By Julia Munchel
I remember being so excited when my intern caught my eye that morning.
"Do you want to present a patient in the ED?"
Yes! This was finally my chance. Take a detailed history, do a physical exam, impress my attending with competence, or at the very least give him a reason to learn my name. But my excitement of impending success was quickly stifled upon reading the note. Its first line was as follows: 21 year old female known under many aliases to ED staff was brought in by NYPD after being thrown naked from a vehicle.
A little hot spring of panic begins to well up within me. Be cool. Looking up I manage to catch Natalie's eye and motion her to come over.
"Read this note."
She leans over and smiles in spite of herself, saying, "Do you want me to come with you to the ED?"
"I should be fine. I can handle an interview. What's the absolute worst that can happen? She'll yell at me? She'll realize I'm just a stupid medical student pretending I know how to work the blood pressure cart? "Yes, if you have time. But if you don't that's totally cool. Obviously."
Walking down to the ED I carefully take the steps one at a time. What I know is that this patient was brought in by NYPD, against her will, with a urine toxicology positive for cannabinoids, cocaine, and methamphetamine. End of story. What will my attending want to know? What will my first question be? How will I introduce myself? I could just say my name and leave my role in the medical team up to her imagination. Technically it's not lying. Technically. What will I say if she's angry? What will I do if she wants to leave? Can she leave? I take deep, conscious breaths and stand a little straighter as we arrive outside her room.
All I see is hair. A shock of greasy, stringy clumps poking out from white sheets. Kneeling down I gently shake her.
"Ms. Valentine? Ms. Valentine? Can I talk to you for a moment?"
I look around self-consciously. It's probably not her real name. She makes no sound or movement. I shake her a little more vigorously this time.
"MS. VALENTINE? CAN YOU HEAR ME?"
Again no response. I turn to Natalie
"What should we do?"
Natalie shrugs, equally at a loss. The only solution I can come up with is to make one last honest attempt to wake Ms. Valentine. As I shake her back and forth, the bed begins to roll, escaping from my fingertips. Immediately I give up, suddenly preoccupied by the fear that some nurse is going to wander by just in time to catch me assaulting this patient.
"Well, I guess we should go back upstairs and ask Dr. Poll what we we're supposed to do."
"Yeah," Natalie agrees. "Just write ‘Patient unarousable' or ‘Unable to conduct physical exam'."
It feels like a ridiculous reason.
By the time we get back to the floor our attending is already rounding. Following him into each patient room I attempt to lurk at the back of the herd. I need time to organize my presentation. I know her name, not her real name, but a name. She has a medical records number. She is naked. My first presentation and all I have to present is: 21 year old intoxicated female, found naked, currently asleep in room M-12.
"We have a patient in the ED?" Dr. Poll finally asks, looking around.
I make eye contact, or at least attempt to make eye contact. "Yeah. M-12".
"Lets go," he curtly replies, opening the door to the stairwell.
Running behind I present the meager sentence I have prepared. I think I see him nod and take that to mean he has heard.
Ms. Valentine is now moving in sharp, staccato bursts. She sees us enter and flops to face the wall, a single butt cheek exposed.
"Ms. Valentine," Dr. Poll says. "You are naked. Cover yourself."
He pulls the sheet down.
She looks over her shoulder, squinting, and for the first time I can see her face. It is crusted over, her features obscured by scabs. Quickly she burrows back under the covers ignoring us.
"If she doesn't want to talk to us she doesn't want to talk to us," Dr. Poll says. "We'll come back tomorrow."
As the team files out of the room I try to imagine what this nameless girl is thinking but invariably come up short. She seems to be this thing; this creature of the deep washed up on the shore after a great storm. A humongous jaw bleached white by the sea air, filled with row upon row of tiny, sharp teeth. I can only imagine what the rest of the animal was like, how it related to its world, how it came to be stranded on the beach. When I press myself to think of how she feels or who her parents are or the things she enjoys my mind is black. And I am scared.