Over. Under. Over. Under. Over. Over. “I’ve never braided hair before.”
A pause. “It looks silly.”
“It’ll look worse if I’m bald,” she says. Her laughter sounds like a bubbling spring, washing over a stone caught in her throat.
Fear. It’s heavy and dry. Familiar.
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Two women sit together, like a before-and-after portrait. Similar ages, they are on two sides of the same knife. One is waiting for surgery. One is recovering.
In another life, this could be a waiting room. Waiting for a bus perhaps, or a flight. Waiting for a friend. Waiting for a haircut.
Scars. Sutures. Skull-flaps. Head drains. Hair. These are the topics up for discussion today.
Somewhere lurking underneath, there are other words. Functional impairment. Brain damage. Paralysis. Comatose. Death.
These words are unspoken, but they hover uneasily at the peripheries. Written in charts, printed on consent forms, spoken on the phone, dismissed by loved ones.
Risks. They are everywhere on the ward.
Outcomes. They are behind curtains.
Recovery. They are here, right now, in this room.
“Ah you’ll be grand, love. Sure just look at how I turned out!” A voice calls out, grinning, from an adjacent bed. They gesture to their own head, a jagged scar from ear to crown, an inward curve where once there was bone. It’s a well-meaning heckle. A shared experience. Gallows humour.
Somewhere lurking underneath, there are other questions. When can I go home? Who do I call? How do I say goodbye? What do I tell my kids? Why?
“Are they going to shave all of it?” she asks, a hairpin between her teeth.
“I don’t know. Maybe.” I say this slowly. I am only a medical student. This is, like so many questions, one that I can’t answer.
Somewhere lurking underneath, there are other questions.
When can I go home? Who do I call? How do I say goodbye? What do I tell my kids? Why?
Why?
She inspects herself in the hand mirror. Her hair is now pulled over tight to one side, exposing the planned incision site. “I always wanted a fringe,” she says. Weak smile, strong smile, two halves of a whole. I feel the conversation has ended, silence pulled around us like a curtain rail. It is time to be alone. I stand up to leave.
“Will you come by tomorrow before they take me down?”
I promise that I will, too fast, too easy. I am finding that in the hospital, promises must be rationed. There is only so much time. There is only so much that can be done. There are so many limits, and yet limitless need.
Beds. Staff. Skill. Money. Time.
Black, white and grey
The room is swelteringly hot. A smell of fresh coffee and stale sweat hangs in the air. There are a dozen or so people, seated, all staring at a wall of monitors. Some stand, shifting in place from foot to foot. On each display there is a brain scan waiting for review, all ominous black, white and grey.
Closed blinds serve to block out the rising sun, though its golden fingers still curl invasively around their slitted edge. A single strip of sunlight crosses the room, cutting a razor-thin line through the middle of what looks to be a tumour. A lone piece of dust glints in the beam, swirling in and out of view.
There are two parts to this meeting. First, there is a discussion of things that have already happened. A list of names, procedures, outcomes, and concerns. I listen out for names I might recognise, people from whom I may have taken histories earlier in the week. I try to pick through the jargon, grasping for some sense of an outcome, good or bad. Medical language, devoid of emotion, is so clear to its speakers, yet still so clouded to me.
Is she okay?
I am unclear where to stand or sit, when to speak or be silent, or what is happening on any given day. I find myself wondering whether I should I be thinking or feeling my way through
I wish to know, but I lack the words to formulate my question. Even if I knew what to ask, I’m doubtful I could understand the answer. Her name passes rapidly, one among many, from which I glean little more than a location – ICU – and a condition – stable. There are other names, a handful of people I remember with disturbing clarity, and a growing mental list of beds to check.
It is my first placement in hospital, and none of this experience is familiar to me. I am unclear where to stand or sit, when to speak or be silent, or what is happening on any given day. I find myself wondering whether I should I be thinking or feeling my way through.
There are social rules, esoteric hierarchies which can only be understood through feeling and observation. It is not my time to speak. There are also academic problems, medical knowledge which can be acquired only through thought and study. I should look that up later. Then there are practical skills, which require repetition to reach proficiency. See one. Do one. Teach one.
There is a rhythm to the hospital – circadian, as though it itself is alive – a rhythm which leads staff to similar rooms, at specific times, for meetings just like this one.
The second part of this meeting is a discussion of things that have yet to happen. Plans, schedules, discharges, admissions. It is for this last purpose that the monitors have been erected, and all attention now turns to the images waiting on the screen.
From all around the country, concerned regional hospitals send brain scans here to be evaluated for surgery. Limited beds. Each one is a story, no different from those I’ve been hearing all week. Limited time. Some are too old, too far gone, too unlikely to survive intervention. Limited hope. There are far more people who need help than can be helped. Limitless.
Decisions are proposed, reasoned, and accepted. When there is nothing to be done there is a moment of silence, as though the humanity of that person is suddenly in the room. Just like the words and the questions, this is always lurking somewhere at the peripheries, pushing itself in with the sunlight.
Father. Mother. Brother. Sister. Son. Daughter. Friend.
There are few places more sacred than this room, few decisions more sacrosanct than those made within its walls. The weight is almost unbearable to witness, as scan by scan, life by life, each is taken by the tide.
Do what you can
I am driving home. It is a warm evening, no clouds, with the sun slung low in the sky.
I am a new driver, nervous, almost as uncertain on the roads as I am on the wards. My window is rolled down, and as the wind cuts in across Dublin Bay, memories cascade over me as if carried on the breeze.
It is not the duty of a doctor to serve as a bulwark against hardship, injustice, cruelty, loss, or happenstance. You didn’t cause these things
What else can be done, but to feel? What more can be asked, but to witness?
Do what you can.
It is not the duty of a doctor to serve as a bulwark against hardship, injustice, cruelty, loss, or happenstance. You didn’t cause these things.
You can only do so much.
The problems of the world are relentless, systemic, and infinite in scope.
One thing at a time.
There will always be more to do.
A job half done is better than none.
We are all of us together in the swell.
We are none of us alone in the sea.
- Stephen Clare is a medical student, RCSI University of Medicine and Health Sciences, and wrote about his experience of being on a hospital placement.