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Medical Humanities

Morning Report

Shaoli Chaudhuri

June 16, 2019

On the heels of a night shift, you shuffle into the morning report room, hiding a yawn behind a bagel and paper plate of fruit. You mentally count down the hours before you can crawl into bed. The chatter around you subsides as the resident, Dave, and the attending, Dr. Johnson, start to discuss a case of a woman with arm swelling.

The details trickle out as Dave reads from his notes. A sixty-seven-year-old woman with a lung cancer history, thought to be in remission, came into the hospital for left-sided arm swelling and shortness of breath. The first time she came to the emergency room, they did an ultrasound that showed no blood clots and sent her on her way. The second time, they started to work her up with a CT scan, but she’d been kept waiting for 8 hours and couldn’t take it anymore. The third time, she was in full-blown respiratory distress, hypoxic to 80% and went directly to the ICU.

A picture forms in your head. A diminutive woman normally wreathed in smiles. Small, twinkling eyes and a tightly cropped cap of gray hair. The swelling creeps up her arm and into her already cherubic cheeks. She even sounds like a young girl, her voice high-pitched and childlike. Every day, she always wants to know how you are doing first, even as she breathes at 40 times a minute and can’t suck air quickly enough into her lungs.

One morning in the ICU, you needed to escape the pain and yelling and chaos (and homicidal patient who maybe planned to follow you home when he got out, who knows), so you slipped into Ms. Gomez’s room. You asked how she was, listened to her lungs, and leaned onto the side rail of her bed for a chat. For a moment, you both forgot you were in a busy medical ICU with people dying and occasionally living around you. She had a window room overlooking the Hudson, and the sun shining through landed on her bedcovers, smooth and yellow like butter.

She was from Guadalajara, originally, but longed to tell you about her time living in Spain. “I sold fruit,” she confided, and you could see from her face how fully content she must have been. Every day she set her wares out in the Santa Caterina Market in Barcelona, its whitewashed walls and orange doors complemented by a waving metal roof tiled with splotches of pink, yellow, and sky blue. You pictured her lovingly handling strawberries and mounds of blueberries, chatting up her customers, handing free apples to any small child who smiled in her direction. You watched her amble back down the streets, arm-in-arm with her husband at the end of the day as the church bells tolled in the background.

She laughingly recounted the rare evening of indulgence spent eating tapas, savoring thick, toasted bread dipped in tangy olive oil, thin slices of beef, spiced gambas al ajillo, all topped off with a glass or three of Rioja.

“Sometimes I didn’t know which was more red, the wine or my cheeks!” she said without a blush. You unsuccessfully attempted to hide a chuckle.

You remember the morning you were tasked with the responsibility of telling her that the lump in her arm was the cancer, back again. Her eyes shined too bright. You hurried to hand her a tissue box. She struggled to look brave. You didn’t want to be brave; you wanted to go outside and kick a computer.

The two of you spent Christmas morning in the ICU. Her whole family gathered in her room, now transformed into a holiday miracle of colorfully-papered presents and ribbon. They handed you a red tin of cookies and chocolates, thanked the team for everything they’d done. Ms. Gomez’s daughter played Christmas carols on her iPhone while her roly-poly grandson climbed onto her hospital bed. Everyone made themselves sick with sugar.

You left the unit the day before New Year’s Eve. Ms. Gomez’s breathing had improved and she was set to start chemotherapy. A whole treatment plan and hopeful future lay ahead of her.

You forgot about her because that is the nature of your job. Or maybe, it is your nature now. It’s hard to know, and it’s hard to know if it’s reprehensible or understandable.

“In spite of starting AC-paclitaxel and doxorubicin, the patient was readmitted multiple times to the ICU for hypoxia, then septic shock secondary to pneumonia. Ultimately, as her prognosis and quality of life worsened, she was made comfort care. She passed away soon after… So, Dr. Johnson, what are your thoughts on this case of SVC syndrome? How commonly do you see it and could different imaging early on have helped?”

The drone of excited resident minds and academia continues and the death of Ms. Gomez goes largely unnoticed.

You hadn’t known she’d died. You’re not exactly shocked, but sometimes the last time you see a patient is how you remember her and how you expect her to remain: happy, comfortable, with a glimmer of hope in her eye.

“Thanks for that morning report, Dave! Great case,” someone says.

You see a picture: a petite woman arm-in-arm with her husband walking home, the shadows of gothic churches and cafés trailing behind her as bells toll out, sometimes lilting and bright, sometimes harsh like the report of a gun.

Editor's Commentary

Shaoli Chaudhuri is a second year medicine resident at Columbia University Medical Center. In time not spent in the hospital, she enjoys writing prose and doing ambitious food tours of NYC.