brief seconds, I stood there, in the middle of this crazy hallway, taking inventory while rebuffing further angry glares. It seemed that people were quite frustrated and openly showing it. A nurse walked by in this instant. "Hello, Dr. Jim," she said, nodding at the lined hallway, "it's a rough one today." "Hi Kelly," I answered, "how long is the wait?" "Over six hours," she said, hurrying away with one of the wheel-chaired patients. Can you imagine, at eight at night, waiting over six hours to be seen in an emergency department?

And then, among this havoc, where multiple eyes were dancing around looking for the next person to direct their anger towards, I saw it. A sweet and tender moment. Between a mother and daughter. One of those little spaces of time where a typical and mundane, yet incredibly special, happening occurred that was missed by everyone else. Where I was reminded, once again, of our humanity.

They were halfway down the lined hallway, about twenty or so feet from me. The mother was sitting in the wheelchair, attempting to stand. She was fragile, polyester pants and a buttoned-up sweater clinging to her slight frame, with pursed lips and determined eyes. Beside her, standing, trying to help, was her daughter, obviously tired, middle-aged, in capri pants and a short-sleeve shirt, wearing the same pursed lips and determined eyes as her mother.

What made this scene remarkable was the intimacy of their moment despite all of the obnoxious stimuli that bombarded them. While a patient near them dry-heaved into a big pink basin and another grimaced while tightly gripping her head between her hands, this daughter wrapped her thin arms around her mother's waist, gently guiding her to her feet while leaning into her, chest to shoulder, her nose buried into her mother's short hair.

Oddly, as much as I wanted to help, I also wanted to continue watching. "Breathe in," I thought to myself, willing the daughter to inhale the scent of her mother's clothes, of her hair, maybe of the perfume that in years to come the daughter would casually smell and be taken back to this moment of familiarity. "Hug tighter," I willed the daughter's arms, wrapped around her mother's waist, hoping that they appreciated the inherent core strength of this woman who raised her. "Whisper something encouraging in her ear," I willed the daughter's lips, watching closely to see the mother lean even moreso into her daughter before successfully standing. She turned to her daughter and smiled. Soak this all in, I willed the daughter, this little moment of having your mom need you.

Maintaining her tight embrace on her mother, the daughter kicked up the foot pedals on the wheelchair before turning her mother toward where I was standing, guiding her several steps in my direction. As they approached me, the daughter and I gained eye contact.

I shifted my work bag over to my other shoulder and approached this patient's left side, opposite the side where the daughter was being supportive. "May I help either of you?" I asked, hoping to help this patient from the middle of this hallway. I could picture a runaway cot or a hurried tech clipping her and, despite her daughter's support, this patient falling to the ground.

"I think we're okay," the daughter answered, "we're just going to the bathroom." They were but ten feet from the bathroom door and looked comfortable enough to make it there. "How long have you been waiting?" I asked, grasping the patient's left elbow to help them the last few steps.

"Too long," the mother blurted out, showing her piss-and-vinegar. I laughed. It seems that an elderly woman's gumption is indirectly proporionate to their physical size. This woman, I had no doubt, had big gumption. "Probably a couple hours," the daughter added. I explained to them that I was one of the doctors and asked them what brought them to our ER. Plain and simple, it was a UTI. The mother had several days of burning and frequency of urination, and her family doctor "couldn't fit her in." Thus, the ER visit. And long wait.

After helping them into the bathroom, where the daughter would stay until her mom finished, I wished them luck and left them to their privacy. I found a tech who was able to wait by the door to help this patient back to her wheelchair from the bathroom, once they were finished.

I plugged myself into my hallway computer, sat down, and found this woman's results, confirming that she had a simple UTI. Thankfully, she was only a few patients down on the waiting list and would be discharged from our ER in the next hour from our express side.

As they left, I got a message sent to me from the daughter through one of our techs, thanking me for my help in the hallway and for "speeding them through." Although I would like to think I yield such power, I don't. It is the result of a cohesive, hard-working staff.

I jumped from my chair and ran to say goodbye to these people, only to find that they were already gone. I was disappointed I had missed them.

That still didn't keep me, though, from willing this daughter to cherish her care-giving role. And remaining time with her mother.

As always, big thanks for reading. A crazy schedule here...thanks for bearing with me. I hope this finds you all well.


Kate said...

I forget to cherish even the trying times.

The Hopeful Elephant said...

I try to remind myself of that on a daily basis as well.

Just breathe.

kate sweeten said...

Every ER should have a doc like you!

