By: Elizabeth Mitchell, MD

I apologize a lot at work.

I’m sorry it took so long for you to be seen” “I’m really sorry about the hallway sir, we don’t have any open rooms.” “No ma’am I don’t know when they will be doing your cat scan, I’m sorry.  I’ll check for you. ” I’m sorry you’re still down here ma’am unfortunately there are no beds in the hospital.”

And on and on and on.  I deliver a constant stream of excuses for the state of our department, overfull like many others.

I look around and the orderly “U” shaped side I’m working on tonight, 12 rooms separated by curtains, has become an unrecognizable mash unit of gurneys, stuffed into every available space, topped by the endless humanity of people seeking medical care. Our hallway beds are a series of land mines. Patients with problems likely to explode at any moment. The patients are so close to each other that privacy is impossible. I ask personal questions, feel abdomens, and explain that we have to wait for a room to open up before I can complete an exam, again and again.

I sit and glare at the computer screen.  This is a joke I think. There are 12 names listed in rooms and another 12 listed literally nowhere.  “Hallway” repeats endlessly down the screen. It screams “good luck finding these folks” at me in jest. I feel exhausted and overwhelmed but I begin the challenge of locating at least temporarily, the patients without an actual place.  I ask a nurse for help.

Oh he’s between the supply closet and back door.”  “She’s near the Pyxis,

and on and on.  I locate people until they are moved to get an X-ray or make more space and then lost once more.  It is a frustrating way to spend 8 hours in a job that has challenges enough without the added burden of being bombarded by congestion, confusion, and chaos.

***

I make my way back to room 7b an arguably closet sized room where a woman who hasn’t seen a doctor in 26 years, has just been diagnosed with metastatic ovarian cancer. For 3 months her abdomen has been getting bigger and tighter, and when she started having trouble breathing, she came to the Emergency Department.  I apologize for the tiny room and immediately this little woman breaks my heart.

0h no it’s wonderful, fine. You seem so busy, don’t worry about me”.

She is lovely.  A petite aging woman with a slash of red lipstick and darkly penciled eyebrows accentuating her pale lined face.  Her small body is burdened now with an oversized abdomen, hiding the cancerous tumor from view.  I want to sit with her but there is no chair.  We laugh when she tells me she quit smoking 2 months ago.

“Wouldn’t you figure” she says. “I quit smoking and then I get cancer.”

She holds my hand while we talk.  She is bright and warm and for the few minutes I am with her I feel better. The chaos around me dims and I feel lifted by her presence.

Darling would it be possible to get a cup of tea and some toast?” She asks. “I’m so hungry. I’ve not had a thing all day

I wilt, knowing that our department has neither of these.

I’m sorry” I start to say, again.

Then I stop and think. My lunch bag has an assortment of teas that I never seem to have time to make. I brighten.

“I can bring some tea, at least.” ” Would crackers be ok instead of toast? “

She smiles and nods enthusiastically.  And I am off to the break room.

I reach the refrigerator and look for my bag.  Much like the department it is stuffed well beyond capacity.  Something always falls out when I open the door.  The smell of rotting food assaults me as well.  I finally locate my bag and rummage through its contents until I find what I am looking for.  A bag of earl gray, my favorite.  I find a white styrofoam cup and add the hot water. As it steeps the aroma of bergamot scents the steam.  I hastily bring this back along with some saltines and I am greeted with a large red smile, and a hug that is the best thing that has happened to me tonight. I spend a brief moment more in this tiny room reluctant to leave this woman facing an uncertain future. I apologize and tell her that I have to go, then move on to the ongoing tasks, new patients, and chaos in the rest of the department.

Faculty Author: Elizabeth Mitchell, MD