The moments I remember best are the ones spent in quiet – or at least, what felt like quiet.
Hospitals feel chaotic. Frenetic energy fills the halls, especially at Bellevue. Rapid response teams, behavioral response teams, and stroke codes are constantly heard overhead. The occasional “missing person” announcement joins them.
Sometimes, I thrive on this energy. Both feet are never fully planted – one always lifted, in waiting, in ready. Feeling unsettled has started to feel safer. This isn’t bad – it’s necessary. I have to learn to feel at ease with the uneasiness.
Other days, I yearn for a sense of mastery that never comes. As I chase this feeling, I lose track of why I’m here. It’s not about me. As uneasy as I may feel when I am unprepared for rounds, today might be the scariest day of my patient’s life. As much as I may crave a moment of quiet, they desperately need one.
The halls may never be quiet, but together, we find peace and meaning in our moments of connection.
In my month at Bellevue as a medicine clerkship student, several of my patients could not or would not speak. Sometimes we didn’t know why. Pain? Confusion? One patient in particular just lied in bed and occasionally moaned. When I first met him, he would only mutter, “I’m okay” in a barely audible rasp.
“Are you in pain?”
“I’m okay”
“We need to draw some blood”
“I’m okay”
“Does that mean it’s okay to draw your blood?”
“I’m okay”
Sometimes, he would nod or shake his head in such a way that it seemed he understood us. Other times, I wasn’t so sure.
He refused all interventions. IV placement, blood draws, even having his blood pressure taken. He refused most medications. He wore mitts 24/7 (not by choice) and had a patient care associate by his side all day and night; still he pulled out his IV more than once. He seemed lost, scared, more than just uneasy. So, my first few days – when everything was new and the halls felt especially loud and especially busy – I sat with him. I held his mitted hand. We didn’t speak. In those moments, the hospital felt still. I think he started to recognize me. I like to think I made the (sometimes overwhelming) hum quieter for him as well. Occasionally, if I was there, he would let us draw blood without being held down.
One day, it was decided that we would place a nasogastric tube. I held down his left leg. Someone used the phrase “moral injury”. Our efforts to heal him felt brutal. The next day, he wouldn’t respond to me. His toe was bloody – the patient care associated said he had tried to pull the tube out with his feet. He lay in a fetal position, unwilling (unable?) to interact at all. A curbside consult clued us in to a truly dismal prognosis – weeks, maybe a month. He somehow pulled out his NG tube. We didn’t replace it.
I tried to find time to sit with him. But, now weeks into my time at Bellevue, I felt I was becoming part of the noise. It followed me. I felt rushed to see my other patients. I felt pressured to practice my presentations. How could I create stillness for my patient when I was swirling?
Over the next few days, he started to respond to me again. We transitioned to comfort care. One afternoon, he spoke a few words – “I want to stop the pain, now. Please help, I want to stop the pain now.” I asked if he knew who I was, he said yes. When I had to leave, he said thank you.
Early the next morning, before I arrived at the hospital, he died.
I took solace in the quiet moments we had together. The polish of my presentations, the narrative of my notes, felt unimportant in comparison. They were just noise. How could I ever think they were more important than holding his hand?
The chaos of the hospital can be magnetic. It’s easy to get swept up. I hope I remember that the peace I found with this patient was so much greater than the satisfaction of a beautifully worded description of interval events. I hope to continue creating connections that make the halls feel a little bit slower and a little bit quiet.