Revise and Reconsider

Abstract

“The decision is ‘Revise and Reconsider,’” reads the e-mail from Academic Emergency Medicine. I sit at my desk almost too excited to begin editing. This is one of my first attempts at creative nonfiction and, given the topic, Academic EM is the ideal journal. But the editor requests some difficult changes. I'd written it in third person, because “He remembers” leaves the possibility that this is fiction, or about someone else. The editor asks me to write in first person. That's harder, more vulnerable, because this story is true, and it's about me. * * * * * Was it thirty years ago that I'd been the emergency department (ED) attending on Christmas Eve? The old county hospital ED was relatively quiet, with waiting times down to two or three hours, and I headed back to the minor care area to knock out a couple of quick cases in between the sicker, more interesting ones I'd see with the residents. I picked up the next chart: Spanish-speaking woman, age 37. Chief complaint: headache. Something I could treat and street in ten minutes. She sat on the exam table in her hospital gown. Unremarkable appearance, mildly obese. “Hello, I'm Dr. Lowe,” I introduced myself. Blank look. No family with her to interpret. “Buenas noches, me llamo Doctor Lowe,” I tried, hoping that she would reply slowly enough that I could understand her. “¿Por qué está aquí esta noche?” She brightened slightly and replied, “Me duele la cabeza.” I continued in Spanish: “How long has your head hurt?” “What does the pain feel like?” Her answers were longer and more complex than they needed to be. I worried about what cases the residents hadn't yet presented to me and I cut her off: “Where does it hurt?” “Does the pain go anyplace else?” “Does anything make it better or worse?” It was an easy routine—the usual set of questions for a common complaint. I felt the tiredness in my feet and sat down, trying to document her history in the chart while she talked. The stethoscope around my neck made my shoulders tight. My white coat was too warm and I felt sweaty. Then it was time for past medical history—operations/hospitalizations/illnesses/medications/allergies—and on to physical exam. “Mire la pared.” “Míreme el dedo, voy a moverlo … sigue mirándolo.” “Stick out your tongue.” “Hold your arm up and don't let me move it.” And on. * * * * * I try to remember more. Could I smell casseroles and pie from a holiday potluck in the break room, or were the smells vomitus from an overdose patient and urine from a seizure patient being observed in the hall? How many sexual assaults would have come in that shift? How many cardiac arrests? Or did this happen after she had already left me? * * * * * “¿Tiene otras preguntas?” I concluded. Any other questions? As I left, something made me turn to say, “Feliz Navidad.” Thirty years later, I remember what happened next. She smiled. It was not a dramatic smile but rather a release—of the wrinkling in her forehead, the tightness of her jaw muscles, the contraction in her lips and cheeks. “Gracias, doctor,” she replied. There was no one who would have noticed my own transient smile as I dropped her chart in the discharge bin, thinking about the fleeting connection I'd made with a woman so lonely that a single Christmas greeting mattered that much. I checked on the residents, walked through the trauma resuscitation room, and picked up another chart. * * * * * I feel the tears in my eyes at the memory of her smile. And as I reread my words, “So lonely that a single Christmas greeting mattered that much,” other tears fall—for the poverty of the aged ED; for the days, months, and years of blood and vomitus; for the sexual assaults and cardiac arrests; for the nights of cold cereal and silence. When we reconsider our past, we revise our understanding of who we are in the present. I gaze out the window and a sunbeam reaches my desk; it reflects off a silver, hinged photo frame and into my eyes. I open the hinge. On the left are two photos: my wife by a mountain lake just after I'd asked her to marry me and our daughter in my arms as a baby. On the right, below a recent photo of my best friend and me atop a mountain with our backpacks, is a photo of my wife and me on our twenty-fifth anniversary. Holding the frame in both hands, I close it to look at the single Hebrew word engraved on the front cover: זכר (zachar)—remember.