The Pondering Grapefruit
a blog of moments
I remember when I visited New York for the first time. One of the most distinct things I remember from that trip is the incredible range of smells, and even moreso, how fast the environmental odor would change. One corner would have the scent of hot, greasy pizza, and then I'd walk past someone with a strong perfume as I make my way down a metro stop. As I walk down the first few steps, there's the smell of urine, and once down the steps, the smell of vomit from a trashcan. As I approach my train, an abandoned bag of pastries that didn't quite make it into the trashcan smells like cinnamon, and then the guy next to me on the train reeks of body odor for the next twenty minutes.
That was the first time I remember being so odorously aware of my world, and that mindset of smell comes back to me again now whenever I work in the hospital.
One of the first things you notice, whether or not you want to, about a patient is the smell.
I walk into a room with the PA I'm working with, and the first thing she says is, "Oh, you have a UTI."
The patient stares at her and asks, "Really? How do you know?"
"It's the smell," she says. "There's a very particular smell that comes with a UTI. And when you've worked long enough, you can spot it."
I stood in the corner of the room watching this conversation, and tried a few sniffs of the air. There was certainly some funky smell--a bit metallic, sodden. It smelled like illness, something I would not want irradiating from my food. But I never would have associated it with a UTI. My nares were not as trained.
Sometimes, when seeing patients back to back, the experience of going from one room to another becomes a sampling plate for smells: room number one, an overwhelming stench of urine from a homeless man; room two, the patient just vomited onto the bed, and there's that fresh smell of half digested food and digestive enzymes; room three, cigarettes.
Yet, there are things on the plate that I can't identify. I've run into so many smells I've never smelled before, and trying to describe them is like describing a color that doesn't exist, at least not in the books. But I do know that the smell is there. Cancer has a unique smell. Fresh blood has its own smell.
And there was once a smell that I will never forget. The patient was lying flat down on her stomach on the bed, and the abscess was clear to view. It was the largest one I had seen before, a large red, bulbous protrusion that looked like a miniature model of Venus, hot red and stormy, had embedded itself into this woman's skin.
I didn't realize just how big it was though, until the Jennifer made the first cut to start draining it. A thick river of bloody pus squirted out of the hole and started flowing down the woman's skin. It would not stop oozing. With the stream still going, Jennifer stuck her hemostats into the pus, and the blades literally disappeared inside the woman. The room suddenly became overwhelmed with a a bacterial stink, as if an invisible cloud of pus was swarming into our noses. It felt like my face was being lathered in whatever was gushing from the abscess.
The abscess continued to drain. Whenever Jennifer pressed on the surrounding skin, a pool of the bloody pus would well up and overflow out of the crater of the abscess. It flowed between the patient's butt cheeks, down her legs, and onto the bed sheets, staining it with infection.
We were in there for almost 10 minutes waiting for all the pus to finish draining, and I felt like gagging several times. In the end, a total of 10 mL of that drainage was exorcised from the patient's abscess. Jennifer told me that was the biggest one she had seen before.
I will never forget that smell, and I can only imagine how many more distinct smells are to come. My last post talked about how interesting it can be to think of diseases through a musical lens, and it is also interesting to think of every disease as having its own smellable fingerprint. The olfactory tour of humanity goes on.
It began with flu-like symptoms, just like any other day, any other flu. This patient came in with cough, body aches, runny nose. It seemed like it would be a simple case, just like any other flu. When we interviewed her more though, we asked if she had been around any sick people recently. She said yes, and then added that she lives with seven other people at a rehabilitation facility, and they were all sick with the same thing, and they had come here all together.
That day the ER was packed with patients. At one point the hospital was on diversion, and there were 70 patients in the ER. They were crammed and placed in all possible nooks and corners, the hospital literally overflowing with patients. We saw patients in the waiting room. Some of them were held in small rooms here and there, and all the hallway beds were filled. We tried our best to see these flus to make more space for those in the waiting room.
As we ran from room to room, I was expecting for each story to be the same, but was surprised to see how different they all were. One girl had the cough and the body aches, but she also had urinary retention for several months. Another also had right ankle pain. Another one said that she usually has bronchitis every year. With each patient, it was like seeing variations on a theme, each ailment with its own added sub melodies and instruments.
Perhaps it would be helpful to think of sickness as a song, a song that plays slightly differently in each person. The basic melody is recognizable in all the major symptoms, but each case has its own variations unique to that person. No musical performance is the same. I just thought that viewing illnesses in terms of variations on a theme, could add some layer of insight to the way we think of medicine.