I spent over eight hours in a ER (around six of which in the waiting room) when my gallbladder decided to stop working...I was in so much pain and couldn't stop crying while surrounded by a hurricane of people and sounds. I told my husband at one point that if he really loved me, he'd stab me (just a little bit) in the side so that I could be seen faster ;) The doc that I saw when I finally got into a room made it all worthwhile - what a sweet, caring and compasionate person. It's amazing to see people keep such composure and be so pleasent when surrounded by such insanity and anger.

Katie Axelson said...

What an awesome snapshot. Way to realize the little moments within the chaos.

And thank you for the birthday wish. :-)

<>< Katie

SeaSpray said...

I'm crying. Too close to home ..having lost my mother in April 09. And wishing I had done more the last two years of her life.

I saw her every week except when ureteral stent in the last summer of her life because it took a lot out of me because of the size. But before that ..I had periods of fear ..seeing her seem to age so and slow down ..and denial. She was also feisty and it was complicated. But I wish I got in there and just did stuff anyway. or wasn't too busy to do something fun.

Wish I overcame the obstacles.

It was hard on her ..but I am grateful she had six mos in nursing home where life's complications were out of the way and I git to be attentive toward her.

But it's never enough. I could've done more.

But ..I guess I did the best I could do at the times these things were happening.

You captured that moment well.

Savor the moments. Appreciate the caregiver roll. It's really hard but someday ..you'll miss the moments and you'll be glad for what you did do.

She lived alone and when I came in or would leave ..on some days I would hold her frail body close and long and say .."I love you Mommy." The Mommy coming from her adult daughter (who hadn't called her that since at 7 yrs old thought that was for babies), evoked a smile from her.

i don't know anyone who wheres Tabu perfume. Only Mom. She loved it and I saved it. Smelling that takes me right back.

Sorry so long.

Your post touched me ..sweetly ..painfully so.

SeaSpray said...

oh and maybe I am not fair to judge ..but he couldn't squeeze her in for a urine sample, 5 min and a script?

I know ..multiply that x how many patients and he wouldn't ever get home. just seems wrong.

Friend's 86 yr old mother having repeat visits to the ER, dizzy, bowel issues has Sjogren's and I don't know what else and her docs ..do not bring her in. She NEVER abused going to docs and daughter is frustrated because she wants to speak with pcp, etc and mom won't give her the names/numbers stating she'll go when her appt comes up.

then recently the mother asked her to come down and stay a night because she didn't feel right. Tried to get in and office said no not til next day. She's 86! This woman is fiercely independent and for her to ask daughter to come stay a night ..something is wrong.

i have a question and wonder if anyone has insight about it.

with the geriatric population ..most will get chronic conditions and things will increasingly go wrong. But do their physicians put a limit on office visits because they attribute stuff to old age, believing they are increasingly not feeling well because of their age ..not necessarily health issues?

I know MDCR doesn't pay as well as private ins and that could be part of it.

Just wondering.

I would think you'd have more concern with an elderly patient.

Have Myelin? said...

this post made me cry. my daughter waited all day in the ER to be admitted. i asked her to go outside and call 911 so she could get in that way. she refused.

when she was finally admitted... she went into a coma 4 hours later and died of multiple organ failure.

a coma....4 hours after waiting all day.

her friends kept telling the front desk how sick she was but they thought it was a "cold".

SeaSpray said...

I am so sorry for your loss Have Myelin.

It seems so senseless when help was so close.

Cal said...

Nice of you to notice the tenderness among the hurricane of noises and worries.

coulrophobic agnostic said...

Geez, I need to thank my doctor for letting me come in whenever I have a UTI - I just pee in the cup and leave it there. No appointment necessary.

Tonjia said...

I guess I am in good company here, I lost my mom in February of 2009, and to make it even worse we lost my dad in October of 2009.. This post really hits home.

I know its not about me....

Doc, I so appreciate your kindness and caring heart. I wish more doctors had what you have.

I keep telling our patients that a 2-3 hour wait is not nearly as bad as it could be!!

Seaspray, I dont know where you guys live, but here the family docs stop seeing patients at 4:00pm so everyone who calls or stops in after that time is sent to the ER. (and several who call or stop in before 4:00pm too)

Empress Bee (of the high sea) said...

great story doc. we are SO fortunate that we have a vip doc and not only is he available to us, but he is the best diagnostic doctor i ever knew. i cannot tell you how lucky we are. the fact that their doc could "not fit them in" just stinks. we have had to go to the er twice this year for my hubby's cancer and both times he beat us there and took care of us immediately. he even got another bed for him because the one he was on was awful. he is amazing. one time i called his office and told his nurse that i was calling 911 and before they got there our doc was in our apartment. can you imagine???

smiles, bee