Three patients, four families

A couple of weeks ago, I took care of Mrs. S., an 81-year-old woman who was brought to the Emergency Department by ambulance because of trouble breathing. With a host of medical problems and fragile baseline health, in the few days prior to our meeting, she had gotten even sicker: what started as a cough grew into a fever and then difficulty breathing, so she called 911. By the time we got her stabilized, discovered a pneumonia on chest X-Ray, and started her on IV antibiotics, she perked up a little bit. “Where’s Linda?” she kept asking, and when she realized Linda was not there: “Could you help me call my friend?”

I had to leave Mrs. S. to take care of other patients, but when I returned to check on her a while later, another woman, who appeared to be in her 40s, was also in the room. “You must be Linda,” I said, and then explained about the pneumonia and treatment plan.

“I live across the hall from Mrs. S. in public housing,” the younger woman explained. “You have to look out for each other in that neighborhood. I go over every morning and help her get dressed and then wait for Meals on Wheels to bring her breakfast. Then I go to school. She buys groceries, and when I get home at night, I make us supper and help her get to bed.”

“Oh,” I responded, inspired by the notion of a woman about my age bettering herself by returning to school while at the same time taking care of her aging neighbor. “Good for you. What are you studying?”

The other woman paused for a minute, then looked me in the face and said unapologetically: “I have a mental illness. The school is a program that teaches skills to adults like me.”

“And you still take care of your neighbor?” I asked, flipping in my head through every self-absorbed and vacuous thing I had done in the last week.

“No,” she said. “She takes care of me.”

* * *

I do not even remember what brought Mrs. N. to the ER for the first time, but I do remember her family. Mrs. N. is in her early fifties and suffers from Picks Disease, a form of rapidly progressive dementia, somewhat akin to Alzheimers, but that strikes people younger and debilitates them—and often their caregivers—more quickly.

She was immaculately dressed—and so was her family. These were bright, professional people, used to functioning well and succeeding in the world, and this was the approach they had brought to their family member’s illness. So although Mrs. N. could not tell me what day it was—or even where she was—her hair was attractively styled and she was dressed in clothes straight out of a Brooks Brothers catalog.

What was remarkable about this woman’s attire was not that her clothing was expensive, but that as her disease had advanced, her family continued to dress her well. Too often I see people in the end stages of disease whose families stop bothering to dress or even bathe them. They come to the Emergency Room in pajamas or sweat pants that they have been wearing for a week, or worse, in adult diapers that reek of urine and their last bowel movement.

This was not the case with Mrs. N. While she paced back and forth in the room, her family answered my questions about her symptoms, stopping to hold her hand or wipe her nose when it ran. But she was uncomfortable in the small room and kept trying to leave. Each time she reached the door, her husband would gently redirect her until she got to the back of the room where her son and daughter-in-law were positioned. They would then turn her around and she would walk back to her husband. She did this walk again and again, dressed like she was going to work in a downtown office and seemingly unable to remember that she had just made the same walk. The family performed this task as if it was completely familiar, and something they did all day long.

I have taken care of Mrs. N. multiple times since I first met her, and she has gotten sicker. She is incontinent now, and can no longer walk, but her family’s approach to her illness has not changed. Although I am sure they never imagined a life with a family member as debilitated as Mrs. N has become, they seem to take it in stride. Many aspects of Mrs. N’s life are ugly now, but her family is unembarrassed as they change her diapers and unapologetic when her dementia leads her to say inappropriate things.

* * *

I met S. several months ago when she came to the ER for vaginal bleeding. An emancipated minor, she was 15 years old and a G2P1 at 7.5 weeks—medical shorthand for a woman who had already given birth once and was almost two months pregnant with her second child. Her nearly one-year-old son was also in the room, an energetic child who was in the care of another teenage girl who had come to the ER with them. While I asked questions and examined S, the other young woman kept the baby occupied. She knew when the child was hungry, what his favorite picture was in the book they had brought, and when he needed his mother. What a great friend, I thought, and then went to see the next patient.

