Tuesday, February 19, 2013

A Hug Is A Hug Is A Hug

Sometimes as human beings, despite all the layers we consciously build upon the shell of our souls to shelter us, define us, and project an image to others of what we hope we are, our basic inherent quality of goodness emerges on its own free will. A kind word, a gentle touch, a hint of a smile, an understanding patience--these are all things that escape uncontrollably in moments where our consciousness is left behind, running to catch up to our spontaneous reaction in a moment of crisis for another. 

Of all of these unconscious acts of inherent kindness and compassion, though, none ranks higher than a heartfelt hug. Not a light tap on the back, or the fake kiss of a cheek, but rather a hug that emerges from the tightened embrace from one to another that, for the briefest of moments, conveys the wordless caring that we all crave to receive. Like cake batter in waxed pleated cupcake sheaths, these hugs are ready to emerge, when fed warmth, to spill out of us into the want of another.

It was one of these moments, of private hugs and hushed whispers, that I was recently privy to witness in the trauma hallway of our department. Suprisingly, however, it was given from the most unlikely of persons.

Trauma patients are typically the most complex of all our patients, with a wide spectrum of issues ranging from life-threatening physical injuries to the endless abyss of psychological and social tolls from the unexpected event. Like trauma patients before her and trauma patients since, Room 18 held an unfortunate patient (in her early twenties) who presented via helicopter from a car-accident scene. She had been a front-seat passenger who, due to a multi-car collision and the twisted secrets of fate, sustained both severe physical injuries and, more importantly, powerful psychological injuries that would be life-long. Sadly, her mother, the driver of their car, had died at the scene of the accident.

Although I wasn’t the primary ER attending treating this unfortunate patient, I poked my head into the room to see if I could help in any way with her treatment. The mood of the room was somber, an understandable heaviness weighing down any spirit of knowing our quick actions might help this patient recover fully from her physical injuries. The bright lighting that reflected off shiny metal cots and posts and equipment could do nothing to deflect the pain and misery of this patient’s future. Of her impending misery. Of a future life where her mother would not be available to share a secret ingredient to a recipe, to consult over whether to serve ham or turkey on Christmas day, or to call “just because.” Nor did the room’s sterility help clean our own pain for this patient’s tragic loss. Adding to the senselessness, we later learned that the mother’s unselfish reaction in the crash had been to swerve their car in a direction that would protect her daughter from being directly hit, or t-boned. This patient’s mother had given her own life so that her daughter might keep hers.

After this patient was stabilized, it was shared with her that her mother had not survived the crash. Her mournful wails and cries after learning her cruel truth could be heard the hallway through. As tragedy’s effect usually does to each of us in the emergency department, we paused in this moment, recognizing the profoundness of change in one of our patient’s lives.

Eventually, family members trickled in and supported this patient as further emergency treatment was provided to her. Occasionally, I would pass by a pair or group of family standing in the hallway, outside of the patient’s curtained room, hugging and whispering to one another, trying their best to simultaneously provide and receive support. With each pass, I would slow down just a bit and nod my sympathies, wishing I could sponge even just a tad of despair from their shoulders.

It was soon after that Amelia, one of our “regulars,” was placed in the only available room, Room 17, next to the unfolding trauma tragedy. Ms. Amelia was an elderly woman with an extensive mental health history who had signed into our ER, yet again, for a multitude of miniscule complaints. Although she was well-known to much of our staff, I had only met Amelia one prior time a few years earlier.

I walked into Room 17 to introduce myself to Amelia, only to find the room empty. Reentering the hallway, I couldn’t help but notice two younger people fully embraced by the strong, steady arms of their slight, grey-haired grandmother. It was a breathtaking scene—the younger boy and older teen-aged girl leaning their heads into the gathering arms of this strong woman. I walked slowly by, looking for the nurse to ask her where our patient had disappeared. Not finding the nurse, I ran to the lounge for a quick bathroom break.

Returning down the hallway, I happened upon the same scene playing out that I had just passed by, the shorter older woman still embracing the younger two people while turning her head and softly taking turns whispering into each’s ear. It was a touching scene, one that struck me as both comforting and tragic.

