She was nearly 18 but just a touch underage when she arrived in the emergency department projectile vomiting. I was the student on the pediatric surgery service consulted to monitor her during her hospital stay — making sure we were ready to intervene if her esophagus ruptured and all that. After admitting her to the floor, we attempted to contact her parents. Mom was somewhere in another state, Dad doing I-still-don’t-know-what in another country, both completely unaware that the life they each helped create was potentially in jeopardy at a Southeast Michigan hospital. It came out later, during her interview with the social worker, that she had spent most of her life being told by her parents that she was nothing but a burdensome mess. It’s one thing to have an inner demon whisper something nasty in your ear from time to time, but this was different. It’s moments like this that make the cynical parts of me wish that you needed to pass some sort of test to become a parent.
Somewhere around the second day of her stay, we arrived at a diagnosis: cannabis-induced cyclic vomiting syndrome. It wasn’t the urine that gave it away. She spent almost six hours each day in the hot shower adjacent to her room — the relief it provided made Zofran look like a placebo. When she wasn’t in the shower, she lay prone on her bed, elevated at 20 degrees, topless and silent. When we would visit her twice daily for rounds, a thumbs up or two, especially to a non-“Yes or No” question, was considered a high level of engagement — I heard much more retching than talking during her stay.
But her silence, and the absence of hope in her eyes, told me so much more. It would be impossible for any acute physical or psychological intervention to undo the damage of a lifetime spent being let down by every important person in her life. However, that didn’t stop me from hoping with each new morning that I might at least get to see something, something in her that knew she was loved by someone unconditionally and completely. More than we long for anything: food, remission, a deep breath, relief from pain, much less any illusion of connection and affirmation the internet might provide, I think many of us, maybe all of us, long for love. I tell the attending surgeon that the first priority for this patient is fluid resuscitation.
Less than 100 feet away was another girl. She had just celebrated her eleventh birthday. This little one had an extremely complicated medical and surgical history — an esophagus connected to the jejunum, a chest and belly full of plastic tubing and wire weaving in and out of her like highways. She also had significant intellectual and physical disabilities that rendered her immobile and nonverbal save a few moans and groans. She was in the hospital for an acute bout of constipation that was compromising her intestinal function.
Fortunately, she wouldn’t end up needing surgery. After prescribing a generous bowel regimen, we would often find her sitting in overfilled diapers with a wide smile on her face. Her mother and father took turns staying in the hospital with her, staying overnight, bringing each other coffee. It only took five minutes with them to feel touched by the warmth, joy and love they radiated from the inside — enough to stop my shivering as I stood under the air conditioning vent on the ceiling. The way they were able to interpret the patient’s posture, her laughs, her moans and her groans — they knew her. The way she leaned her head towards her mom when speaking or followed her dad’s hand as he transformed it into an airplane during her tube feeds — she trusted them. Being around love like that made me look at the bags of IV fluids, breathing tubes and scalpels with a more passive gaze. This patient was being healed by a different kind of medicine.
These two would be discharged on the same day, each vitally stable in their own way.
This is Water is an attempt at documenting intentional living. This column will strive to highlight the extraordinary meaning of the often unnoticed, and to greet the hard and joyful parts of the medical school experience with gratitude (even when, especially when, we don’t feel like it).