Editor’s note: This is a work of fiction.
If you come into the hospital room before she arrives, you might miss the telltale signs of her existence. They are subtle — a soft sweater thrown over a chair for those drafty hospital wards or an absurdly expensive vegetable tray from the café downstairs on the patient’s table. The notebook is the giveaway, the pathognomonic proof she has been there, but to see it you have to really look, for it is easy for such an item to blend in with the general debris of a long-term patient’s hospital room. It will be battered with dog-eared pages and a pen slung through its spiral binding always at the ready. The pages you see will be filled with a breathless scrawl with many sentences completed by a question mark springing from the final word. Several phrases will be underlined harshly, and their importance demarcated by a thick, dark line.
Your patient is most likely an older male who has recently begun the precipitous decline into complicated aging. He likely has some memory issues — not severe enough to get him sufficient care, if that exists, but the kind that make getting everything done just a little bit more difficult. He was probably trundling along in his sixties and seventies with some of the classics: hypertension, diabetes, osteoarthritis and the occasional myocardial infarction. Now, in his eighties, those ingredients have been whipped into congestive heart failure, and he is here with his first exacerbation. Or, he recently had a fall — he isn’t sure exactly how — and he was brought in for a “check-up,” but an abnormal lab value was found on his triage blood work. A COPD exacerbation is also equally likely for he is of the generation who heaves a deep, raspy nicotinic laugh when you ask if he smoked.
You barely get to speak a word to him before he interrupts you, his eyes darting to the doorway nervously. “I’m sorry, but you really need to speak to my daughter. She’s the one who knows everything…”
The attending might plow ahead despite the complete lack of comprehension on the patient’s face because the clock on this patient had already begun counting down. A minute more might go on before she arrives. She will not be empty-handed, this is absolutely certain. She could have a newspaper that contains her father’s favorite crossword or a water bottle because she asked for a glass of water two hours ago, and it never came. Often, she bears some vestige of home like a soft pillowcase or an extra blanket. She usually also has something for herself, a snack or a tea, because she is wise enough to know she will be there for a while.
She comes into the room flustered and her frustration at missing the first half of the attending’s visit permeating into the air. She tosses her things down quickly introducing herself as she goes and quickly takes her position in the chair with the notebook. She asks politely, yet firmly that you start again because there is no way in hell she is missing anything. She has not slept at the hospital for two days only to miss this moment.
You might hear the tiniest perceptible sigh escape from your attending’s mouth, but he will acquiesce for he knows he should have waited for her. He might say otherwise to the team in the hallway: something about how he can’t always wait for family members, and this is true. His time is stretched so thin that he doesn’t even get to see his own family: a new, happy baby smiling at him from his phone lock screen. But he has seen enough women with notebooks to know that seeing a patient without them is a waste of time. He will learn soon enough to just come back if they aren’t there, but he is still somewhat new to this role.
Before the attending really gets going, she interrupts to ask a question. Her voice is firm with an edge of uncertainty; She knows enough to ask the question but also enough to know that she is talking to “Very Smart People,” and this fact intimidates her. She starts with an easy one usually a clarification of a hastily described acronym or perhaps the name of a drug. The attending slows down. He is somewhat chastened by his haste for he knows that he shouldn’t use acronyms or brand names but does so out of habit. She is gracious and thankful for his explanation even though she knows that it was owed to her without prompting. She is setting the stage. At the tail end of her question, she always mentions the following: “I actually have a list of questions I would like to ask you when you’re done.” She pointedly says this to the attending (her tone teeming with politeness, of course, for she is a woman who knows how to get what she needs) as both a head’s up and a warning that he will be giving her more time on the clock than he allotted.
He nods and says, “Of course, we will gladly answer them,” projecting confidence from his role as the expert. But under his starched, blue button down, he starts to sweat from the unexpected pressure of having someone in front of him truly paying attention to his lines. She then lets him carry on; she won’t really say much until the end. She is too busy writing down every word he says. Her pen flies across the pages of the notebook, and she will pause only to ensure that what she is writing down is painstakingly accurate. She does this for her own benefit, of course. She is creating the Encyclopedia of Dad’s Health Stuff: First and Only Edition.
But she is also drafting the email that she will be sending to her siblings later that day (if she is lucky enough to have a sibling who cares). She will type this out verbatim late that night when her own family has gone to sleep so that everyone is in the loop. Her siblings will ask her many questions and analyze her emails at length by copy-pasting phrases into Google, but you will likely never see her siblings at the hospital. Some live far away, some work long hours and most just “can’t handle it.” They tend to be the sons, and not the daughters, but of course, there are meaningful exceptions.
The patient smiles at his daughter, completely tuning out what the doctor is saying because he knows that he is being cared for by her. Near the end of the attending’s monologue, she gets ready for her question period. She flips to a dog-eared page and looks up at him expectantly. He glances at her face and realizes that he forgot she had questions for it is a rarity to get more than one during a visit. He hastily wraps up his explanation of congestive heart failure, COPD and delirium and says with shaky confidence,
“And yes, you had some questions for me?”
She smiles and nods feeling a little nervous herself. She has waited for this moment, the one where she gets to actually ask the doctor what is going on, all week. Her questions are always practical, essential and well thought out: exactly the kind of question doctors get uneasy about answering.
Sometimes, she references something he said last week that has completely escaped his mind, and he is a little flustered by someone fact-checking his work. But usually, the heart of her questions go something like, “How will this affect his function?” or “What does this mean for the rest of his life?” The attending answers to the best of his ability, but she is visibly dissatisfied with the answer. She is still learning to speak medicine, and the gaps in her vocabulary make it difficult for her to fully comprehend. Still, she is quickly learning the limits of the system and when she is pushing them. She is left with a feeling of helplessness because if even the doctor doesn’t know the answers, who does? She dwells on this for only a moment; a wave of panic crossing her face. But she quickly regains her composure for her sake and for ours because she knows that we are all relying on her to carry on.
After the third question, the attending gives many indications that he needs to leave both subtle and not. He checks his watch and starts edging toward the door. He ends his answers with “Next time,” and “Later on.” She knows that he has reached the end of her time, and she doesn’t push it. She profusely thanks him and shakes his hand. The attending directs a quick, sincere goodbye to the patient, and if the patient is not asleep, he will beam and say goodbye to the attending with enthusiasm. His daughter smiles at her father, adjusts the now-rumpled sheets on his bed and gives him the newspaper/water/snack she brought on her way into the hospital.
As you round on the patient in the bed next door, you notice her poring over her notebook. Her phone is in her other hand; She is either texting her siblings or looking up all the words you and the attending didn’t explain. Her father is sound asleep so you are catching her just as she is. You see a scared, overwhelmed woman thrust into a role for which she had not prepared. She is astounding in her grace and compassion and one of the most underappreciated members of a healthcare team. Since the healthcare system relies on these women to pick up the never-ending slack, you will see many like her in the hospital. And every time you see one, you will feel a sense of relief because you know that there is no intervention more powerful and effective than having a woman with a notebook by your patient’s side.