Westlake, Ohio, USA
|Scene in the New York morgue.
A month before my gig as senior medical resident at Bellevue Hospital was up, I spent a morning in the New York City morgue. Why? I lost a patient. A young man with end-stage AIDS, a prisoner from Rikers Island.
The morgue, a stone’s throw from Bellevue Hospital, was what I expected: windowless, antiseptic pungent, shivering. What surprised me was how quiet it was, solemn as a monastery. Underneath the cold and calm that mask the smell of death, there was a sense of urgency.
Bodies were waiting. That morning the intake worker showed me the list of names – single-spaced, two-pages long. All from one weekend. He was kind. My patient’s autopsy would be done first because I was a busy and important doctor and all.
He showed me to a closet; I understood it to be a change room. I took off my white coat. Gowned and gloved, I walked rapidly past gurneys when a little body caught my eyes. Lying flat, she took up less than half of the stainless-steel table. Palms open, arms straight, legs slightly splayed apart. Smooth, flawless chocolate skin. Her dread locks, braided with care, had fat roots, tips gathered in colorful beads, like a jester’s hat. Her back arched from muscular buttocks. leaving an inviting space for a loving adult to hook an arm under and scoop her up.
I half expected her to sit up suddenly and breathe noisily, as would a newborn baby. But my eyes kept going back to the charred, off-centered, pin-sized hole on her forehead like a misplaced bindi.
I stood there dumbfounded until a low voice asked me, “Are you ready, doctor?”
I spun around, facing the masked face of the coroner at the next autopsy table. Holding a glistening scalpel inches from a man’s neck, he kept his eyes on the body in front of him, out of decency, I supposed, to give me time to compose myself.
I tugged and pulled at my own gown and mask with purpose. “I’m ready,” I spoke in a gravelly voice tinged with irritation. Those days I always sounded irritated and impatient. I found that people argued with me less when I was curt.
I looked at the face of my young patient on the table. We had spent four days together, but I barely recognized him. He had a square jaw and generous lips that were half-closed. The scalpel moved swiftly, bloodlessly. The skin split in silence.
In a matter of seconds, I too was transformed, detached, blending in with the other blue-gowned figures hunched over still bodies on steel tables.
He had been admitted in a coma. Despite our best efforts, we couldn’t locate the source of infection. Now he lay on the next gurney to a girl, who could not be more than seven, maybe a victim of a drive-by shooting, random violence. I did not know. I did not ask. But minutes into my patient’s autopsy, I understood why he died. When the coroner cut into his pelvis, I smelled it before I saw it.
His pelvis was a mustard color, reeked of a putrid smell unique to bacteria which thrives in little or no oxygen. I recalled his hair-raising fever, dangerous rising and falling blood pressure in the ICU. He was dead before he came to me. I was relieved. Unless I cut his pelvis off, I could not have saved him.
When this patient arrived, I remembered saying to my team of somber interns and medical students:
“Look,I know he is very sick. And he was just discharged from Dr. Baum’s service. But he is not going to die on my watch. And you are going to make sure of it.”
So when he died, tethered to a ventilator, IV lines, bladder and anal tubes, like a badly made marionette, I called the morgue. “I am the senior resident on the case. If it is OK with you, I would like to come to his autopsy. I need to know why.” I always found out the whys because ‘Natural Causes’ was never good enough.
I played God. And for the longest time, God played me. The monitors in the ICU pumped me with a sense of power, control, and discipline. I manipulated each breath and each drop of fluid and dosage of antibiotics. The ventilators and patients huffed and puffed in synchronized precision to my command. I never cried. Once, after a hard night on call, a fellow resident complimented me. He said, “You have balls.”
Those were the days I gave fact-based advice—calmly, sensibly—without humor. But things changed. The transition was slow, punctuated by uneven events, occurring at the most unexpected times.
The first time I lost it at work, I had been in private practice for over three years. It was the middle of a drowsy afternoon of wholly humdrum visits: constipation, headaches, body aches, everybody feeling blue, blah, and bloated. One of my regular patients came in. She had well-controlled hypertension. I saw her once a year. As I was walking into the office, I was already pulling a prescription pad out of my pocket, anticipating a refill request. But before I even sat down, she, eyes wild, started at the end of a story—the only story that ever mattered in her life.
Her seventeen-year-old daughter, a college-bound basketball star, was murdered by a boy, also seventeen , whom she gave a ride to from a burger joint. He stole her car. They found her body stuffed in a box under his bed three days later.
I leaned into the heat, the sourness of her breath. I listened to her reliving each hour. It started with simple concern that roiled to gut-wrenching panic, then hope, shock, disbelief, anger, crushing sadness; emotions of a lifetime all in three days. My thoughts fled to my toddler son, who had just recovered from a severe asthma attack from a simple cold. For several days and nights I watched him wheezing and choking on snot and tears. I was bleary-eyed with exhaustion and fear. The fact that I needed to go to work and dispatch him to daycare before he was completely well filled with me guilt. After all, he had inherited asthma from me and my father. I was overwhelmed with jumbled fear for my patient and her family, my son and me.
Unknowingly I tightened my grip on her forearm. When I let go, I saw, we both saw, the red streaks I left on her pale flesh. In horror, I stammered, “I’m sorry, I’m sorry, I’m so sorry.” Then I lost it. I began to cry, heaving uncontrollably. I could not utter a sensible word, let alone that cultivated, doctorly confidence and control.
What was my job again? Putting conflicts and conundrum into perspective? Offering sincere and sensible condolence? Reassuring her that things will get easier? Dispensing magic-bullet pills to control her hysteria, insomnia? I used to say, “It takes time, but it will get easier…”
I did nothing. Instead, I looked at her with profound sadness and helplessness. Then a strange thing happened. She reached out, grabbed both of my hands and pressed her hot face on them, and started to pray for both of us.
Years later she would tell me. At that moment, to her, I became more than just a physician. I was her friend, a trusted lifeline.
“You care about me,” she said. “You understood me. I’ll never leave you.”
That day I ran late in clinic. I splashed cold water on my face. My nurse looked at me with a frown and gave me ice in a plastic bag wrapped in a towel for my puffy eyes. She did not say a word or ask any questions. She tiptoed around me, apologized to my patients who had waited too long, and rescheduled those who could not wait any longer, apologizing more. That was the day my emotional bulwark, which I had equated with dignity and professionalism, flooded and crumpled like a breached levee.
I do not miss it.
In the ensuing years I sat and held hands with people from all walks of life. They recounted secrets from the past, their shame, the deaths of their loved ones–in the past tense. But sometimes they slipped into present tense, betraying their real thoughts. “Am I crazy? I hear her voice in the house.” They told me things they could not tell their family and friends. Sometimes I could hold it; sometimes I teared up faster than they did. I offered no solutions, no absolution.
I learned to listen.
I realized as a physician the toughest thing I have ever done is walking in my patients’ shoes. The toughest thing I have ever admitted is—I am a woman. A teary one at best.
The ghost of the little girl on the steel gurney rarely haunts me anymore. It helps that my son is grown and healthy. But I have never forgotten her. She could have been my daughter. She could have been everybody’s daughter. In my thoughts, I would scoop her up at her arched waist and say a prayer—for the both of us.
DIANA PI, MD, is a general internist who currently works at the Lorain County Free Clinic. She also opens a biweekly health column for the Westlake/Bay Village Observer.