Today, Miss Betty died. I met Miss Betty yesterday morning. After diligently waking up early, opening Epic to look up our new admits, and familiarizing myself with her backstory, I formulated my thoughts and walked into her room. She was lying in her Stryker bed in the teal flowered night gown that she had left her home in. She was thin and small looking in the bed. She had short, straight, coarse grey hair and a matching 5 o’clock shadow. She had freckles on her face like Morgan Freeman and surprisingly striking caramelly hazel eyes. I asked how she was feeling and in her polite, high pitched voice she replied “I’m feeling good”. I believed her. I took her story in her words, listened to her heart and lungs, made some small talk, and excused myself, explaining that I would be by with a big group a little later. I went back to prepare for rounds and the intern and chief were in the workroom ordering a Doppler as we couldn’t find Miss Betty’s peripheral pulses. We started rounds and after flubbing my way through her presentation outside her room, we went in to check on her. Her eyes grew wide as we all traipsed in, anticipating the big reveal of her feet. We pulled up her blankets revealing her purple, swollen, cold, mottled feet. They didn’t fit the picture. They were disproportionately disfigured in comparison to the disposition of this woman. The other students all took turns feeling her feet. The back of our hands, just like we were taught. We Purelled out and continued rounds.
When we returned up to our floor, I overheard the intern talking with the vascular team about Miss Betty’s surgery. One of the medical students explained that she might lose both of her feet today. The nurse came in and said that her blood pressure was falling and they couldn’t get access. I followed the intern out of the room as we went to collect the US machine. “What would happen if she didn’t get the surgery?” “Did the heparin not help?” “Would she make it through surgery, given her comorbidities?” No good answers. I returned to her room and the intern and upper level asked her son, daughter, and niece to step outside the curtain while they used the ultrasound to look for a good artery. I felt unqualified to be inside the curtain, while her family had to stay outside. The upper level sent me for an IV kit and when I returned the family was talking with the Palliative care specialist they had met during their last stay, only a few days before. When the upper level was prepping for his first stick, I took her hand and told her to squeeze it if she needed. I asked her about her childhood and where she grew up. A few sticks later, the upper level decided to try her neck. She didn’t flinch, she didn’t blink, she didn’t squeeze, not once.
The team decided to call Rapid Response. 2 strong, trim RNs in royal blue scrubs and fancy backpacks rolled in. This was the second time today that I had seen them in action. While down in radiology, we had witnessed them run a Code Sepsis on a hypothermic woman. While we waited for them to start a line, I listened to her talk about life in Boomer, NC, “a flat little territory” where she lived on a farm with cows and horses and pigs and goats. She picked green beans and cooked ‘em up good. She played basketball and softball. She climbed trees. She enjoyed cleaning and running and jumping and cooking. Palliative care came in and joked about her hair cut since her last admission. Her daughter explained that her mother preferred this length because bad things always happened when it was long. I expressed my own appreciation for short hair, especially in the hot, humid summers I still have not grown accustomed to. Rapid Response was also unable to start a line, but by that time a bed had been secured for her in the ICU, so off we went. I asked the nurse if I could tag along and he said of course. I introduced myself to the family on the way out and they joked that I’d better be careful or she’d try and adopt me when this was all over. I laughed, but knew that this was going to be over all too soon.
I helped them push the bed down to the ICU, holding Miss Betty’s hand with one of mine, and directing the bed with the other. It was the same ICU where I spent my first day of 3rd year. I already felt like a changed person since that day. I got out of the way while she was being transferred to a new bed and stepped back in to hold her hand while she was being changed. The NP, resident, and attending came into her bay to talk to her, so I left to talk to her palliative care provider. We talked about the big picture, lifelong ventilation, worst case and best case scenarios. I returned to the bed as the ICU nurse was starting to place the lines. At some point, the other medical students came up behind me. We stayed and talked with Betty about southern cooking and North Carolina, when the attending and fellow rushed in to do an ultrasound. She winced as he shoved the probe deep under her xyphoid process. It was the first visible pain I had seen her show all day. She looked off into the distance, dehumanized, as he threw her left breast around, trying to get the right shot. Another medical student and I caught each other’s eye, disgusted. We had just had a discussion earlier in the day, on the way up from the biopsy wondering when doctors begin treating people as objects. At what point in our teaching do patients become part of the machine, the protocol that comes along with doing procedures? They turned to leave, leaving her exposed and covered in ultrasound gel. “Do you think you could clean her up and put her gown back on?” “Oh, yea”, he muttered as he half-assed cleaned her up and snapped her gown back up…
We stayed a while longer, listening about sweet potato pie, collard greens, lemon pie, coconut cake, and what she was going to make for her sister-in-law’s birthday party the next day. When the tech came in for the chest x-ray, we thanked Miss Betty for chatting with us, told her to take care, and left the ICU. We had a discussion on advanced directives on the walk back up to our floor. The intern saw us as we were walking back to our workroom, asked us what the hell were we still doing here and told us to leave. One of the other students stayed behind to sit with her patient, to help order her a Panini from the cafeteria. Myself and another student left.
All night I was worried that she would die overnight and followed her course on Epic. 95.6°. 95.5°. DNR. Blood pressure 78/52. Respiratory rate 8. Comfort care. When I woke up this morning her temp had rebounded somewhat. When I arrived at her bay this morning, her eyes were open but she couldn’t hear me very well. She grabbed for my hand and arm, attempting to pull herself up and onto one side. I made sure she was situated and as comfortable as she could be, told her that I would be back, Purelled out and went upstairs to round. Time of death, 7:46 am.
Julia Camille Thomas
Year in Medical School: MS4
Grew Up: Concord, CA
College Attended: Wellesley College
Favorite Quote: “Well-behaved women rarely make history.”
- Laurel Thatcher Ulrich
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