Download The Pharos Winter 2011 Edition - Alpha Omega Alpha

Going first
About the author
I was born and raised
in rural Utah. I attended
Smith College and graduated
with a degree in
philosophy in 2004. I
am a recent graduate
of Northwestern
University Feinberg School of
Medicine where I earned my
MD and my Masters in Medical
Humanities and Bioethics. I am
starting my residency in psychiatry
this year at the University of
Southern California. I hope to pursue
a career in geriatric psychiatry.
guarded. She accepted my explanation
but called the family anyway.
Jenn reminded me again: “Kat is my
power of attorney.”
“Yes, of course.” I was relieved they’d
done the paperwork, aware of all the
hospital horror stories that had befallen
other gay couples, thinking also that
it was premature to be worrying who
would make decisions for her if she
couldn’t do so herself. She looked just as
healthy as I did.
Radiology paged my attending the
following afternoon. I pulled up Jenn’s
CT. She had an abscess in her back muscle,
on the left, just where her pain had
originated. It was large enough for a med
student to see it, meaning it was pretty
damn big. It was a pillowed pocket of
air and fluid, indicating either active
bacteria or a fistula between her bowel
and back or both. Either way, the recommendation
was to stick a drain in it. I
remember being surprised although not
alarmed. We’d stick a central line in her
neck and send her home with IV antibiotics
and a drain coming out of her side.
She continued to appear very well—
moving around her room, her pain
under better control. I was shocked
to see an elevated white count on her
CBC. She didn’t look sick! I scheduled
her with interventional radiology the
following afternoon. The drain was
placed without incident. That evening,
I dropped by her room to say hello.
She and Kat had visitors: Jenn’s sisters,
brother, and niece. Jenn seemed jovial.
Kat appeared more at ease than before.
She even smiled when I told her goodnight.
“See you tomorrow,” Jenn said. Her
sister hugged me. “See you tomorrow,
girlfriend,” she said.
Before heading to her room the next
morning, I pulled her vitals up on the
computer. Her heart rate was up, all
night, into the hundreds. Her most recent
blood pressure read 90/60: alarmingly
low. Topped with a fever of 102
degrees. All signs pointed to sepsis. I
could feel my own heart bump around
in my chest. I could feel my fingertips
and groin get numb with the anxiety of
heavy failure. How could I have not seen
this coming?
I waited for my attending before I
went to the room. I was afraid of the
picture that the vitals had painted for
me, and I knew that if I actually looked
at her, that would only make it real. I
wasn’t ready to hit that on my own.
“It appears that Jenn is septic,” my
attending explained to the family. They
didn’t know sepsis from a septic tank,
none of them medical. But the connection
between the two seemingly related
entities conjured a fitting image of severity.
I could see that. Kat knew best
though, herself a nurse. The word softened
her voice and cut deep lines in her
weary face. She looked ruddy, almost
hungover with sadness this morning.
She knew it all along. She had been
guarded, accepting our explanations and
speculations throughout the admission.
Carefully optimistic, but knew to call
the family anyway.
Looking at Jenn: she knew too. It
wasn’t the pain that brought her in, I
decided, looking back at it from where
I was in time now. The pain had been a
sign, and she knew.
We asked the regular questions.
“What’s your understanding of what’s
going on, Jenn?” That’s my attending’s
gentle voice, priming them for the
events looming on the horizon.
“Well, it looks like I may die.” Her
frankness was killing me. I had to swallow
hard and look away from her. Kat
took her hand and moved to sit on her
bed. She couldn’t get close enough to
her. I remember feeling that way as a
child, small spooning my mom in my
parent’s bed at night, thinking that if I
could just get closer and closer, I would
be invincible. This is how Kat looked
at Jenn now—like if she could just get
close enough, maybe she could keep her,
get away from the bad-news voices, and
be invincible.
Jenn was weak, intermittently trailing
off, but lucid when she needed to
be. In between cracking jokes about
the doom in the room, she made her
intentions very clear, careful always to
speak in the first person, plural. Now,
she was speaking for Kat, too. Jenn may
have been dying, but it seemed Kat was
surrendering. She asked us to stop the
antibiotics.
“I’m at peace, you know,” she huffed,
showing her exhaustion. “Everyone is
here. Kat’s here.”
“She keeps twitching,” Kat said,
watching Jenn’s legs worm around under
the sheets.
“Oh, that doesn’t bother me,” Jenn
said.
We ignored Jenn and started something
to stop the twitching. Our focus
had shifted from treating Jenn to protecting
Kat. If Kat didn’t want to see
twitching, then we would make it so.
That was the one thing we could do for
her. It made me feel a little more useful
in my attempts to make up for the colossal
failure I’d suffered against the natural
forces that were claiming Jenn.
Jenn didn’t really speak again after
that. She fell into a kind of trance,
sometimes restless. At those times, we
gave her morphine, and she was quieted
again. Her breathing was rough.
We patched her with scopolamine and
fentanyl.
14 The Pharos/Winter 2011