She was faceless, nameless. She was placed in our care after presenting with sudden unexplained paralysis and altered mental status. Each day at table rounds, her story was retold again and again. None of us had seen her except for the one intern that met with her briefly each morning and reported any changes in her clinical course to the team. But she was our favorite intellectual challenge. A seemingly never-ending list of differentials.
Each failed surgery and medication and unremarkable test piled up before us. Yet, we kept working. We kept throwing things at the wall in hopes that something, anything would stick. Weeks in our care, yet she remained only a vignette to be delved into each morning. That was until she became the limit to our knowledge. We had exhausted every option, and the day finally came to sign off on her care as the neurology consultation team. The defeat was palpable. In this wake of failure, we finally went to see her.
A ghost. So frail. Her pale skin pulled taut against her cheekbones. Deep shadows gripped her eyes. And she moaned … to us? To herself? To God? Contractures gripped her body, but her chest heaved like her soul was clawing its way out. A small man stood beside her bed, hands folded tight against his core. His eyes fell over each of us — a frantic searching of our faces, the edge of hope followed the deepest sorrow. My eyes were burning before a word had even been spoken. I had to look anywhere but him, so I watched her and ached. Oh, how irrelevant the past intellectual adventures seem now standing before her. This real woman. This hurting woman. And her husband, whose mourning you could feel like a weighted blanket in this room.
The conversation we had with her husband was long. I wasn’t expected to talk, and the heartache in my throat wouldn’t have let me anyway. We didn’t have answers, and we certainly had no solutions. We couldn’t explain how the woman he loved went from living a normal life to being bed-bound and unable to speak in only a matter of days. How unfair is that? To spend weeks pouring over her case, reducing her to nothing but a list of learning issues, only to offer nothing. In return for her dehumanization, we’ve only given her more suffering.
Guilt. It must’ve been guilt that I was feeling. Especially in the presence of his patience, his graciousness, his gratitude. We watched silently as he accepted our words and allowed them to settle gently into his gut as the tears finally billowed over. “Before you go,” he said, “I have one thing for you all.”
His hands were shaking as they gently peeled open a tattered envelope. I leaned forward, attempting to understand what he was trying to show us, then gasped. She was 25, and her blonde hair curled away from her face in the wind, her laughter ringing out warm and clear. And then she was 30, looking away with an intelligent smirk. Then 40, eyes illuminated with joy as they gazed at the person behind the camera.
He tenderly went through each photo in the stack, his voice quivering as he told us her story. Her real story. My vision was damp, salty, blurry, but I saw her. For a moment, we all saw her as he did, intimately, through a lens of complete admiration and love. The juxtaposition of her radiance to this current cold reality made the devastation even more tangible. It was almost too much. A not-so-gentle reminder of the humanity we serve as medical professionals and how easily it can be lost in the intellectualization of modern medicine. What a gift he gave us that day — an imprint on our soul and a renewed humanized lens through which to serve our patients.
The time we spend with our patients is just a small frame in their beautiful elaborate stories. When we care for them, it can be easier to see them wholly as this frame, their entire identity that of a patient and nothing more. It provides psychological safety when the job gets challenging. But in this framework, we lose meaning in our work and the compassion that truly heals our patients. I have taken care of many patients since this encounter. In each of these interactions, I can’t help but think about what snapshots their envelope would hold. We are gifted the privilege to heal people, not patients. And I’m reminded that I am not just caring for them, but for those who lovingly carry their envelope when they cannot.