As the clouds of brilliant white languidly were traversing the cerulean Hawaiian sky, flashes of blue scrubs darted swiftly around the gathering crowds of pale faces. As bystanders were watching with amusement, I, notably crimson from a mixture of panic and fatigue, briskly maneuvered around the hospital furniture to keep up with the cardiac code team. My mind ran over my intern's earlier morning presentation, “This is a 58-year-old man with a history of atherosclerosis and hypertension who was admitted yesterday for a complaint of chest pain and EKG changes.” With my white coat fluttering on my back, perhaps sharing in my anxiety, I raced to the room to meet the tumult of a code. As my attending supervised attentively, my resident bellowed commands at frantic staffs scurrying to find the appropriate medications. Stricken with nervousness, I stood by the door, unsure if I should enter the threshold of responsibility or presume my current idle role. As I was taking in the flurries of IVs, chest compressions, and mechanical beeps, a somber sob tore through the commotion. Tightly clutching an older Asian woman's hands, a young girl was vacillating between watching the medical interventions and turning away in anguish.
The older woman, visibly weathered by a lifetime of tribulations, held the young girl closer and uttered some words in a foreign language, as if trying to reassure her, and then the pair watched on. Snapped out of my bewilderment, I approached the pair to offer my assistance, albeit uncertain of how. The older woman watched me apprehensively, and stuttered in broken English, “I am wife. That her dad.” I quickly tried to assuage their distress with a quick overview of the pathophysiology of myocardial infarction and the current ACLS protocols being applied to their loved one. However, I found my explanation, al be it in appropriate “patient-friendly” vernacular, eliciting only their vacant faces and monotone choruses of “Okay, doctor.” As I was ransacking my brain to provide more information to them, my train of thoughts was derailed by the daughter's heart wrenching wail. A jolt from the defibrillator had coursed through her father's body and sent his limbs flailing eerily. Her repetition of “Okay, doctor” was interspersed with the renewed sobbing. The mother embraced her daughter and again muttered words of encouragement in their native language. Suddenly realizing that I understood their conversation, I offered a simple “Are you okay?” in Vietnamese.
My greeting startled the grieving pair, and their sullen eyes opened widely in astonishment. In Vietnamese, the mother sheepishly replied, “Can you understand us?” When I nodded, the pair ran to me and dissolved on my shoulders. Feeling the tight embrace of the mother, who had desperately tried to remain strong for her daughter, I squeezed back at the now weeping figure. As I held the two in my arms, a solemn calm fell over us. The thundering noises of the code team faded into the background, and I could only hear the silent anguish of their tears. I heard the endless cascade of medical words and foreign explanations. I heard the deafening silence of their husband and father lying insensate on the hospital bed. Then I looked down and heard the muffled bawling of two lonely people without any family or financial support. Suddenly, I felt the dampness of their confusion, fear, and heartache seeping through my white coat, and the coldness of its melancholy stunned me.
Wiping the cathartic tears from her eyes, the young girl stepped back and finally spoke in her native tongue, “This is my mom. My dad came here yesterday because of a heart attack.” Still clutching her daughter's hands, her mother looked forlornly at her daughter and then at her motionless husband. “He was just complaining about his chest pain this morning, and he still wanted some fried food.” Her woeful chuckle trailed off as she continued, “We went to get him some food, and when we came back, there were so many people in here doing all sorts of things on him.” The mother reticently nodded and squeezed her daughter's hand. The daughter went on dejectedly, “A doctor came by and told us that there's something wrong with his heart, and he could die if they don't fix it.” Shaking her head, her tears began anew, “He was just asking for food this morning. How could he leave us like this?”
Her question was so simple, yet immensely complex. My explanation of post-myocardial infarction ventricular arrhythmias was not able to explain why her father would not be eating dinner with them, nor was it able to provide her family with the income of her father's taxicab. As I was struggling to find the right words, I was interrupted again, this time by an eerie absence of noise. The code team had stopped; the patient had been completely asystolic for the past twenty minutes. Suddenly, noticing the dead silence, the mother started repeating louder and louder “No, no, no!” Her screaming shredded the tense air in the room until she finally collapsed in her daughter's arms. Holding her mother tightly, the daughter wept desolately, as our medical team stood tacitly around them.
In the aftermath, our attending explained meticulously, as I tried to interpret as much as possible, the events leading up to his cardiac arrest and the course of interventions and treatments during his code. Although their crying had somewhat subsided, the mother and daughter only nodded. As our team was leaving, I lingered by the door and asked again, “Are you okay?” The pair finally looked up and shook their head. I was utterly floored, trying to swallowing the uncomfortable lump in my throat, and trying desperately to restrain the insurgent tears in my eyes. I told myself that I was the healthcare provider, and I needed to maintain my professional image. Perhaps, perceiving my internal turmoil, the daughter came over and asked me, “Are you okay?” Those three simple words evaporated all my burdens, and suddenly, I felt a familiar dampness rolling down my cheeks.
I ended up staying behind for several hours, just simply speaking to them about their lives: their home in Vietnam, their immigration journey to America, and even their favorite foods. They were no longer the patient's family, nor I the healthcare provider. We were just talking and sharing our lives. As we continued our musing, I realized that medicine permitted me the incredible opportunity to connect with them. Yet, this medicine was not the archetypal pill, or injection, nor was it involving the familiar stethoscopes or CT scans. The lack of familiar scaffolding, upon which I frequently relied in medicine, made me feel vulnerable. As my train of thoughts stopped at the word “vulnerable,” I found myself entrenched in the sensation. As healthcare providers, we incessantly ask our patients to lay bare their lives; yet, I wondered how emotionally and mentally unclad are we in receiving their life stories. In this story, I could not cure the ventricular arrhythmia of the husband/father, nor could I heal the heartaches of the daughter and mother; however, I comforted them in their moment of need.