I recall with great clarity my first surgical case, a man stabbed in the neck. I was asked as a medical student to hold pressure while great debate raged regarding the status of his carotid artery. The question was answered when my hand grew tired and I slipped. Blood spewed across the room. I had settled the debate with action, not thought, making me perfect surgical material.
I matched into a Urology residency and made my way to New Orleans, Louisiana and Charity Hospital. My first two years of six were in general surgery. During those years I learned to care for the violence one man could place upon another. Chest cracking, heart massaging, “Intern to the Ramp” to pronounce another man dead and so much blood in the OR it would soak through your gown, through your scrubs onto that final tight white cotton barrier: just another day.
I had kids, a house and two cars so I had to moonlight on my off days to make ends meet. South Louisiana Medical Center in Houma Louisiana was a Sisters of Charity Hospital. It was old and it was dirty and it hired people like me, untrained doctors, desperate for money and in possession of both medical and driver's licenses. This emergency room smelled of stale tobacco, unwashed bodies and bad feet. My shift would start at 7 p.m. and last 12 hours until 7 a.m. the next morning. Alone I would diagnose pregnancies in young women, sew-up lacerations, clear people for jail, jerk fish hooks from hands, splint and cast, run the occasional code, pronounce people dead who should have lived, and marvel at people who lived who should have died. I even drained a few tooth abscesses. There was no supervision and nobody to over-read CT scans. I cleared more C-spines on plain films than I care to admit, remember, I was a Urology resident, 28 years old and I was alone.
This rhythm would wax and wane until around 2 a.m. and things would slow. I’d see my last patient and then try to escape. There was a place I could change clothes and wash my face. It was though I was washing away the cares, the stains, and the human misery of the day. Brushing my teeth was always the last best part of this routine. I’d look for a room as far from the nursing station as I could find. I’d stack two or three mattress from empty gurneys, find a fresh sheet and blanket, curl up on that newly-made bed, and try to forget that people had died where I slept. I’d block out the murmur and laughter from the nursing station and I’d try to sleep. If I could just sleep, it would all be ok.
One night, in this slumber, a nurse intruded, flipped on the overhead lights and said, “Doc, we got one for you.”
I grudgingly made my way to the far end of the emergency room and entered the exam room. It was long room, five bays for five patients. Privacy was a curtain and a soft voice. The room was constructed of cinder block and painted brilliant white. Add fluorescent lights and there was my patient, a woman of color. She lay on a gurney, alone in this cavernous room, swaddled in a blanket. She was facing the near wall as if to draw the room itself around her. She was crying without control. Her sobs would rise and fall, ebb and flow. It turned out her child had died that day, her only child, a son, another victim of senseless violence. Her only everything had died violently that day and she became inconsolable. She had been like this all day. Finally, exhausted, and the family not knowing what else to do, they brought her to my emergency room.
For the first time ever, I looked deeply into the person entrusted to my care. We couldn’t be more different. Violence was unknown to me or my family. I am a white man from a middle class family. My father was the primary provider, my mother a nurse. I had succeeded in most everything I had attempted and here, a woman of color was asking for my help. More than help, she was asking for a piece of my humanity.
I stood in that room and noticed for the first time how depersonalizing fluorescent lights are. I turned the lights off and cracked open the door. Enough light slipped through that I could see her shape and I could watch her breathe. I grasped the metal railings of the gurney and just stood there. I stood at her side for how long? I have no idea. I had no idea what to say, what to do. Somehow valium didn’t seem the best answer. Finally, as I refused to leave, her sobs grew faint and distant. She gathered herself. While staring at the wall, not looking at me, she said with desperation and a promise of hope, “To be absent with the body.” I recognized that phrase, a phrase of my youth, a phrase of my faith, our shared faith, so I finished. “To be absent from the body is to be present with the Lord,” I said. She rolled over and took my hand as I took hers.
I went back to my “bedroom” and retrieved my gurney-bed. I pushed the bed down the long hall, past the staring nurses and into her room. I pushed my bed next to hers, turned the lights off and slept, we both slept.
Dr. Donaldson is a clinical faculty UNC and Duke Urology and now MAHEC family medicine and chief urology proctor for Wingate PA school.
Illustration by Yi-Min Chun