Ms. Betty

Disclaimer: The medical references in this story are made-up, as well as the name. The quotes aren't. I did my HIPAA training, I swear.

Ms. Betty was a patient I fell for, pretty quickly. But the unfortunate thing is, I don't know if the person I fell for was Ms. Betty, or who her dementia made her to be.

She was a teacher. Taught at PS 443, she would always gleam and say proudly. For how many years? I would always ask. Oh, way too many, would always be the response.

She got cranky a lot. A lot of yelling, about how nurses were trying to feed her poison (medicine). But I knew how to calm her down - "Ms. Betty do you like traveling?". "Oh, I traveled the world!!" Her face would always soften when she said that. "Of course, I can't do it anymore, but I went everywhere!".

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Ms. Betty doesn't have the capacity to make decisions for herself. Jenny, contact her nephew to get consent for an endoscopy.
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Ms. Betty was found confused and dehydrated in her bed at home by a concerned doorman, who had not seen this 93 year old tenant in 3 days. She lived alone, and had no family in this city.

"You're a medical student?" She looked up at me as I introduced myself over her hospital bed. "You know what my first choice career used to be?"

"Let me guess, could it have been....a doctor?"

"That's right!" She gazed off with a big smile, "I was pre-med, and I really wanted to go to medical school...but a job as a teacher was easier to find back then..."

"Wow that's funny!" I couldn't help sharing "I wanted to be a teacher! Almost didn't come to medical school, if you can believe it!"

"Oh that is very funny," she chuckled "We could've traded places!"

We stayed in that moment for a few seconds, smiling at each other. Then she exclaimed, "Anyway, these thieves just stole my money, my bag, and 4 of my canes! Find me my New York Times, will you help me?"
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Ms. Betty doesn't have the capacity to make decisions for herself. We need this procedure done.
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I held her hands as they prepared to poke a large needle in her belly. To take the fluid out.

"What is this, a circus?" Ms. Betty was displeased "I'm old, I don't need you to take all these heroic measures to save me. Whatever happens, happens. I don't want this."

"You'll feel a lot better after this, Ms. Betty."

"I'm old!! I'm never going to be like you again. You just have to accept it! If things hurt, I'll just have to accept that it's a part of the end!"

I didn't know what to say.

"Do you have any old people in your life?" She demanded.

"Yes, I do."

"Well talk to them, ask them what they want at the end. It's important."

And the needle went in.
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Ms. Betty doesn't have the capacity to make decisions for herself. She can't go back home. She has no family. We have to send her to a nursing facility.
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"Were you ever married, Ms. Betty?" We were trying to distract her as the nurse prepared her injections.

"Oh no." She replied "I had millions of children, though."

"Millions?" Here goes her confusion again, we thought, and exchanged glances.

"Yes. My students."

A New Project

Over the last couple of years I realized the importance of reflection.

I remember chilling on the hammock in my Boston backyard, getting over my quarter life crisis, and thinking, "Damn I'm lucky to have all this time to come to terms with my values, and the decision to go to med school."

I won't go into details there, but the point is I want to make time, often, to sit back and reflect on my experiences. On how they affected me, changed me, for better, or for worse.

Especially during this year - 2017 is going to be a year of endless learning and new experiences, because I will spend it in clinical rotations! It is arguably the most exciting, education, and exhausting year for any med student, so I don't want it to blindly go by!

I'll share stories here of moments that made me think. If you want, I'd love to hear what you think too. :)

P.S. A huge thanks to Peter for this wonderful idea! You're an inspiration in many ways.
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Time of death, 7:06.

Well, it was 6:49 first, but I guess they weren't ready to give up. There was still a hint of a heartbeat.

This was how I started my day this morning. I walked into the rounding room at 6:30AM, and before I could open my patient's chart, the intercom announced a code down in 2 South.

A "code" is a code used to announce a patient who enters cardiac arrest. When this happens, the designated medical team rushes to the beside in an attempt to resuscitate.  My intern was on that team, so I followed. I had never seen one before (!)

Things were already in full swing by the time we got there. A nurse was behind the bed handling the oxygen, which was blowing into his lungs. A tired looking resident was doing chest compressions while standing on a stool. A nurse had a syringe of epinephrine ready to shoot, on the order of another resident, who loudly took charge, and shouted directions with an unhesitant ring.

"Who's keeping time?" He demanded, "Take out your phone and start the timer" as he pointed to a doctor who had just rushed in. He did.

"XX, get ready to take over chest compressions, YY, get ready to step off!"

Now the room is steamy. No less than 20 people had crowded into this corner of the room, putting gloves on as they looked for ways to make themselves useful. On the other side, the curtain was being drawn around another patient staying in the same room (most rooms are not private, those are expensive).

"Check the pulse!" Two people on either side of the patient stuck their fingers out to do that. And my gaze switched onto the man on the bed. I could really only see his legs. which were pale and flabby, spread out wide, revealing a diaper in between. His chest rose and fell steadily in rhythm with the Oxygen he was receiving through a large tube. His eyes might even have been open. I couldn't tell.

He had a history of strokes, they said. Call his wife, they said, so a nurse rushed out.

The minutes passed as doctors lined up to take turns doing chest compressions, nurses filled syringes with different electrolytes and epinephrine, passed them to other nurses for administration, someone went and printed something useful, someone else kept a record of what has been done, shocks were delivered, machines were brought in, "are you sure there isn't a pulse", "shock one more time", "Clear!!"...

They really tried. They really did a good job.

Time of death was 7:06.

The crowd scattered, and mourned their way out of the narrow room in a silent, brisk file.

They have just completed another task for the day.

"What a way to start the morning, eh?" One resident said outside the room, as he pulled off his gloves.

"At least you're not that other patient in the room," said another, as they rushed off in their separate ways.

7:07, back to work.