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across my oval mirror
CHANGE OF SHIFT
across my oval mirror Adaira Inez Chou, MD* *Corresponding Author. E-mail: [email protected]. 0196-0644/$-see front matter Copyright © 2016 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2016.04.035
[Ann Emerg Med. 2016;68:511-512.] I look at myself this morning, across an oval bathroom mirror, with the hope to see the image of my mother instead of my own. I look for her aged wrinkles—canyons carved by tears and smiles—found at the crook of her eyes and mouth. The sneaky gray hairs, faded from her almond brown, representing the memories gained and loved ones lost. My mother is remarkable. She has the valor to care for others as if she is their only chance for survival. An ability to listen to you as if the rest of the world cannot produce sound, and you are the first noise she’s ever heard. Even in my pink canopy bed, she’d shut off the light and I’d plead, “Just one more,” and she’d sing me her favorite homemade lullaby, “Hello Mrs. Sunshine.” I’d love to go back to those days—any of them—a time when I was unaware of what it meant to age. When I could just be breastfed and naive, sit on her lap and be a cowgirl, or tinker at the piano just because it made her proud. A time when I thought I could, in fact, become as spectacular as my mother. She was a registered nurse who spent her life prolonging the lives of others. When a patient died, she wore her black scrubs to work, like a member of the family who wanted nothing more than an opportunity to mourn. With every loss, she’d crawl home from work and move just a bit slower, weighed down by small mistakes she felt she made. She left an imprint—I’m here to impact the life of others; I’m not here for myself. Because of her, I decided to dedicate my life to a career in medicine. But now, years later, I sit idle in my childhood bedroom, legs thrown over the armrest of my chair, head tilted back. I feel hypnotized by the old rickety fan that has seen better days. I’m so much older and so much has changed from then to now. My naive dreams and mumblings of being an actress, musician, or preschool teacher are now just echoes trapped within the walls of this room. I close my eyes to think of my past, until my mom’s hazy sobs interrupt me.
Volume 68, no. 4 : October 2016
I regret that I only visit her for holidays and funerals. I walk down the hallway to the kitchen and I see the calendar my parents have pinned up—September 27th—it’s not a holiday. Days earlier, I got the news that my grandma had died. My mother’s weak voice on the line, breaking from the heaviness of it all. She tells me she’s “not ready to live a life without a mother.” She calls me twice more that day. She must have felt so alone that the mere presence of a transcontinental voice was enough to keep her company. I imagine that phone had been glued to her hand for hours. Calling relatives, making funeral arrangements, just breathing into the mouthpiece—hoping that she’d hear her mother’s breath back. I was jealous of my mother’s reaction, her ability to be surprised by Grandma’s death. Her ability to have hope that Grandma would make it home for just one more plate of mashed potatoes coupled with a glass of cranberry juice. Just how she liked it. The tip of my tongue, dense and full of a want to say, “Grandma is dying and we should welcome the truth.” Restricted from candor, I’d blurt out stock emotions just to fill the empty space. “Don’t worry, mom. She’ll be home in no time.” I had to play the part. Who was I to rid my mother of her hope? Grandma had gone into the hospital months earlier for a failing heart. I knew it was dismal because I had taken care of the same patients myself. I work in the emergency department attached to a small hospital, tucked into the corner of a street. Elderly patients present often with respiratory distress. Sweat dripping from their faces and eyelids wide open, scared that the next weak breath will be the last. My own reaction to death has been muted or at the very least numbed down. Unlike my mother, over time I have become more removed from each scene. The repetition removes the mystery and morphs it to nearly a checkbox, where you forget that the standard of care is actually to react, to digest, and absorb. I think back to that elderly woman who arrived from a dialysis center, without any papers or witness to tell us her end-of-life wishes. So with apprehension, we presume she
Annals of Emergency Medicine 511
Change of Shift
wants everything done, and hope to God she wouldn’t have wanted to die in peace. Compressions are started, a tube goes down her trachea, and she’s hooked up to a metal box that does all the breathing for her. I notice her lifeless hand flopping around with the beat of compressions, like a dying fish out of water. We realize we’ve been foolish, and despite our best efforts, we can’t do anything else. We check her belongings for a name, a photo, an address—for relics of life. Like that silver gum wrapper, folded twice and kept safe in her pocket. Or her nails, freshly painted, a mint green that matches her toes. I bet she got them done for a wedding or graduation—some event to celebrate the progression of life. No one stops to discuss this. It’s not important for her management but it registers for a second to me. It’s a shame I can’t be lost in those nuances—the small treasures of her life that could make my job less mundane. And hours later, on my bus ride home, when I think back on that one patient, that old lady, I won’t even recall the shade of her polish. Was it lime or forest green? My team will break for lunch with no time to debrief. No chance to question who that lady was and whom she raised. We don’t meet the child she breastfed or the husband who made her feel at home. At the time of her death, that gum wrapper, those memories, were tossed onto the floor—trash for the 19-year-old janitor to sweep away. She is wrapped in a clean hospital sheet, hands tucked in and eyelids shut, and wheeled to an even colder place. My mother doesn’t see death the way I do. She’s the lucky one. She wonders if Grandma wants lilies or orchids on the casket. She irons her favorite dress and fluffs the feathers on her beautiful church hat. I can’t see it that way. I’m the one left wondering about the mechanics of my grandma’s death—who was the doctor who put the tube down her airway? Was it a nervous intern, unprepared for the task at his hands? Was that intern congratulated at the end of it all, as my grandma was wheeled off and covered in a sheet? Nice job, Stephen; sad she didn’t make it but at least you got some practice. Don’t forget to log the procedure so you get credit. I worry about the similar times when I have also been detached from the incredible event I just witnessed.