But over the course of the time these girls were in the ED, I came to understand something different: that these two teenagers were partners and lovers, and that together, they were finishing high school and raising this baby. As someone who barely knew where babies came from at age 15—let alone having made one and then decided I preferred dating girls—the situation these two young women found themselves in blew my mind. It also moved me deeply. In the two or three hours that they were in the ER, it became clear that the baby’s best advocate was his mother’s lesbian lover, and that S. was the best friend and companion her teenage girlfriend had ever known. If there were adults in these girls’ lives, they were nowhere to be seen. Nevertheless, the girls and their child seemed to be holding their own.

I have taken care of S. several times since then, and saw her a week ago for some minor complaint. Her pregnancy has progressed, and she explained to me that she and her partner had decided to give the baby up for adoption. “We want to finish school and be good parents to my son,” she said. “We want to make somebody who can’t have a baby happy.”

I told her it sounded like she and her partner were trying to make good decisions.

“You wanna see a picture?” she asked, and then handed me a photograph taken at a recent school dance. In front of a stock photography background stood two young girls, dressed in their very best, holding a small child between them. “This is our prom,” she said.

“You’re beautiful,” I responded, and meant it.

* * *

I met my husband in 2002 when I was 38 and he had just turned 35. By the time we got married I was closer to 40. We do not have any children. I am a former English professor turned reluctant-ER-doctor. My husband works in theater, doing lighting and backstage technical stuff that makes performance possible. He grew up in upstate New York, went to Catholic grammar school, and attended church every Sunday as part of a Slovak immigrant community where Mass was still said in the parishioners native language on holidays. My family comes from Mormon pioneer stock that settled in the Intermountain West. I do not drink alcohol. My husband does not eat meat. When we got engaged, both families were concerned—for very different reasons—that we were going to hell. Others just thought we would not last.

But we have lasted—in our own herky-jerky way. Because of work requirements, we have spent much of my residency apart, making enough money to pay bills by living in two different cities. We have both had run-ins with dark times and carry ugly wounds from the failed relationships we survived before we found this one. We are kooky, complicated people.

Now that my residency is nearly over and we will be moving to the same city, we find ourselves asking what kind of a family we want to be. We will never be very good Mormons or Catholics, and may not always even be able to eat the same things when we sit down to dinner. Whatever additional family comes to us will likely be assembled rather than created the old-fashioned way: an older, adopted child from foster care or another country; assorted friends gathered from lives we lived before we were a couple; dogs rescued from the pound; and neighbors willing to share our table in spite of our schizophrenic approach to religion and family and food.

Growing up, I had an idea of what my forties would look like: spacious home, beautiful children, the kind of good-provider-but-aloof-husband my church suggested would make the right spouse. I would be settled. Secure. Instead, at forty I find myself just beginning many things: a family, a job, a new career.

Perhaps this is why I find myself thinking about the families I meet in the Emergency Department. The realities of their lives put my fantasies of a settled family-life to shame, and expose my teenage ideals as the girlish dreams that they were. Real families do not always look like we imagined growing up, or even what we see on TV. They are more real and more gritty, but also more grace-filled and kind.

This is what I am learning from practicing Emergency Medicine right now: that some families are born, but most are made. The families I meet are cobbled together out of the mess of life and last because of the love members have for each other, not because of how beautiful or orderly they look. I take X-Rays and write prescriptions for prenatal vitamins and try to ease some of the suffering in my patients’ lives. In return, they teach me how to live mine.

29 responses to “Three patients, four families”

  1. Marleyfan says:

    Hey Doc,
    Gotta say I Loved your post. You sound like one heck of a compassionate lady. I recently went to get a checkup, just after my birthday. Maybe I should back-up just a bit. About ten years ago I wasn’t happy with my Doctor, so I started asking some nurse friends who they went to; many of them talked about this fantastic new female doctor. I was a little hesitant, because of a family history of prostate cancer, and the thought of having a female doctor do the “finger” exams was a little uncomfortable. However, I did switch physicians, and my wife did as well. And it wasn’t just a couple years later when my parents and aunt changed to this same doctor.