I had never seen a flag ceremony up close before, but I saw my first one recently when working in the ED. It was early in the morning, and we had just begun our shift. The PA, a chipper and beautiful young woman, and I were sitting in the doctor's nook talking about our Thanksgivings, when a silence suddenly penetrated our conversation, like a creeping fog that subtely immerses an entire city. I turned around and saw that everyone was standing up around the nurse's station, eyes directed at something to the right.
My eyes followed their gaze, and I saw three men dressed in handsome military attire standing to the right of the nurse's station. They had the caps on, the buckles and the buttons, white gloves, and erect posture. One of them held a folded flag in his hands, and with a nod of his head, signaled his partner to unfold the first flap. The flag ceremony began.
I watched, captivated, as the two unraveled the flag. Their movements were so swift, precise, and synchronized. They locked their eyes, nodded, and then made the same movements to open the flag wider, and wider, one folded triangle at a time. The stars and banners began taking form, and soon the flag was opened wide,
Up to this point I still did not know why this ceremony was taking place. I thought there was a holiday that I missed, or perhaps this was a yearly, or perhaps even monthly ritual, at this hospital. Or perhaps they had opened up a new facility and were honoring it. I was correct in that they were honoring something, but I was also completely wrong.
All activity had stopped in the usual ER. All the nurses, doctors, techs, and patients had paused to stand and watch, some with hands over their hearts. The room felt sacred and serious.
The soldiers were standing behind the nurse's station, so the station's counter covered most of my view of them from the waist down. It wasn't until they lowered the flag, and my eyes followed it's graceful movement downwards, that I saw it: something long, a lump, a mass with a a protrusion at one end. The whole thing was covered with heavy, velvet, black cloth. When I heard the sound of wheels creaking, my suspicions came true. That mass is a human. That human is on a gurney. That person is dead.
That last second right before the flag finished covering the body seemed to last an eternity. Once the body was completely covered, and the obvious evidence of life lost hidden behind the flag, time sped right back up again. Within seconds, the soldiers had wheeled the gurney out the double doors. I watched as some of the standing people followed. His family members. I suddenly felt so much love for them. The rest of the party separated, and the day progress as usual.
Still in the minutes, seconds, and hours afterwards, I still felt a chill. I kept on thinking of the protrusion at the end of the gurney. The head sticking out from underneath the velvet cover. so impossible to ignore. The PA spoke to me, "When it's military, it's always really sad."
Even though the patient had already been wheeled away, and the room that he was in cleared and made way for a new patient, I was shaken at how close death was. It was as if, after picking mushrooms and washing my hands clean, the scent of the earthen fungus remains, musky and somber. I had never been so temporally close to death before, and I could feel it still creeping on the floors of the hospital, like a lingering fog.
I only heard about the case from here and there, but the story pieced itself together: came in my ambulance, unable to breath, coughing, coughing, history of heart failure, didn't want any resuscitation, and then, in the middle of the night, a pronouncement was made. I could only imagine the stress, the number of phone calls made, how much that doctor fought to keep the patient alive, how hard that patient fought to stay alive, and how much that family tried their best to keep someone they love afloat. And then knowing that the fight ended, it broke my heart a little.
We saw a good number of patients after that. I saw many cases that I had never seen before: a case of shingles, another of serotonin syndrome, and then a case of something called Stiff Person Syndrome. Some patients were pleasant, others uncooperative and cranky. Some were good historians, some were very poor historians. But they all came into the ER, not just because they wanted to feel better, but because they wanted to live. After starting the morning with a death, I began to see how precious life is, and how everyone's life matters as much as anyone elses.
I think this is a simple truth that is often unappreciated: that everyone's life matters. I think we often go through life choosing to not recognize others as human, choosing to recognize only our own lives. We see others as half human, half alive, negligible. But when you recognize that there is life in others, and you recognize that each life is precious, everything takes on a different light, one that is serious and sacred. It was only after feeling, closer than I ever had before, the darkness of death--that black velvet covering--did I appreciate this light more, and what a difference it has made in my ability to love others.
About this Blog
I have no idea how to describe what my writing is about. I just write. I post when I can, which can be weekly or monthly depending on where the universe is taking me. As for the Grapefruit, my Vietnamese nickname, Buoi, means grapefruit.