The Anzianos

The first time I saw Mr. Anziano come into my critical care section, little Mrs. Anziana followed the EMS stretcher closely with the dedication and concentration written on every wrinkle of her face. It was extremely busy and everyone was milling about so the nurses tried to shoo her out, stating that they wanted to get Mr. Anziano settled in and many tests done. "I 'ave been taeking care of him my whole lahfe!" Mrs. Anziano declared, "there eez nahthing about him I 'ave not seen." She stood resolutely by his bed.

This would have been fine if she did not start coming in while the nurses were drawing blood to inspect their work, or talking to anxiously him in melodramatic Italian. They asked me to escort her out. She refused, of course, but I coaxed her to at least take my arm and walk to the waiting room, just for a few minutes, I promised. She kept staying her steps and looking back, bemoaning that it was ludicrous she should be "shut out" when they had been married over 60 years as teenagers in Italy and how much she hated Germans. "You don't have a German boyfriend, do you?" Err, no- "Good! Those gooud for nahthing---" I let her talk on and left her sitting impatiently in the waiting room.

Returning to perform an EKG, I was putting stickers on Mr. Anziano's chest when the curtains rustled and Mrs. Anziana burst through- "I wanted to see eef I could help." The nurses escorted her out again and again and again, but she came back each time as soon as we left her in the waiting room. She was frail and elderly, but resolution made her strong- it did not seem appropriate to call security on her, but I never forgot how tenaciously the little old Italian lady clung to Mr. Anziano's side for the many hours until he left the ER to go to his hospital bed.

Mr. and Mrs. Anziano returned on an almost weekly basis for the next few months. The first time I helped treat him, Mr. Anziano was still verbal and barely ambulatory. Through the many hospitalizations and strokes he had, his face became locked in a terrible open-mouthed twist and Mrs. Anziana was always shuffling resolutely behind him, jabbering, making a general fuss, and clutching her purse in both hands.

Last night in critical care, I walked into a treatment room to greet a new patient who had arrived... I was taken aback- sitting quietly in the stretcher was Mrs. Anziana, more quiet than I had ever seen her. I called Mrs. Anziana by her name and her bright eyes scanned my face; she did remember me and was touched I remembered her name. Mr. Anziano had died a week ago, she told me. Her daughter brought her in because she had a fever and waning appetite. "I remember you took great care of him." I said. "The best care," her daughter agreed. I wrapped her frail little body in a blanket and mused on how she must have been feeling. When you've been taking attentive 24/7 care of someone you love dearly, it hurt, but at least you always had something to do, something to be of help. In a moment, she lost the love of her life and her daily occupation. Such people rarely take the same good care of themselves, though, and I worry for her. I had always admired her incorrigible spirit.

S

A Love Story

He was very handsome- a student at a prestigious university, a curly lock of chestnut hair hanging jauntily over one eye, an attitude of nonchalance.

She was gorgeous- straight aquiline nose, large bright eyes, dressed in carefully put-together careless chic- short flower sundress with a princess waist and sneakers.

He was trying to make jokes and stop her from crying.

She was crying uncontrollably.

He was stuck on a backboard with a C-collar on after fainting outside the restaurant.

She was beside herself, walking around, trying to be brave, control her tears for him.

He stayed the jokester, making sure to tease her for crying through my EKG, the insertion of an iv, the splurting of blood everywhere, through his shivering fits (before I ran for a warm blanket from the trauma bay), through a rectal exam. He laughed at her.

She could do nothing but watch, pace, and worry... maybe make a phone call or two. She cried silently, since he couldn't sit up to see her, tears flowing down her beautiful face.

His temperature was 103.2. He might have meningitis.

She stayed at his feet and stroked them silently, watching only his face and none of our action around her.

He went to CT scan and x-ray.

She came back in from a phone call and waited in the room... pacing, bracing her arms around herself, worry etched in every line of her young face.

He was still there... for an hour.

She was still waiting. Would always be waiting. I got her a warm blanket she could wrap around her to protect her from the cold, stark, lonely room.

They were in love. It was beautiful to see.

S

Mandy

“Please, please don’t let me die”, she said clutching my hand. “Mandy, you’re in good hands, you’re in the best of hands”, was all I could say. This soothed her, but did not placate her fears. Her heart was beating over 140 beats per minute on the monitor- it had been for more than half an hour since she came into the critical care section where I was working that day.

A young woman a few years older than me, Amanda came in with terrible chest pain. When I placed her on the cardiac monitor and a pulse oximeter on her finger, we found that her heart rate was rapid and oxygen saturation very low. Unsustainably low. She was gasping for breath and bathed in sweat. Her large eyes locked mine and I couldn’t look away. Although the day was very busy, I stopped in her room every minute or so to silence the alarms that sounded for her elevated heart rate and breathing rate.

