“Dr. Liroff, I prepared everything and the patient is ready for you to place the NG tube.” Gloria, the nurse, said to my back as I was typing at a computer.

In residency, being addressed like this felt awkward; especially by someone three times my age with a wealth of experiential knowledge. Sure, I had been a professional book-learner, but this was an apprenticeship. I had told everyone in the emergency department to call me Meghan, but after a year of residency, no one seemed to listen.

I stopped typing mid-sentence and stood up so quickly that the chair groaned in a lazy rotation. “I’ll follow you,” I said. Gloria was going to help me to put in a nasogastric tube for a patient who had been vomiting blood. In the ED, our nurses usually did this, so I didn’t have much experience. I was called to place this one in particular because the hospital protocols had changed and nurses were no longer permitted to place NGs in patients who had a history of esophageal varices; that responsibility now fell to the underqualified and inexperienced resident.

Gloria led me to the patient’s room. I passively recognized the gait of arthritis in her steps as her hips rocked from side-to-side; her shoulders slumped; her mousey waist-length brown hair was gathered loosely with a surprising purple scrunchie at the base of her neck. She turned to face me once we had reached our patient’s room. I was distracted by her coke-bottle glasses and her tired eyes,“ alright, Dr. Liroff, here’s what you need to do: put a little gel on the end of the tube and ask the patient to swallow as you thread the tubing on the floor of the nose….” Her voice was nasal and toneless. We were on either side of the gurney; I reached across the patient hesitantly to take the tubing from her, but I was too late; the procedure was already done.

The patient gagged and recovered. Gloria barely blinked, patted his back and said, “There, there,” and wiped the escaped spittle from his face with a tender gruffness. And then with a little boredom, “thanks, Dr. Liroff. Just put in the x-ray.”

I guess my work here is done?

With too much eagerness, I thanked her and went back to my computer to obediently put in the order.

I hadn’t worked with Gloria often so I asked around. Apparently, she had the most seniority in the department and remembers when the department was first built. She had borne witness to our chairman’s residency and was godmother to his children; she didn’t wear gloves to put in IVs because she couldn’t feel the veins; and after 40+ years, she had decided to go part-time.

Forty years in an urban academic emergency department. My mind gently wondered: How many arrogant residents had she put up with? How many residents and nurses had she seen humbled by their mistakes? How many lives had she saved for forty Julys? What unbelievable trauma had she seen? What patients does she remember the most? Why nursing? Did she want to be a doctor but times were different then? Did she hate taking orders from condescending and righteous squirts? Does anything scare her?

I intermittently saw Gloria throughout the rest of residency but the pace of my training never really allowed for a good talk with her. I wanted to know what she had seen; wisdom through osmosis. I regret that I never had that chance.

***

Meghan Gaffney Liroff, MD is an emergency physician. She is proudly Detroit born-and-bread and is privileged to practice there now. Her favorite book is the Velveteen Rabbit and looks forward to becoming real. Find her if you can; she’s always moving.