by Lillianne Villarreal
From the grainy images [of the portable ultrasound machine] I could see the small ventricles still and pulseless – like a four-chamber pool filling with slowly falling snow. “There's no heartbeat.” The words cascaded out of me on a torrent of agonized breath.
“Can you show me where you see that?” [the obstetrical resident] asked.
… I stared at him, incredulous. Could I show him how to interpret the ultrasound images of my dead baby? The baby whose impossibly small dresses were still hanging expectantly in the guest room closet. I hadn't gotten around to setting up the baby's room, but she had belongings. Small socks and onesies. I'd just begun to prepare.
—In Shock by Rana Awdish, M.D.
“This is quite an interesting case! Can some medical students come observe and ask questions later in the morning?”
It was 12:40 a.m., and I had just been transferred to the hospital from a local ER, where I'd spent the past 12 hours hooked up to an IV pumping me with liters and liters of saline. I'd been having persistent palpitations for the past few days, but I'd chalked them up to dehydration and pushed them aside because Thanksgiving, one of my favorite holidays, was a few weeks away. Early celebrations were in full swing! The morning of my ER visit, I had arrived at Kroger around 11 a.m. to buy pumpkin pie ingredients for a Friendsgiving potluck dinner that evening. I'd never made pumpkin pie before and, as the wannabe pastry chef in my friend group, I was excited to share this attempt with them before the long break.
However, before I made it out of my car, my legs suddenly went numb and a profound dizziness overcame me. Overwhelmed by a wave of fear, my first thoughts were, “Oh my God! This is what a stroke feels like. I'm having a stroke. Wait no—I'm too young to have a stroke. But stranger things have happened! Oh, God!” The palpitations, which I'd made every attempt to ignore, had intensified. My watch notified me that my heart rate fluctuated rapidly between the 70s and 130s, all within a minute or so. Well, that's not good.
Against better judgment, I clung to my ebbing consciousness and drove myself the 1.5 miles down the road to the nearest ER, clutching the steering wheel tightly until my knuckles turned white. Even as I basically stumbled from my car to the entrance of the ER, I thought to myself, “Hopefully, I'll be out by the potluck.”
Spoiler alert: she did not make it to the potluck.
Thankfully, I was not having a stroke, but I did have sky-high creatine kinase, and—after 12 hours of continuous IV saline infusion at the ER had done little to temper these levels—I was shuttled off to the hospital just after midnight. I was sad to have missed the potluck but, more importantly, now it was Sunday night: there was NO way I would make class tomorrow.
It was 12:40 a.m., my plans and routine for the foreseeable future had been completely derailed, and I'd just had quite the health scare for an otherwise healthy 21-year-old. To say I was exhausted, and shaken, by the day's events would have been an understatement.
So, doctor, did I want medical students to come see me and poke and prod? Not really.
In the end, though, I did agree to visits from medical students—as a first-year medical student myself at the time, I thought of the teaching potential my case could provide. I had insidiously developed rhabdomyolysis over the course of a week and its mysterious origin eluded both me and my doctors—it certainly had not been from running a marathon (though that was the first question every doctor asked me!). I concurred; it certainly was an interesting case.
I had agreed, but my doctor's words stuck with me.
“This is quite an interesting case.”
As I reflected on these words, I was reminded of a patient encounter I'd had earlier in first year, one of my first times in the hospital for a clinical experience. As I scoured the hospital for my assigned faculty, I walked through multiple units and, upon passing one patient room, I overheard:
“Can I perform a heart exam? I've never had a heart failure patient!”
I'm certain the student bore no ill will with this statement and were genuinely curious about the clinical manifestations of a disease they had probably only seen in the pages of their First Aid book. But with this statement, the person lying in bed before them, vulnerable and likely fearful, had quickly been reduced to “a heart failure patient.” Who they were irrespective of their medical conditions, what their life story was, and where they came from—none of it mattered in the hospital. They were a patient first, a person second.
My doctor didn't know that the approaching Thanksgiving holiday was one of my favorites and I was excited to try my hand at a pumpkin pie, that the episode of leg numbness and dizziness filled me with fears of a major health emergency at such a young age, or that one of my primary preoccupations was missing class the next day. She hadn't inquired about the personal, human experience behind this “interesting case.” Perhaps to her, I was only “rhabdomyolysis (M62.82)” in room 1140.
We can do better. We must do better.
In retrospect, of course the doctor had asked if students could come see my interesting case and not to see me—how could she, if she couldn't see me?
I realized, with an uncomfortable tug of recognition, I was indeed not a person to him, but a case. And an interesting case at that. I was Abdominal Pain and Fetal Demise to him. I affixed my eyes onto his, willing him to see me.
I needed him to see me.
University of Texas Medical Branch
Graduating Class of 2023