Soon after, worried about the effort it was causing her to breathe, the attending physician gently spoke into her ear. Amanda, we want to help you. We are afraid your body won’t be able to sustain the effort of breathing anymore, so we want your permission to put you to sleep for a little while and let a breathing machine help you. She did not have the energy to resist. There was something seriously wrong with her and she knew it. She had to put faith in the system, in us. Keep this safe for me, she said removing her engagement ring from her finger, S, thank you so much for being here for me.

She grasped my hand as I heard “Push the etomidate.” Help me, she murmured dizzily, help me, I don’t want to die. “Twenty of sux,” and her hand went limp in mine. Her sister and fiancée came in a few minutes later. Seeing her on a ventilator, he began to wail, baby, baby, I love you, oh God, throwing his arms around Mandy’s sister as the world spun around them. When they calmed down to soft sobs as we transported Mandy upstairs, I gave him her ring. I will never forget the look he gave me as his eyes welled up once more- "thank you so much for all that you all have done for her."

Finding out she died that night was like a physical blow. I was winded. I was with her at the last moment of consciousness she ever knew. What did I do to deserve that honor?

I am not sure, but in the months since I briefly flitted into the life of Mandy and others like her, I have found that there is too much in this world to live for and too many people who want to live who can’t.

Live, love, and appreciate the people you have. Anything can change in a moment.

S

The Ones I Go Above and Beyond for

It makes a huge difference when you get a patient who is appreciative, understanding, and, well, patient. These are the ones that you wouldn't mind going on multiple little trips for, precisely because they wouldn't presume it is their right that you serve them hand to foot. Sarah was like this. She and her husband sat quietly in their room, concerned, but resigned to a long wait.

They were an attractive couple, middle-aged with young children. They took very good care of each other, politely introducing themselves and smiling genuinely when I did the same. Sarah was open to talking to me about her sudden-onset pain- like needle pricks all over body- that wasn't subsiding with tylenol or motrin. At first, the nurses thought they were drug-seeking, but she refused anything narcotic. Her husband made gentle wisecracks on the side to make her smile. The atmosphere was so pleasant and genuine; there was no denial nor despair, but his concern was obvious, despite his best efforts at hiding behind his jokes. I liked them so much, I poked my head in every hour or two to see if they were still comfortable.

After myriad tests, none of the blood work, CT scans, even MRI's came back with any conclusive results. She had an extensive family history of autoimmune disorders, so she sighed and said, I was fine but I guess it's all going to catch up with me now. Almost 8 hours after they first came in, the physician came in to explain that in the emergency setting, we couldn't perform in depth work-ups, but just wanted to make sure that the pain was not because of a life-threatening issue. Sometimes, he said, we have to send people out without a definitive diagnosis of what is wrong with them, and that can be very frustrating. She sighed.

I drew six more tubes of blood with obscure test names I have never drawn in the ER and helped send her on her way. She could barely walk, so I pushed her on a wheelchair all the way to the curb of the front entrance, stayed with her until her husband came with the car. Because they drove there separately, I ran to the other side of the hospital to ask valet if they would let her car stay in the garage. When I came back with the news that they would let the car stay in the valet parking zone despite a small fee, the husband shook my hand and thanked me for everything I had done, wishing me the best for my future. With that, they took off, both waving from the window. They told me they had a good visit, despite 8 hours of tests, waiting, not eating, and no definitive answers about what is hurting her.

Compare this with my trauma patient last night, breathalyzing .250, no effort, who gurgled and couldn't speak for all the slurring. Apparently, she fell several times and was walking headlong into oncoming traffic. She had a large bleeding laceration on the back of her head. She swung her fists at us, had to get held down by security while we did the trauma assessment. "Ma'am, we're trying to help you." "**** you." She calmed down, but only until we turned our backs, when she ripped her collar off and sat up, cursing (still slurring) and threatening to **** all of us up. She tried to stand up when security put her in 4 pt restraint and the collar went back on. She was on the point of spitting. For four more hours, she continued the struggle, cursing (no longer slurring) at us- I'm FINE. Get this ***** thing off me. **** you all. I can't wait to get my hands on all you **** ********. Hey, can I get a sandwich or something?? She calmed down at hour 5, when one restraint was taken off so she could eat the sandwich we brought her. Instead, she screamed. Get this ***** thing off me and used the open hand to take her collar off. At this point, I breathalyzed her again, she was .275. She was taken to a quiet place to calm down but still cursed anybody who walked by. In 4 point restraint, she still managed to twist her neck to get the collar off. She apparently didn't break her neck. Nevertheless, her head bled everywhere as she shook it. Seriously? We know you fell, we don't know if you've been hit by a car, and we can't even get you to stay still enough to stay on the CT or x-ray machine to figure it out. I bet she was there for a much longer time than if she had cooperated.

Sigh. Just another day in the life.
S