Bess Stillman - What It's All About

 

So, they wheeled her into the ER at 05:30 PM, 27 years old, unresponsive EMTs had found her slumped over outside the Starbucks on 2nd Avenue, and that's all they knew and she wasn't about to tell us anymore. So, we did what we always do when we have a patient like this. Was she breathing? Was she bleeding? Was her heart still beating? We got her into the trauma room, cut off her clothes, put a large bra IV in each arm, put her on the monitor, started a bag of normal saline and tried to figure out what was going on. 

 

This was the last shift of what had been a horrible intern year for me. I had moved to New York from Arizona after finishing medical school to do my specialty training in emergency medicine. I did it for the same reason I think everybody does it, because it sounds fun and exciting and I'm going to save people, except less exciting is the 80-hour work weeks that you work in residency. I was working night shifts and day shifts and I had no real prescribed breaks. I was learning to work with 104-degree fever the day after my grandmother died, sneaking out between patients to vomit in the bathroom, only to come home and find out that my boyfriend of four years wasn't so sure about us anymore. I still couldn't call out to work, because then I would be publicly shamed as being weak. 

 

I was depressed, because were all depressed. But we didn't talk about it, because if you talked about it and your boss or God forbid your program director thought that you were mentally or physically unfit to do this job, then you would lose this amazing opportunity that you had to learn how to help people, this amazing opportunity that was killing you. And what would be worse than losing that? So, we all had coping mechanisms, casual sex, of course, but it wasn't like on TV where everyone's Dr. McSteamy and Dr. McDreamy. [audience laughter] Here it was more like Dr. McSweaty and Dr. McAnger Management Problem. [audience laughter] So, I stayed away from that. 

 

There were also drugs and alcohol. Not my thing. What I like to do was go home at the end of the day, and get in the bathtub, and put my face under the water and breathe through a straw. [audience laughter] I would wonder if it was true what they would say, which is that those few seconds before you drown, you feel really euphoric. Really good. The lights were off and the water was body temperature, and it almost felt like not having a body at all. And those were the only times during residency when I felt like being stripped of feeling wasn't like being numb. 

 

I'm telling you all of this to explain how, looking at this young woman who was my age, who could have been any of my friends, so you understand how I just shoved a breathing tube down her throat with the same perfunctory efficiency I used to snake the chronically plugged drain in my apartment. So, now she was on a breathing machine and we had that taken care of. But her blood pressure was still dropping and her heart rate was still dropping. And she looked pretty healthy. Usually what that means is an overdose. So, we started looking through her things, trying to get some clues. 

 

One of the nurses found her driver's license in her back pocket and got onto our electronic medical records and tried to find out some information about her. I started rummaging through her bag, trying to see if we could find any pill bottles or any signs of drugs. And that's when the nurse called out that we were totally wrong and she wasn't really healthy. She had been coming to the hospital since she was about 13 for a really rare and really aggressive form of cancer. And over the last 11 years, she'd had 10 rounds of chemo. And the note in the chart from her doctor basically said that she was terminal and she had refused any more treatment, and she was just done. 

 

And so, I figured, this is probably just the natural progression of her disease. I was about to close her purse when I noticed a piece of paper. I pulled it out, and on it was a list. And it said, “12 o' clock, take my dog Misty to the dog park and take three Xanax. And 12:45, go to Bite and get the bacon sandwich with extra cheese and take six oxycontin. One o'clock, go Tompkins Square Park. Finish reading the last chapter of The Girl with the Dragon Tattoo. Take six more oxycontin, three Xanax.” The list just kept going on like this. It was just a perfectly detailed list of schedule, really, of how she was going to die.

 

We had just been shoving tubes in her and needles in her. And that was fine. But reading this, that's really what felt like the violation. I had to tell everyone, right? Because in an overdose, what you take tells you how to treat and I knew how to treat her. But I had taken an oath and the oath basically said, “Do no harm.” I didn't know in that moment what harm was. Do we bring her back and do we have her suffer through this again or maybe die of her disease? Or, do we let her go? But what if she is regretting it right now and can't even tell me? So, I did what we always do in those situations that we have new information. I held it up and I said, “Look what I found.” We treated her, and they whisked her away to the ICU. 

 

My attending, the doctor in charge, she turned to me and she looked at me and she said, “This is why went into emergency medicine. This is why we come to work every day.” And I was like, “Wait, what? [chuckles] This is what we're killing ourselves for?” She'd been doing this for 20 years, but she just looked absolutely beatific, as if we had just pulled school children from a burning bus. I was so envious in that moment of her, how easy she interpreted the situation and how happy she seemed that I just wanted to hit her. But then, she told me I had to go see the guy in room 12 who was complaining of penile pain. I didn't even get a break, so I had to go. 

 

That night, I went home exhausted and sick. I ran a tub, and I got into the water and I turned off the lights and I didn't take my breathing straw with me. I thought how nice it was to not have to make decisions in that quiet dark. I thought how nice it would be to just dissolve into everything, because I had another shift in six hours, and I just couldn't face it. And so, I let all my breath out and I tried to just let go until my lungs started to burn and my body, despite myself, pushed up from the water and I was gasping. I wondered if I would ever really learn how to save others when I was just barely able to save myself. Thank you.