Of all the sounds I expected to hear as I pushed open the thick door of Examination Room 3, the anguished sobs stopped me in my tracks.
Wide-eyed and mouth agape, I stared. Agonizingly long seconds passed.
“Hello, my name is Jimmy…” My mouth instinctively prattled the standard script I had practiced for the last two years. The woman looked up. Behind a mess of straw-colored hair, her red swollen eyes met mine. Dark streaks of mascara painted her face like a Kabuki mask.
I could feel the sweat forming on my face. “I don’t know what to do,” the woman wailed between sobs.
But let’s rewind a bit. It was my first night in the ER. As a clerk, I conducted the initial history interview and physical exam on patients, and then reported back to discuss assessment and management.
A few hours and several cases later, my confidence began to grow. About three-quarters of the way through the night, I asked my attending Dr. T if there was anyone else I could see.
“Why don’t you go see the patient in exam room three? Harris. Jaclyn. She’s been waiting for a long time now.”
That’s how I met Jackie.
Now there I stood, dazed, whatever shred of confidence I had built, gone. Funny how little it takes to bring you back to square one.
My brain moved like molasses. In the neural pathway to my vocal cords, a few synapses fired aimlessly, and words drunkenly staggered out of my mouth. I cringed at the phrasing I used.
Jackie did not notice. She brushed a clump of hair out of her eyes and began to talk.
Over the course of the next hour I followed Jackie through her life. Here and there, I asked questions, clumsy attempts to direct her history. Yet these inquiries fell on deaf ears to Jackie. Gradually, I stopped probing and just went with the flow. I began to listen.
Ears and eyes. Hearing the words of her tragic past, recounting episodes of loss, neglect, molestation and abuse. The nuances of her voice, the trembling of her breath between words, and the sobs that bubbled through while she talked. Seeing her hand clutched around the tear-soaked Kleenex, I could count the veins as they popped out. She shifted back and forth, almost as if it was too painful to sit in one place for too long.
A fog enveloped my mind. How could I help her?
Defeated, my mental arsenal bare of options, I nodded along. She soon concluded, capping it off with another desperate plea of help. I muttered “we would look into it,” purposely shielding myself with the all-disseminating we.
Emerging from Exam Room 3, the rest of the department hummed away at its usual pace, completely indifferent to what just transpired. I scanned the bay for Dr. T. I spotted him hunched over a desk, analyzing an abdominal CT.
“Hey Dr. T, I was able to get a history from Mrs. Harris. Do you want to hear it?”
“Sure thing, Jim. Just one second.”
He leaned back as if reclining on a La-Z-Boy before a Monday night football match. I reviewed the chart, and told him the stressors in Jackie’s life, including an incredibly emotionally abusive partner. I emphasized that she had used the term suicide, a word that cowed me when I heard her say it, a few times during the interview.
“She was so upset and kept asking for help over and over again. She did not seem to know what she could do for herself at the moment, and I’m not too sure what I could offer to help her, considering the time of night it is.” Dr. T listened and nodded as I wrapped up.
“It certainly sounds like she had many emotional traumas, and honestly, we can’t really help her with a lot of that. The emergency room is not the place to heal the wounds that have resulted from so many years of abuse. I’m sure she has some form of PTSD. We can keep her safe and settled here tonight and consult psychiatry in the morning so they can assess her.”
I asked Dr. T, “Is that all? What about all that crying? I just didn’t know what I could do to help.”
“There is never an easy answer here, Jimmy. Sometimes you can solve things. Great. Sometimes you can’t, but you know who can. And sometimes it’s bigger than you. You’re going to have to be comfortable with that feeling of being lost, because it’s going to be with you for the long run.”
Overhead, fluorescent lights flickered. Dr. T wheeled over to a different computer and opened Jackie’s file. He unceremoniously checked a “complete” box. The file disappeared. Swallowed somewhere into the ether of the hospital’s digital network, it was as if Jackie ceased to exist.
“Come on Jimmy, let’s see bed eight. This will be a good case.”
I glanced once more at Jackie’s chart. It was covered in a furious scribblings of my notes. A feeling of doubt still lingered. I did not like it, but I could not shake it.
With one final sigh, I put the chart back into the drawer and followed.
Editor’s note: The patient’s name in this article is a pseudonym and has been changed to preserve patient privacy.
The clerkship experience can be the definition of tumultuous. As we’re suddenly tossed into the wards, it’s easy to become caught up in the shuffle as we move through our service rotation. These posts try to take a step back and become “a fly on the wall” observing and reflecting on the overall movement through clerkships.