    When I went in for this checkup, since I just turned forty, it was time for the first annual PSA test, and the first “finger test”, ugh. As the doctor came into the room, she smiled warmly, and asked about how my wife was feeling, and asked how old each of our children were. She went on to ask (by name) about my parents and aunt. A couple of days before coming to her office I had given blood for all the normal tests. So when she looked at the results of the blood-work, and she noticed that my cholesterol levels were within the “good/acceptable” range, she asked “now you’re not on cholesterol meds are you?” I told her no, I’ve been going to the gym 4 or 5 days a week, and she actually teared-up and said “good for you”, and asked about the gym. The rest of the exam went well, and it wasn’t entirely uncomfortable, o.k. I actually enjoyed it. Not really, but the doctor showing that she really cared, not only made me feel comfortable, I felt cared about.

  2. MF says:

    For over ten years you have been teaching me how to re-define my understanding of families, how to find people and places and love that I can call my own. This post captures the integrity with which you relate to and love people. I’m about ten years behind, but watching you leaves me very hopeful that in the next ten years I will have a family (assembled any which way it happens).

    In that pursuit… I’ve been making a concerted effort to meet a lot of people. Imagine my surprise on Tuesday when I met someone here in NY, who knows you from medical school. (He also knows a close friend from college!) I met him by chance, but these kind of chance meetings with people who know my friends make me feel like I live in a much larger extended family. A lot of fun.

  3. Marleyfan says:

    the kind of good-provider-but-aloof-husband my church suggested would make the right spouse

    What did you mean by this?

  4. Guenevere says:

    When I met you some 10 years ago, your eloquence and optimism inspired me–you had the gift to tell a story and to give it several layers of meaning. In doing so, you imbued your own life with substance. You told your own story as if it mattered, in a culture in which women often have a hard time believing that they matter. And this rubbed off on the rest of us.

    When you went to medical school, I thought of how lucky your patients would be, just as I had earlier thought that your students were lucky.

    I thought of your remaking of your life midstream when I did something similar–temporarily leaving my husband in Europe.while I [and my brand new baby] moved back to America so that I could start a completely new career.

    The way you live your life with courage and integrity gives others the strength to do so too. I am certain that your young patients felt renewed strength from your care.

  5. W2 says:

    I notice the word “unapologetic” in these snapshots of people living their lives unapologetically – as if it is the dream ideal of The Family that they might owe some apology to – when in truth, their reality (and yours) is better than any dream might be.

  6. is that the guenevere known to so many of us from a past life?

  7. oh — btw, annie, i should have included that i loved this post. so happy we still have a doctor in the house.

  8. lisa t. says:

    beautiful, engaging piece, annie.

    i’ve been wanting to comment since dave’s post this week about death and its taboos and living and family. this is mostly due to seeing joan didion speak downtown on monday evening. maybe there’s a post in itself here for me, but i find it a bit strange how ideas i’m encountering/digesting/exploring in my own real time show up in greatwhatsit posts.

    i’ve got too much to say about it all– and heavy work at the end of this semester to do, so i’ll save it for now, but wanted to acknowledge my love of the “made” family here at gw.

  9. Guenevere says:

    It’s me.

  10. welcome to whatsitville.

  11. Guenevere says:

    That wasn’t very clear. Yes.

  12. Guenevere says:

    I meant, my answer wasn’t clear. It was really fun to happen upon this site and find the musings of so many people from my past. Plus, I can vicariously experience Manhattan without having to pay rent there.

  13. Rachel says:

    Hi, Guen!

    Tremendous post, Annie. You only see people at moments of crisis, moments that are extraordinary and rare in the fabric of their lives, but reveal so much about who they are.