512 Annals of Emergency Medicine
Chou
Unimpressed by the fact that the extraordinary has become routine. The times I referred to patients not by name but by disease or room number. I went into medicine to be humane and empathetic, traits that I didn’t know could be weakened so easily. At the funeral, I see my grandma in the bed sleeping, dreaming of what she was and how she got to be where she is. My young cousin, clinging to the prospects of hope, runs to my grandma. “Grandma, time to go home. Everyone is leaving.” He shakes my grandma’s still hand. “Time to go. Everyone is waiting for you.” My mother grabs his growing hand, carries him away and whispers, “Don’t worry, Grandma is waiting for you now.” I’m saddened that I’d never have thought to say something so sweet. Back in my childhood room, sulking into the mattress—dreaming about the composition of tomorrow. I look out of the window and pray for an ability to hope. Hope that when my own mother dies, I lose my badge, white coat, and stethoscope—my armor and shield—and I become human again. Become humane again. A person without medical training and without scientific questions like—Did they start the correct antibiotics for my mother’s pneumonia? Instead I want to ask better questions. Did I make you proud, Mom? When I played that small piano for you all those years. Can you sing to me once more about Mrs. Sunshine and Mr. Raindrops? That was always my favorite song. Can I brush your hair one more time? And she would say yes to everything; she’d smile at me with pride, singing to me about the sun and raindrops, and let me brush her hair—one last time—until she falls asleep. And when that day arrives, I’d sit there next to her, cultivating the memories of my departed mother. Noticing the color of her polish and position of her hands, the creases in her face and strands of gray in her hair. I’d breathe it all in. Hoping to never forget the small treasures of her life. And before my mind wanders, I’d celebrate the possibility of one day seeing her image across my oval bathroom mirror. Author affiliations: From the Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA.
Volume 68, no. 4 : October 2016
across my oval mirror Adaira Inez Chou, MD* *Corresponding Author. E-mail: [email protected]. 0196-0644/$-see front matter Copyright © 2016 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2016.04.035
[Ann Emerg Med. 2016;68:511-512.] I look at myself this morning, across an oval bathroom mirror, with the hope to see the image of my mother instead of my own. I look for her aged wrinkles—canyons carved by tears and smiles—found at the crook of her eyes and mouth. The sneaky gray hairs, faded from her almond brown, representing the memories gained and loved ones lost. My mother is remarkable. She has the valor to care for others as if she is their only chance for survival. An ability to listen to you as if the rest of the world cannot produce sound, and you are the first noise she’s ever heard. Even in my pink canopy bed, she’d shut off the light and I’d plead, “Just one more,” and she’d sing me her favorite homemade lullaby, “Hello Mrs. Sunshine.” I’d love to go back to those days—any of them—a time when I was unaware of what it meant to age. When I could just be breastfed and naive, sit on her lap and be a cowgirl, or tinker at the piano just because it made her proud. A time when I thought I could, in fact, become as spectacular as my mother. She was a registered nurse who spent her life prolonging the lives of others. When a patient died, she wore her black scrubs to work, like a member of the family who wanted nothing more than an opportunity to mourn. With every loss, she’d crawl home from work and move just a bit slower, weighed down by small mistakes she felt she made. She left an imprint—I’m here to impact the life of others; I’m not here for myself. Because of her, I decided to dedicate my life to a career in medicine. But now, years later, I sit idle in my childhood bedroom, legs thrown over the armrest of my chair, head tilted back. I feel hypnotized by the old rickety fan that has seen better days. I’m so much older and so much has changed from then to now. My naive dreams and mumblings of being an actress, musician, or preschool teacher are now just echoes trapped within the walls of this room. I close my eyes to think of my past, until my mom’s hazy sobs interrupt me.
