In the five years that have passed since I met the 14-year-old girl who opened my eyes to the terrible crime of sex trafficking in the United States, much has changed. We have made strides in state and federal legislation to protect survivors, national human trafficking prevention months have been declared, and victims are no longer treated as criminals.
There was an elderly man suffering from late-stage Parkinson’s dementia. There was a patient with schizophrenia experiencing a COPD exacerbation. Then, there was Mrs. G, who was admitted for immune thrombocytopenia. She was a retired teacher who spent her time volunteering at her church and caring for family members.
On the first day of my psychiatry rotation I was anxious, and like most students I worried. I worried I would not have anything to say and I worried I would say too much. I worried I would say the wrong thing at the wrong time and I worried that my words would be more consequential than I ever intended them to be. I worried about my worry.
The white coats and patient gowns that confer the implicit power dynamic of the physician-patient relationship are not to be found here in the operating room. This place has neither the tolerance nor the patience for this subtle symbolism. Here, on the other side of the Rubicon, the rules are stark, the stakes laid bare. The patient lies naked on the table, arms extended on boards, Christ-like, as the surgeon holds the knife handle and plays God.
A frail elderly gentleman was wheeled in on a stretcher and left alone. His paper-thin skin lay gently across his delicate frame like fine linens. His mouth lay agape. His slightly yellowed sclera framed the piercing gray eyes cast upward at the harsh fluorescent lighting. He didn’t blink. He didn’t cry for help. He awaited the inevitable on a stretcher in a hallway of a fully occupied emergency department. I was confused and scared at the apparent lack of treatment he was receiving. There was no crash cart prepared for him. He wasn’t attached to telemetry. He didn’t have a nasal cannula. He lay in bed alone — in waiting.
Everyone at the nursing station turned silent and looked at the nurse who had delivered the news. I looked at her in disbelief, my brain struggling through a fog of confusion and surprise. I squinted at my patient list trying to remember who was the patient in 1152. Recognition finally hit and I remembered the little old lady that we saw during rounds two hours ago.
During my last visit home, my mother waited less than an hour before showing me her medical records. She offered them up the way I’d once presented my middle-school report cards, steering the papers across our kitchen table between bowls of peppercorn chicken and eggplant until they slid to a stop in front of me. Looking at them made my head spin, as they were written almost entirely in Chinese.
In medical school nowadays, there is a heavy emphasis on perfecting a physician’s demeanor when interacting with patients. Classes on essential patient care focus upon the social constructs of medicine, allowing permeable medical minds to ponder over various patient-care scenarios and determine the perfect method of one’s bedside manner. I used to believe such classes were ludicrous.
Seeing this dialog box, which pops up on the hospital’s electronic health record program, is never a surprise. On the list of patients whose charts I’m supposed to review for my summer research project, the deceased ones are highlighted in grey, setting them apart from the otherwise black-and-white list of names and medical record numbers.
White gloves on black skin. The fingers of my gloved hands still interlaced, still resting tensely over her sternum. Elbows still locked. Frozen in the position endlessly refined during CPR training. It turns out that blood flow is important for catheter angiography, which presents a challenge if your patient has no heartbeat. Has not had a heartbeat for 45 minutes.
In today’s America, it is well documented that each year, more of our GDP is being devoted to healthcare spending, and a disproportionate amount of that healthcare spending is towards end-of-life care. According to a 2013 report from The Medicare NewsGroup, Medicare spending reached about $554 billion in 2011. This was 21 percent of the total spent on health care in the US that year. About 28 percent of that $554 billion — $170 billion — was spent on patients’ last six months of life.
We stood in the shadows, a staggered line of nurses, students and surgeons in matching blue scrubs and masks. It was the middle of the night. Our tired bodies sagged against the walls, our bloodshot eyes dancing between the clock above and the gasping life below. A young man was dying in the operating room. He lay on the cutting table with his arms splayed wide, like a martyred saint stretched upon the cross.