  14. Beth W. says:

    This was a lovely, touching post. Like Lisa, this post and Dave’s hit home for me this week. I had my first visit to the ER last week for what turns out to be allergy induced asthma. My wonderful brother was with me late into the night. The first thing the ER doc said to us was “Whoa you two look exactly alike”. I wonder if he was thinking “I hope that’s not your boyfriend because that would be creepy.” Annie, from reading all of your heart-felt posts, I believe you must be a wonderful doctor to have in a time of crisis or anytime for that matter.

  15. Jen says:

    Really great post – it gave me chills :)

  16. AW says:

    Wow. I’m a little overwhelmed by this response. Writing for TGW is an interesting experience of writing for very careful and non-pedestrian readers. Like Lisa T., I am grateful for TGW and to be a part of such an interesting conversation with people whose insights stimulate my own thinking.

    Marleyfan: I may owe you an apology. The line you question may be an inadvertant stereotype or over-generalization. There are some really fine Mormon men in my life–including my brothers, whose passionate and engaged lives I genuinely respect. What I was aiming for with that line was more an account of the “ideal” male that was held up to me in “Young Women’s” (the church’s youth group): he was responsible and church-going, but so busy with work and church service that he seemed disengaged from his family–and probably hiimself. As a girl, I understood my role was to marry and support him in his role. We would then be the Mormon version of “The Family” that W2 talks about. I’m sorry if my discussion of the frustration I experienced with the roles ascribed to men and women during my childhood missed the mark.

    Guen and MF. Thank you. The fact is that both of you greatly underestimate the role you played–and continue to play–in my life. And I was so glad to hear from you, here, Guen. Thanks for reaching out.

  17. PB says:

    Wow. oxo.
    ’nuff said.

    Hey, Guen!

  18. Dave says:

    Loved this post, Annie. I don’t think you have to apologize about the aloof-husband line. That was a significant part of your experience, and it contrasts with your current relationship and with the other families you discuss. I for one instantly recognized the type — the Mormon version of the 1950s dad whose wife greets him when he gets home from work with slippers and a cocktail and makes sure the children stay quiet so he can read the evening paper in peace.

  19. farrell says:

    Guenevere? freakish internet. It’s been years. I hope all is well. And hope you comment more often. Welcome!

  20. Marleyfan says:

    No need to apologize, I just wasn’t exactly clear what you meant. My 14 year old daughter has expressed a number of times similar sentiment; she often says “what about me”, “what about my goals and aspirations” etc. And though she doesn’t get it at church, she gets it at home (which is much more important anyway). Again, loved it.

    And Dave, what’s wrong with the slippers and cocktail? At least be can fantasize…

  21. bryan says:

    marley —

    i heard a local NPR thing about SASSY magazine the other day. one time after another female callers kept saying that sassy made them realize that they didn’t need to marry a doctor, they could be a doctor! it seemed so revolutionary, even to middle-class kids in the northeast in the 1990s.

  22. Miller says:

    You mean I don’t have to marry someone who wears slippers and drinks cocktails, I can actually wear slippers while drinking a cocktail! This whole women’s lib thing is fantastic.

  23. see — everything arrives west coast 5 years later. (25 years?)

  24. Miller says:

    Ahem. 24 years.

  25. Guenevere says:

    Hey back, y’all. This has to by Bryan and SSW’s brainchild. They were always so good at creating communities.

  26. Tim Wager says:


    I didn’t get a chance to read this until today. It’s just beautiful.

    Plus, while many of you are excited by the appearance of someone from your past, I’m excited to see the reappearance of someone else, somebody by the name of Farrell. Fawcett, is that you? I’ve missed the musings of your criminal mind here.

  27. AW says:

    Marleyfan–I suspect one of the best things your daughter has got going for her right now is a dad who is insisting that her goals and aspirations are worthwhile.

  28. puck says:

    wow, i am truly amazed by your ability to continually analyze, interpret and describe so eloquently your life encounters. incredible essay, thank you.
    ps: call me i would love to see you before you leave!

  29. 25: that’s nice of you to say, guen. actually, this used to be dave’s own blog and a couple new years celebrations ago we hatched the idea to re-launch it as a group project. we’re nearing 1.5 years of near daily content!