Suddenly, though, I heard the hallway nurse yell out, and turned my attention to the young, blonde nurse who was doing the yelling. “Amelia,” the nurse scolded as she approached the same group of three from the opposite direction as me, “leave this family alone.” I was confused. I looked to the group of three. I looked at the nurse. And I looked back to the group of three just as the nurse touched the older woman on the shoulder and spoke again. “Please, Amelia,” she pleaded, “you need to go back into your room and leave this family to themselves.” The nurse’s voice cracked, begging of Amelia to not put up any resistance.

I stood still, staring at the scene. I looked at the group of three breaking apart, the older woman lingering to release the younger people from her arms, being urged on by the nurse. I looked at her pained face, watching as she whispered her last words to the young family members, releasing them hesitantly from her grip as the nurse coaxed her towards Room 17. And suddenly, with amazing clarity, the truth of the scenario smacked me in the face. Amelia, my next patient with the psychiatric history, was the “grandmother” who had been embracing two of the family members of the trauma patient.

“Well, I’ll be,” I whispered to myself while approaching Room 17’s doorway. The beauty of Amelia’s gestures were not lost on me, but I readied myself to have a serious discussion with her about privacy issues and respect and all of that stuff. Any family such as this trauma patient’s deserved their privacy in the depths of such crisis. Before entering the room, however, while I was putting a pair of latex gloves on in the hallway, I overheard the two recipients of Amelia’s hugs speak.

“She was a nice lady, wasn’t she?”

“Yes, she was,” the other responded simply. “I wonder what she is here for?”

“I don’t know,” the first answered, “but I hope she is alright.”

I paused to absorb the enormity of the moment, realizing that kindnesses can come from the most unexpected people in the most unexpected places at the most unexpected times. Despite Amelia’s personal struggles, most of which I could only imagine in her daily dealings with mental illness, she gave of herself that which she could, some heartfelt hugs. Hugs that appeared to be received with the intent for which they were given. Those hugs of Amelia’s, well, that was a darn-special privilege of mine to get to witness—one stranger comforting others in their moment of crisis.

Maybe all of this stuff the nurses warned me about Amelia were a thing of the past.

I walked into Room 17, extending my hand in greeting. “Hello, Amelia,” I said with renewed faith in our patient, “I’m Dr. Jim. What can I do to help you today?”

She mumbled something as she paced beside her cot. “Pardon me?” I asked her. The medical student accompanying me gave me a look that he, too, did not make out her words.

She wasted no time in speaking up. “What the hell is wrong with you people I should be out there with those people they need me don’t make me come back in here.” She spoke quickly, hauntingly, in one long exasperated breath.

Even though I knew Amelia wouldn’t like my explanation, I quietly explained to her that, although her hugs were welcomed and appreciated and quite nice, actually, we all had to respect the trauma family’s privacy at such a profound moment of sadness. I reassured her, though, that her actions were a privilege for me to watch and that the family appeared to appreciate her gesture.

“Now,” I continued, “what can I do to help you today?”

“Get me the hell out of here,” she said, glaring at me. “I don’t need to be in no room next to where bad stuff happens.”

I offered to try to find her another room, but she turned the offer down. When I asked her what her complaints were that I could help her with in the emergency room, she ignored me. “I want to leave,” she said with conviction. I made her assure me that she had no pains anywhere. I was reassured by her words that she was having no feelings of despair or urges to hurt herself. Thankfully, she had also assured several of the staff that she was not depressed or having any ideations to harm herself. And judging by her hugs, it appeared that all she wanted to do at this very moment was to help others in need.

“Amelia,” I said calmly and kindly, “are you sure you are going to be alright?” She nodded her head yes. After her hallway hugs, I think she truly forgot what reasons she had that had brought her to our ER that day. I discharged her from our ER without any workup after she passed my screening exam and a consultation with our case managers.

I can’t forget, though, why I think Amelia was there. I think that sometimes, in some mysterious ways, things happen in our daily lives that defy explanation. For unexplained reasons and circumstances, Amelia chose to visit our ER on a day when a few others were in need of a heartfelt hug.

And from Amelia, that got just that.

As always, big thanks for reading. I hope this finds you well. And to those of you who have continued urging me to write, I thank you. Your kindness has been felt…Jim