Portal de Periódicos da CAPES

The Ways We Whisper Love

2022; Elsevier BV; Volume: 136; Issue: 1 Linguagem: Inglês

10.1016/j.amjmed.2022.06.024

1555-7162

Michelle Izmaylov,

Ethics in medical practice

A woman shakes her head; a swallow bobs down her throat and vanishes beneath the crumpled collar of the hospital gown. It was not the news she was expecting. Her eyes are brown and darting frantically like the lightning of a summer storm. With a twisting lunge she turns over in bed and faces away from me sitting at her bedside. Her hands fold into the shape of a prayer . . . but, after a moment, her hands fall apart and lie crumpled on the bedsheets. She curls her spine around tucked knees and hugs her arms across her chest, fingernails digging into the soft fabric draped around her thin shoulders, and she buries her face against the pale blankets piled up all around like walls. “I know you don't care. No one cares. Just go away”—she whimpers what her body tells me. In respect of her wish, I leave thinking about the ways in which we speak to others. In the hallway just outside the room, a young patient with her elbow hooked around a portable intravenous pole pauses her morning walk to offer her own lotion to a nurse with skin cracking from a pandemics’ worth of handwashing. Just past them, at the nurses’ station, a medicine resident shares her breakfast bagel with a colleague finishing up his night shift. He devours it like it's the first food he's had all shift and licks off the smear of cinnamon at the corner of his mouth. “You didn't have to”—but he's cut off as she offers him yogurt and a plastic spoon out of her lunchbox. She pushes the yogurt into his hands against his feeble protests. She smiles: Please take it, I have plenty. The young patient and medicine resident are both saying the same thing, aren't they? With the hospital census far past capacity, there were no spare cots for visitors tonight. On rounds I find a father curled up on a thick nest of blankets on the floor at his son's bedside; better a stiff back than to leave his son without a hand to hold before he's wheeled off to surgery. Another patient tilts her head as a nurse's careful hands help fasten an elastic and tie her hair into a ponytail. Two doors down, a respiratory technician brings a patient her inhaler treatment and his own charger for her electronic tablet; later, with her device recharged, she will be able to watch her daughter cooking lunch through a video communication application because it just isn't the same if they aren't making the meal together. “You aren't bothering me at all,” says a physician to assure his worried patient who knows she has been talking for twenty minutes straight about gardening, potato recipes, and other topics, unrelated to her medical condition. “I'm here to help,” he says, and sometimes that means just listening to what a patient needs to say even if the information isn't relevant to diagnostic and treatment planning. “Don't worry,” says a case manager 3 floors above, “we'll get it taken care of.” Her uninsured patient pumps her hand and relaxes against his pillows, grinning because the hospital's medication assistance program means he can afford his blood pressure medications this month. Another patient thanks his social worker for bringing a list of alcohol rehabilitation programs and for taking time to sit at his bedside to hear the story of how his life rolled so far downhill—and helping him plan for how to climb the cliff back up from rock bottom. In the coronavirus ward, a nurse slides to the floor with her back against the hallway wall and sobs loudly into her hands. Her third patient was intubated this morning, and her hands are heavy with the ghosts of all the lives she could not save. An intensive care unit physician slows his steps as he passes by her, and he circles back to sit down on the floor beside her. He hugs her as she cries, and he takes her hands so that she has something to hold on to. A trash can clatters past them, wheeled by the determined grasp of an environmental service employee who has double-masked to keep his wife and 2 young children safe. And yet, he volunteered to work on this ward; there are rooms to clean and linens to disinfect to ensure the patients arriving in these rooms stay safe, too. Down the hall, in the last room on the right, a mother's shoulders shake but she tightens her grip and steadily holds up the phone from 6 feet away so her son can say “I miss you” between hacking coughs to his sister who has waited all day for a glimpse of his face and to hear his voice through the staticky connection. Back in the hospitalist workroom where I sit down to write notes after rounds, someone brought a surprise delivery of cookies. “Well, you know, it's been busy”—found around here in the mouth of every clinician having a hard time but determined to set aside their own needs and get their patients the care they need regardless of anything. A tired colleague drops a stack of papers. Another scoops them up for her before she leans over to grab them. Someone has a child home alone and sick; every person in the room raises a hand ready to cover her pager and double their own overwhelming workload so she can go home and help spoon chicken soup into her daughter's mouth. Later someone will point out the sunset, and 7 exhausted hospitalists who have stayed late will encourage each other to leave their white coats draped over their chairs for just a moment and cross to the wide workroom window for a shared moment of comfortable quiet as they study the ultramarine sky shot through with amber and coral light. As the light of sunset cools to darker shades, I return to the room of the woman I met earlier that day. I bring a dinner tray because she missed breakfast and lunch while waiting for a biopsy. The interventional radiologist missed all his meals and dinner, too, but today was Friday. He stayed late to add on her procedure because he thought she might be worried if her biopsy was delayed over the weekend. The patient sits up and turns to look at me as I cross the room. Her gaze falls to the tray loaded with a sandwich, soup, a fruit cup, ice cream, and other assorted snacks I picked up for her from the cafeteria. She bites her lip, and a slight tremor returns to her thin shoulders. But it seems it may be for a different reason than the shaking of that morning. She murmurs: “You didn't have to …” In reply, I place a bottle of her favorite soda and another of the orange juice she asks for every morning next to the tray. I wave off her concern for my sake. “Don't worry about it. I just thought you might be hungry.” As I turn to go, she grabs my sleeve and tugs me back. Her eyes are damp, the lashes clumped together. Her mouth hangs open, working hard as if struggling to conjure the right words into existence. Then as her lips fall slowly closed, she leans forward and hugs me tightly. I feel her smile against my white coat. Kneeling at the bedside, I return her warm embrace.