It was an early morning on everyone's favorite day of the week, Monday. Beep...Beep...Beep... my alarm chirped as I tried to ignore it. Maybe if I ignore it long enough, it'll forget I'm here, I thought. No such luck. Beeep...Beeeeeep...Beeeeeeeep.... My alarm screamed louder, sounding angrier each time. Alright, alright, jeez I'm up I said aloud. It was 5:00 in the morning and my first day back on wards in several months, and already I dreaded going. Light had just barely started to dribble in between the blinds. From my feet hitting the cold floor, to the sad empty fridge, to the barren streets on the early-morning drive to work, everything told me to go back to sleep.
I had just stepped into the hospital and breathed in the sanitized airso unnatural, yet it felt natural to me. I had a fresh list of patients for rounds and had just received a welcome text from my attending: Good morning, I've got two more admissions in the ED, please add them to the list. Obviously, my attending didn't know what good morning meant.
Morning rounds were at 10 o'clock. I figured I should head over to the Emergency Department and see what was waiting for me there. Our ED, like most emergency departments, was closer to a bustling street bazaar than a section of the hospital. I waded through the crowd to get to my new patient. (For the sake of patient privacy, we will call her Pam.) She was a frail, elderly woman with a distended abdomen that made it look like she was pregnant. She was laying in bed tossing and turning, either in pain or possessed. The most-likely differentials began to flow through my head. I thought to myself, Looks like liver cirrhosis, with distended abdomen from the ascites; she likely got the cirrhosis from alcohol abuse or some IV drug use when she was younger. Anyway, Let's start the day I told myself.
Pam was in and out of consciousness; I was unable to get much history out of her. Luckily her husband, a chubby and pleasant man in his 60s, walked in. He was a stickler for details, so I was able to get a thorough history from him. His face was wrought with concern as we both watched his wife writhe in discomfort and confusion. Apparently, they were from out of state and just visiting Texas for the holidays. She had gotten hepatitis from a bad blood transfusion almost 20 years ago and was currently on the waiting list for a liver transplant. Unfortunately, they had run out of medication while on vacation and her health took a rapid turn for the worse. We got her set up with all the appropriate medications; I didn't think much else of the situation. Her mental status quickly returned to baseline after she had a few good runs of lactulose.
The next day, when I went to round on her, she welcomed me with a smile and said, Good morning, the sun is rising, it's going to be a great day Obviously, she had not seen my patient list for the day. Yah Pam, I bet it'll be a great day, I lied. She did this day after day, on her good days and even on her bad days. I just kept nodding and telling her about her updates. Her ascites kept getting worse despite aggressive diuresis, and she was becoming short of breath. We were waiting on her peritoneal tap. She didn't have enough fluid for an emergency tap, and her INR would just not cooperate with us for the elective tap.
One day her shortness of breath got bad enough to send her up to the ICU. Things were not looking good, and yet when she saw me, she would crack a smile and say The sun is coming up, it's going to be a great day.
She continued to worsen over the next few days. Having grown attached to her by now, I would visit her and her husband at least twice a day to chat and make sure they were doing okay. One night she seemed particularly down. Without a smile she whispered, The sun is coming up. Was she getting delirious? I've heard a lot about ICU delirium, all the beeping and buzzing and no windows would drive any sane person mad. Were the toxins building up in her blood again? How? Infection? But from where? What should I do? What is a safe antipsychotic to use in liver failure?
My mind raced but I couldn't come up with anything. I saw her tiny frail little hand and scooped it up in my hands. Sitting down by her bed, I told her we were going to get through this. Then something happened. She began to sob, Please don't leave me. I sat with her for hours that night, just talking about her family, her friends, her fears. She was strong but she was scared. We ended the night with jokes and laughs. Before I left, she told me, What you doctors do is a blessing to the rest of us. You have the power to help us when we are at our weakest. At that moment, I realized: all of the struggles, all of the long hoursmoments like this made it all worth it. Maybe that was all the medicine she needed. Maybe it was the medicine I needed.
Eventually it was my last day of wards, and I was just leaving the hospital after the night shift. A month had passed, but it felt like one very long day. The sliding doors split open, and a bright yellow-orange light flooded in and basked over my eyes. I squinted to bear the brightness; it was beautiful. A smile crept over my face. You were right, Pam: the sun is coming up, and it's going to be a great day.