My cell phone was flashing as I slid into my car. It was Christmas Day and I had just finished brunch with friends, omelets, Christmas cookies, and Champagne. I was headed to my next stop, Christmas dinner. I thought about ignoring the phone, decided one of my brothers must have called with holiday greetings and so listened to the message.
“Dr. Cary, this is Thomas. My mom is in the emergency room. Call me.”
Lovely. A chance to abandon my festive holiday plans and spend the day in an emergency department with someone I barely knew. So much better than Christmas dinner and exchanging gifts with my friends. I recalled how much I hated being on call when I had a medical practice.
Thomas’s mother, Laura, hosted our bimonthly women’s poker evenings. She had been laid up with an awkward leg cast after a car accident left her with a broken kneecap. When I called, she told me she had slipped earlier that day while walking down stairs.
“Can you help me?” Her words tumbled out through an opioid haze.
I was wearing my bright red Christmas cashmere sweater and had plans for celebrating. The last thing I wanted to do was go to a hospital. I worked in emergency departments during the endless years of medical training and I ran an emergency department in a ski resort. I triaged patients during ski season, deciding who needed to be seen immediately and who could wait. In the ED culture of treating emergencies, patients who are not actively dying can be ignored for hours.
“Can I talk with your doctor?”
“We haven’t heard back from the on-call plastics and orthopedic surgeons. I’ve ordered x-rays and a CAT scan.” Dr. Rainey was in control.
I relaxed and returned to Laura.
For the uninitiated, an emergency department resembles a hostile foreign country where you recognize only a few words, such as “CAT scan.”
“Would you like me to come see you?” I asked, hoping she would say she was all right so I could head to Christmas dinner and conviviality, not the sterile atmosphere of a hospital.
I remembered visiting Zhuo in Shanghai several years ago. She called me in a panic at 5 am the morning after I arrived. She was in a taxi, headed to my hotel to pick me up and take me to the hospital where her mother had just been admitted. Her mother smiled when I showed up. I remembered the value of presence, which transcends language.
“I’m on my way.”
“Thank y . . .”
I flattered myself, thinking her joy at my coming outweighed the morphine she had been given for pain.
As a child I bandaged my horse, applied a splint to a bird’s broken leg and drained my cat’s abscess. My bedroom was a veterinary hospital. My mother moved me to the master bedroom so I had the bathroom as an obstetric ward for abandoned pregnant cats.
In fourth grade I decided to be a small town doctor, doing everything from delivering babies to caring for old people. I loved science and wanted to help people.
Laura’s hospital looked like all those I have been in over the years. Years before my friend, a high powered Washington lawyer, asked me to go with him to see his wife in a hospital. He confided, “I feel helpless in hospitals.”
Just like I feel in courtrooms.
Being a patient is enough to confuse the toughest and smartest of people. Helping my friends negotiate the medical maze is my calling. I have never been able to turn my back on anyone who asks for my help.
While an emergency department doctor, I remember moments of mind-numbing boredom, waiting for the next patient to show up, alternating with the chaos of more patients than you can see at once. Which is a bigger emergency, a 63-year-old man with a heart attack or the 33-year-old woman with a jagged cut to her femoral artery, caused by a broken femur sticking though her skin? Or perhaps the 19-year-old legally blind young man who skied through the red flags in the middle of a snowstorm, hit a tree and instantly became a quadriplegic? I had to make immediate decisions, knowing they could mean life – or death – to my patients.
I approached the emergency room receptionist and said the magic words, “I’m Dr. Cary,” the medical equivalent of “Open Sesame.” The Doctor has arrived. Deference is paid.
The receptionist immediately ushered me ten feet to the locked door, swiped his card and I entered.
This emergency department was not too busy, certainly not the Saturday night gun and knife club, as we call those in inner cities.
I walked to Laura’s vacant cubicle. I wondered about security and why no one questioned me, why no one asked what I was doing or if I needed help.
After about ten minutes I walked toward a white-coated woman. “Are you Dr. Rainey?”
She looked at me as though I smelled bad. “I’m not Dr. Rainey. Laura is not my patient. I will tell the clerk to let Dr. Rainey know you’d like to speak with her.”
I scuttled back to my detention chair. I may not have liked her attitude, but I knew what it was like to be stressed and preoccupied with patient care. She didn’t know I knew the secret handshake, that I was also a physician.
Dr. Rainey eventually approached. “The on-call plastics guy isn’t answering. I called two other plastic surgeons, but they’re not on call and won’t come in. The on-call orthopedist is busy but he will send someone to evaluate Laura.”
Laura returned from x-ray on a gurney. Her right wrist had a dinner fork deformity, most likely a Colles’ fracture. She also had a gaping crush wound to her right forehead. She had been in a non-busy emergency department over two hours and was still spattered with blood.
“Could I have some gauze?” I asked.
I donned gloves and, using warm water, gently wiped the blood from my friend’s face, neck, hands and arms, rather than wait for a nurse’s aide. When I finished she looked like the professional she was, not like a homicide victim. I knew the routines. Whether it was my job as a physician to clean patients or not, I knew it needed to be done. I knew what to ask for and I could make it happen.
A few years ago I helped a shrieking woman in a big box store in Northern Virginia. She seemed mentally ill and the store employees gathered around her, paralyzed. Despite my initial impulse to leave the scene, I walked over and sat next to her. I touched her forearm, asked what was going on and listened. Laying on of the hands is powerful medicine.
After Laura’s Colles’ fracture had been formally diagnosed from x-rays and her wound was sutured, I asked if she needed me.
“I’m OK now,” she smiled, her eyelids half-closed. “Thank you for coming. It’s so confus . . .” She dozed.
I have come full circle to my original decision to become a physician and help others. I enjoy helping people individually, not as one of an endless string of appointments. I enjoy helping people from my heart, without worrying about billing.
An hour helping a friend in an emergency room is more meaningful to me than 20 years in health policy.
I headed to the ED doors, back to the world of Dr. Cary incognito, and Christmas dinner.