I wish House, MD was here

The wards had an odd sanguine feeling that day. The large glass pane doors were streaming a glow from the summer outside, and all was right because I had actually managed to have a lunch break. The High Care Ward is where the most intense monitoring is done so that we doctors can observe suffering in slow motion. I can’t remember what brought me there but in the first bed on the left a young woman was lying dishevelled, with dark locks matted to her forehead, displaying that particular beyond-desperate gasp for air that only the imminently dying can do. It’s one thing I’ve never seen accurately portrayed in movies, and its something I hate that I can recognize with such ease. The family is crowding around and I notice a doe-like face with a look of abject terror and her arms folded tetanic around herself. It’s her eyes with a film of lacrimal fluid that I remember as I rush to start the resuscitation.

I hung around afterwards which somehow led to the family latching onto me as their boatman, navigating the Styx of the medical underworld for them. Lady (fictional name of patient) had a few tattoos, she’d been known to use cocaine in the past and had a tattered life by the time she was clinging onto the ventilator. Now for some reason she was in a coma and had a perilously low serum potassium level with a normal CT scan of the brain. A metabolic mystery! I thrive on this – the real oxygen in the medical wards, not those big black gas canisters. Like many doctors, I’ve had this bent since I was first introduced to clinical reasoning as a medical student. But here, due to my lack of experience, and the fact that she’s not my team’s patient, I can only act as the comforter.

I’ve never been able to juggle oranges in my hands but my head does this fairly well – Conn’s Syndrome, valproate toxicity, RTA Type 2 are the names of the little multicolour clown balls I’m shuffling mentally. Casually I discuss it with the seniors doing her case – Lady is critically ill but the test results aren’t out yet. Thanks for starting the resus by the way.

A day later and the oxygen saturation monitor which should be in the 90′s is now getting readings like my First Year Chemistry marks. Once again I fight my Jekyll and Hyde battle between full empathy and deciphering the diagnosis.

“You’re here because she’s an interesting patient to you guys right?”

“Well yes, but also because its satisfying for us when young people who are very ill get better.” Sister perceives a subtle uncertainty that I can’t hide with bravado in the intonation of my whispered, “she’ll be fine.”

She turns to her friend, voice choking to expel a jest, “I wish House was here.”

And that was it for me – the moment where I realized exactly what I was not, and how much it burned in me to become that physician.

House, the fictional character, is my hero. He got me through medical school and I would learn just by watching episodes end-to-end whilst analyzing the diagnostic process. This job is seen as best suited for the intensely pragmatic who believe that they can always succeed with hard work or a scalpel. Unlike me. Later in my training I started meeting the real diagnostic and physician-scientist role-models, but House was the original bedside savant for me.

“Me too,” I said, and meant it.

The next day I was climbing up the stairs towards the wards when I saw Lady’s family in the waiting room, now with hopes asunder – weeping in anguish and twisting across the plastic chairs to cling onto each other. I duck evasively down the landing, hoping they didn’t see me because I can’t offer more comfort, answers or any further optimism. I don’t know why she died, in any sense of the question, and this somehow fills me with anger and a strange sense of embarrassment.

I never saw her again, the sister who shook my hand as if my words and checking up on her sister’s condition for the family was a kindness akin to physical healing to them. In my heart I knew that we didn’t yet have a stark-naked ‘why’ that could have cradled a cure in its hands. If I did see her I knew I would avert my eyes, ashamed and hurt that this is all we doctors could offer. And worse, for telling her that it would be alright.

So I performed the one service that I could still do for them. I poured over my textbooks, finding the answer late one night whilst sitting crossed-legged on my bed. I closed the heavy hard-cover book before finally closing my eyes to fall asleep. It is only a theory but its my silent gift to that family and to the next Lady I meet one day.

Ashley Jacobs is a medical intern in South Africa.

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