Words In My Palm

Two simple words traced into my palm. Slow. Deliberate. Undeniable.

Now on BiPAP, unable to remove the mask long enough to speak or eat, my patient was deteriorating and fully aware of it. The mask swallowed half her face. Her eyes looked piercing, searching. She took my hand and spelled out “I’m scared.”

I leaned closer so she could hear me. “I know it’s scary,” I said. “Healing isn’t linear. There are ups and downs. Be patient. You’ll get through this.” 

‍

A middle-aged woman with no significant medical history presented to the emergency department with new progressive shortness of breath. She tested positive only for a routine viral illness. Antibiotics were trialed. Steroids. Lasix. Nothing changed. She looked comfortable enough at rest, but her oxygen requirements crept steadily upward. 

I was an intern barely acquainted with hospital medicine when she arrived on our service.

Her CT chest suggested hypersensitivity pneumonitis. We started standard treatment. Within 24 hours she improved dramatically. 

“She looks great. Probably home in a couple of days,” I told my senior, confident in the neat arc of recovery.

I proudly wrote my progress note and moved on.

Two days later, she was maxed out on BiPAP. I sat there fighting tears. I reassured her again, hoping to soothe the discomfort of her panic, for both our sakes. But inside I felt the shift — the quiet realization that we were likely heading toward intubation.

Outside her room, I called the ICU provider. We agreed she needed a higher level of care. I returned composed to tell her that she would be moving so we could watch her more closely.

“I’ll check on you once you’re settled,” I promised.

Now she’ll be okay, I told myself. The ICU will turn this around. She’ll go home soon.

I exhaled and continued down the hall, seeing other patients, writing other notes.

A couple nights later I woke suddenly, remembering I hadn’t visited her in the ICU. But the next morning came with new admissions, more notes, more discharges. I went home to my own babies as quickly as I could.  I did not stop by to see her.

The following day, my senior said he’d been thinking about her too. We opened her chart together: Deceased.

No. That wasn’t right. She was supposed to be okay. We told her she just needed time. We told her husband not to worry. And I never said goodbye. 

I felt the urge to find the husband and ask if there’d be a memorial service or visitation I could attend. That would almost certainly be crossing some unstated but expected physician-patient boundary though, wouldn’t it? And the family may blame us. I shouldn’t open myself up to that debacle. 

I kept my distance and mourned her quietly.

‍

In residency orientation, an attending tried to prepare us for difficult outcomes like this. “Some patients are like tombstones. You visit them every now and again in your mind. Pay your respects, tell them you miss them. But you can’t stay there.” I find myself lingering at her tombstone. I must go. More patients to see. But walking away feels disrespectful. What if I get too busy again to come back? I want her to know I remember.