Volume 68, no. 4 : October 2016
I regret that I only visit her for holidays and funerals. I walk down the hallway to the kitchen and I see the calendar my parents have pinned up—September 27th—it’s not a holiday. Days earlier, I got the news that my grandma had died. My mother’s weak voice on the line, breaking from the heaviness of it all. She tells me she’s “not ready to live a life without a mother.” She calls me twice more that day. She must have felt so alone that the mere presence of a transcontinental voice was enough to keep her company. I imagine that phone had been glued to her hand for hours. Calling relatives, making funeral arrangements, just breathing into the mouthpiece—hoping that she’d hear her mother’s breath back. I was jealous of my mother’s reaction, her ability to be surprised by Grandma’s death. Her ability to have hope that Grandma would make it home for just one more plate of mashed potatoes coupled with a glass of cranberry juice. Just how she liked it. The tip of my tongue, dense and full of a want to say, “Grandma is dying and we should welcome the truth.” Restricted from candor, I’d blurt out stock emotions just to fill the empty space. “Don’t worry, mom. She’ll be home in no time.” I had to play the part. Who was I to rid my mother of her hope? Grandma had gone into the hospital months earlier for a failing heart. I knew it was dismal because I had taken care of the same patients myself. I work in the emergency department attached to a small hospital, tucked into the corner of a street. Elderly patients present often with respiratory distress. Sweat dripping from their faces and eyelids wide open, scared that the next weak breath will be the last. My own reaction to death has been muted or at the very least numbed down. Unlike my mother, over time I have become more removed from each scene. The repetition removes the mystery and morphs it to nearly a checkbox, where you forget that the standard of care is actually to react, to digest, and absorb. I think back to that elderly woman who arrived from a dialysis center, without any papers or witness to tell us her end-of-life wishes. So with apprehension, we presume she
Annals of Emergency Medicine 511
Change of Shift
wants everything done, and hope to God she wouldn’t have wanted to die in peace. Compressions are started, a tube goes down her trachea, and she’s hooked up to a metal box that does all the breathing for her. I notice her lifeless hand flopping around with the beat of compressions, like a dying fish out of water. We realize we’ve been foolish, and despite our best efforts, we can’t do anything else. We check her belongings for a name, a photo, an address—for relics of life. Like that silver gum wrapper, folded twice and kept safe in her pocket. Or her nails, freshly painted, a mint green that matches her toes. I bet she got them done for a wedding or graduation—some event to celebrate the progression of life. No one stops to discuss this. It’s not important for her management but it registers for a second to me. It’s a shame I can’t be lost in those nuances—the small treasures of her life that could make my job less mundane. And hours later, on my bus ride home, when I think back on that one patient, that old lady, I won’t even recall the shade of her polish. Was it lime or forest green? My team will break for lunch with no time to debrief. No chance to question who that lady was and whom she raised. We don’t meet the child she breastfed or the husband who made her feel at home. At the time of her death, that gum wrapper, those memories, were tossed onto the floor—trash for the 19-year-old janitor to sweep away. She is wrapped in a clean hospital sheet, hands tucked in and eyelids shut, and wheeled to an even colder place. My mother doesn’t see death the way I do. She’s the lucky one. She wonders if Grandma wants lilies or orchids on the casket. She irons her favorite dress and fluffs the feathers on her beautiful church hat. I can’t see it that way. I’m the one left wondering about the mechanics of my grandma’s death—who was the doctor who put the tube down her airway? Was it a nervous intern, unprepared for the task at his hands? Was that intern congratulated at the end of it all, as my grandma was wheeled off and covered in a sheet? Nice job, Stephen; sad she didn’t make it but at least you got some practice. Don’t forget to log the procedure so you get credit. I worry about the similar times when I have also been detached from the incredible event I just witnessed.
512 Annals of Emergency Medicine
Chou
Unimpressed by the fact that the extraordinary has become routine. The times I referred to patients not by name but by disease or room number. I went into medicine to be humane and empathetic, traits that I didn’t know could be weakened so easily. At the funeral, I see my grandma in the bed sleeping, dreaming of what she was and how she got to be where she is. My young cousin, clinging to the prospects of hope, runs to my grandma. “Grandma, time to go home. Everyone is leaving.” He shakes my grandma’s still hand. “Time to go. Everyone is waiting for you.” My mother grabs his growing hand, carries him away and whispers, “Don’t worry, Grandma is waiting for you now.” I’m saddened that I’d never have thought to say something so sweet. Back in my childhood room, sulking into the mattress—dreaming about the composition of tomorrow. I look out of the window and pray for an ability to hope. Hope that when my own mother dies, I lose my badge, white coat, and stethoscope—my armor and shield—and I become human again. Become humane again. A person without medical training and without scientific questions like—Did they start the correct antibiotics for my mother’s pneumonia? Instead I want to ask better questions. Did I make you proud, Mom? When I played that small piano for you all those years. Can you sing to me once more about Mrs. Sunshine and Mr. Raindrops? That was always my favorite song. Can I brush your hair one more time? And she would say yes to everything; she’d smile at me with pride, singing to me about the sun and raindrops, and let me brush her hair—one last time—until she falls asleep. And when that day arrives, I’d sit there next to her, cultivating the memories of my departed mother. Noticing the color of her polish and position of her hands, the creases in her face and strands of gray in her hair. I’d breathe it all in. Hoping to never forget the small treasures of her life. And before my mind wanders, I’d celebrate the possibility of one day seeing her image across my oval bathroom mirror. Author affiliations: From the Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA.
Volume 68, no. 4 : October 2016