Editor’s note: The following article is a work of fiction, hence its inclusion in our “Off the Shelf” section for artistic works.
They have a term for it in the medical school curriculum: Breaking Bad News. An important communication objective. As a physician, I championed the “Breaking Bad News” clinical skills sessions, preferred them to the physical exam teachings that became dry and stale year after year. I volunteered to facilitate a small group every autumn, gently redirecting students as they fumbled through the contrived scenarios with an often over-zealous actor.
You would expect those sessions would have better prepared me to receive the news of my son’s death from a clerk in his third year of medical school. They should have prepared me, and yet they didn’t. But then, I guess nothing prepares a mother for that.
Instead of preparedness, I just keep thinking, how old is this kid talking to me? He looks no older than Devin. His white coat sleeves extending well past his wrists, he busies himself with rolling and unrolling each cuff as he circumvents the message he’s been tasked with delivering. I manage to decipher bits and pieces of his words, although a dull roar has developed in my ears, and the emergency department lights are suddenly overbearingly bright.
In the tiny family room, reserved for just these meetings, the clerk is releasing just a word at a time, dangling it in front of me for the briefest of moments. Leaving me to string them together in order, to form a logical chain of events. It has to be a trick; the more clues he gives, the less sense it all makes. I feel like I’m listening underwater suddenly, struggling just to keep my ears above the surface, gasping to get a full breath. Or like I’m playing a perverse game of broken telephone. Devin loved that game as a child.
The clerk shifts positions, can’t get comfortable in these chairs. In this role.
Did everything we could.
Anyone we can call?
Still in the little room. I’ve been here many times; with my own patients on nights I worked the ED. But today I’m certain it is the brightest room I have ever been in. The clerk holds his sleeves securely over his hands now. Why are they so long? He should be fully grown by medical school, right? Devin is still growing, but he’s only seventeen.
He shifts again on the hard seat. “Um. Dr. Patterson? Dr. Patterson…?”
I sense I’m not fulfilling my role as “family member.” Muddying the waters, confusing the scenario by acting as “physician,” too. I’m the opposite of the over-zealous clinical skills actor, stone-walling the poor clerk when I should be escalating the performance. He’s moved to the very edge of his seat now, ready to pounce to action and expertly diffuse the situation, to throw well-rehearsed supportive phrases on the flames of my rage, denial, grief. God, what is he waiting for, sitting like that? My feedback? Does he have an evaluation form hidden in that giant white coat?
The roaring in my ears gets louder, envelopes me like the sea and I’m slipping underwater. Can’t tread anymore. The lights, so bright and powerful, push me down — deeper and deeper.
I think I’m vomiting. The clerk rises so quickly his wooden chair crashes down beside me while he backs out of the room. I have a flash of an idea, that I’ll have to remember this for clinical skills, before I close my eyes against the light.
Night, suddenly. Home, somehow. Maybe Rex picked me up? I can’t be sure. We sit in the darkness, the house cold and quiet. Is this what our home sounds like now? Emptiness? A power outage? With energy drained suddenly from every room, every wire. We’re on the kitchen floor, too exhausted to make it farther into the house. Both of us huddled, clutching a bag they handed me at the ED, a white plastic bag with the words PERSONAL ITEMS stamped in blue. One hand sweating inside the plastic bag, I gently finger each of the items, over and over.
His helmet, indeed cracked down the midline. Blood crusted to the inside.
His T-shirt, black, made soft with wear. He hates clothes shopping, just like Rex.
The sickening correction creeps in and jars me — jerks me involuntarily, like a reflex. Hated. He hated clothes shopping. Is this what my thoughts sound like now? Like past tense?
His iPod, screen shattered. Worn so often, Rex and I joked it was a permanent fixture. We need to get the ear buds surgically removed, we would tease him.
“What’s that?” Devin would shout at us then, feigning he couldn’t hear us. Tuning out his parents and their lame parent and doctor jokes.
I run my fingers lightly over the sharp cracks in the iPod screen. What had he been listening to? I press the round power button and wait for the screen to illuminate. A list of songs I’ve never heard of. I realize I’ve never even wondered what was streaming into his ears all day long, the soundtrack to his days, to his life. I move my fingers over the screen, careful not to cut my fingertips on the shards, scrolling to the top of the playlist.
Chill out mix.
Chill out. I feel something like laughter rising in my chest, but a sob quickly deflects it. Clutching the iPod, I lean back against the fridge, eyes closed against the erupting tears. Immediately I picture him in this same spot, one random Sunday morning that could have been a thousand other mornings in their comforting sameness. Devin clamoring in the kitchen, still wearing his soccer cleats, wet grass and dirt trailing behind him in clumps as he runs across the room. Scanning the fridge. Milk straight from the carton. Always straight from the carton with him. Always in a rush.
Me, at the table. “Devin! Take your shoes off!”
One last gulp, then his silly, milky grin as he tosses his sweaty brown hair off his forehead. “Chill out, mum.” Then his ear buds in, and he’s off again.
Weeks later. Months, maybe.
“She walks around all day with those goddamn ear phones in, like a zombie.” Rex, on the phone with someone. I’m about to enter the kitchen when the truth of his words pierces me, stops me short. It is true that I do spend most of my time these days wandering our home, walking the stairs that Devin always took two at a time, stopping in the doorway of his room where he played on his computer, curling up on his bed for which he was getting too tall. With chill out mix washing over me, absorbing me. Whispering to me. Is this how he felt as he listened, with this same plastic against his skin? Detached? With the volume up enough, blaring, I can almost imagine Devin is singing along. Hear him, almost. Singing to me. Clutching his iPod to my chest, eyes closed, detached from my too-empty home. “I know. I know it’s grief. But it won’t bring him back, she must know that. She needs to talk to someone.”
Grief. With its insidious onset, and differential diagnosis of crazy and weakness. Don’t our white coats protect us from that, make us immune? Isn’t that at least in part why we become doctors, because then we’re inoculated? I back away from the kitchen doorway as my finger finds the smooth, circular volume button of the iPod, now so familiar, and I begin the walk back upstairs.