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Other people's stories.

There is a bustling, fluorescent clamor that governs hospital hallways during the day and so fills the air that any sound wanting attention has to vie for it, each alarm louder and more cacophonous than the last. But at night, an altogether different temper settles over the hospital. A restrained, low-lit quiet descends, transforming those long corridors into a space that seems smaller and almost comforting. Almost any sound stands out at night.

I was once trudging down one of those subdued nighttime hallways after many busy hours on call, allowing the glimpse of sleeping patients in each passing room to give me hope for a nap that night, too. My head was down and my thoughts were elsewhere, but the faint sound of a person struggling for breath stopped me cold. At a nearby workstation, a young nurse's aide was sitting bent over the desk, breathing heavily and holding a burrito. Her eyes were glassy but vaguely focused on the burrito, which she looked intent on eating.

I asked her if she was all right.

She struggled to tell me between gasps that she felt faint, and that she thought she would feel better if she could eat.

She did not look in any shape to be eating; I suggested that she put the burrito down.

Acquiescent and apparently relieved, she let the burrito drop into its Styrofoam container.

She was becoming pale and sweaty. Her eyelids fluttered closed, and she began to slide from her chair as she mumbled that she was going to fall. As she did, I found my way under her to catch her. We landed in a heap, her weight pinning me to the wall while she slumped backward onto my chest and outstretched legs like a large, sleeping child.

A nurse came by, and I asked her for a stethoscope. Because of our tandem position on the ground, I turned the stethoscope back toward us as though the aide were a part of me and I was listening to my own heart through a double-thick rib cage. Her heart was racing. The nurse took her vital signs, which confirmed an extremely fast heart rate, but were otherwise stable. I glanced down at her, still slumped against my chest and breathing heavily. She looked pale and scared and on the edge of consciousness.

By that time, quite a crowd of nurses and aides had gathered around us. One of them called the emergency department and reported back that someone would be up soon with a stretcher to take her there. Another nurse brought ice water for me to apply to her face (a maneuver that could decrease her pulse if the cause was an aberrant electrical conduction path in her heart). I held an ice-cold washcloth to her face and asked her to take deep breaths, trying to calm her down, but her heart rate stayed stubbornly high in the 180s.

While we waited for the stretcher, she was able to tell me her name, her medical history, her medications and allergies. The nurses who knew her filled in the gaps--this had happened several times before, she had undergone a thorough workup, and the cause had not been found. When the emergency department staff arrived, we transferred her to the stretcher. When I stood up, I felt light and insubstantial without her weight upon me.

I rode the elevator down to the emergency department with her, followed her to the trauma bay, and waited for the emergency physicians to rush in. I quickly gave them all the information I had about her. When I said goodbye to the girl on the stretcher, she still seemed to me like a child, terrified and young. We looked at each other. She thanked me, and I told her I'd be thinking about her.

I rode the elevator back upstairs and went to my call room, this time without incident. I lay down, no longer sleepy, and stayed awake worrying about the young woman for a while before nodding off. When I woke several hours later, one of the nurses told me that she had been discharged from the emergency department with an improved heart rate but still no obvious cause for the arrhythmia.

The next week I saw her standing in the hall, laughing raucously with a clerk. She looked strong and vigorous, and her complexion was downright ruddy; she was nothing like the pale, fragile creature I had cradled in my lap several days earlier. I was thrilled to see her looking so healthy, and I beamed at her, nodding as I walked past. She looked at me without any suggestion of recognition, then looked away--a bit embarrassed, it seemed to me, by my familiar greeting.

There is no way to know whether she remembered me. For a long time, I was certain that she did not. After all, the whole event lasted no more than fifteen minutes, she was facing away from me for most of that time, and she was nearly unconscious from the moment I met her. When she looked away from me in the hall, I was sure that it was only because she did not recognize me.

That is how the story jelled in me. It was an account with a known end, added to a collage of stories collected by a young physician. Here was a time when I connected with another person intensely, albeit for only minutes, and it was forgotten. It is true that many times the patients we work hardest for will sicken, or will turn on us, or will never even know we were there. Other times our most trivial advice will set a patient free, and we will hear later that we were remembered and named and credited with things far beyond our capacity. So this story became, for me, a parable about doing our work for its own sake--a reminder that no matter the strength of our efforts, we cannot choose what comes of them.

But stories are live things, even when they have been wrapped into neat conclusions, and in time they always raise new questions. I was so sure that she did not remember me, but perhaps she did. After all, she was collapsed on top of me for fifteen minutes, and we had a long look at one another just before I left her in the emergency department. What if, instead of simply not having recognized me, she really was embarrassed by the whole episode, exhausted by the attention in its aftermath, and terrified knowing that it could happen again without notice? What if she looked away not because she did not know me, but precisely because she did, and she wanted to forget?

As physicians, we spend our days in the midst of our patients' stories, living and moving in them as if they were our own. Patients share secrets with us, admit their fears to us, become vulnerable before us. They collapse in our arms and deliver babies into our hands. They submit to examinations and show us their blemishes of all kinds. There is perhaps no other vocation in which one is connected, so constantly and so intimately, with other people.

And yet, strangely, loneliness is a real hazard of the profession. At the end of the day, we may have been drawn deeply into our patients' stories and changed by them in real, tangible ways. But all of those stories--even the ones we are materially part of--must belong finally to the patient, and not to us. This asymmetry is built into the law and the Hippocratic oath: patients may retell these stories at dinner parties or around the water cooler, fleshing them out with whatever level of detail they desire, but we may not--if we do, we must strip out the details to protect the patient's privacy. Likewise, patients may choose to ask us medical questions when we run into them at the bank, but we cannot ask them how they are getting along with their diabetes management when we see them buying ice cream at the grocery store. They may smile at us in the hallway of our mutual workplace, or they may turn away, and we must follow their lead. The price we pay for being allowed into the sacred spaces of our patients' lives is that, in the end, they are the authors and the heroes of their own stories, and we are only bit players.
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Title Annotation:in practice
Author:Kirst, Nell Burger
Publication:The Hastings Center Report
Article Type:Column
Geographic Code:1USA
Date:Sep 1, 2011
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