By Greg Jasani
“Hey, I think you should come see this.” It’s Ryan, my intern. I’m sitting at my computer, furiously trying to finish my notes. As usual, I’m behind in my documentation. I’m thirty minutes from the end of my shift, trying to catch up on all the charting I’ve neglected. It’s important that I get out on time today. My daughter has a ballet recital, and I promised her I’d be there.
This morning, she’d asked me, “Daddy, are you coming tonight?”
“I wouldn’t miss it,” I had told her.
Behind my daughter, I saw my wife rolling her eyes. I had already missed her last three, thanks to this job.
Now, of course, triage has roomed someone this close to the end of my shift. Typical. It’s as if ensuring I don’t leave on time is their job. I briefly look at the chart:
Room 17: Jackson, Sierra. 24F. Chief complaint: Wound check
Seems simple enough. More importantly, it sounds like someone who could wait thirty minutes for the next shift. I had sent Ryan in to make sure it was nothing serious, but now he’s calling me in. Not exactly what I wanted.
I get up, and we start walking. “So what’s up?” I ask Ryan. I’m slightly, and I’ll admit irrationally, mad at him for pulling me away from my computer.
He hesitates. “I honestly don’t know. I’ve never seen anything like it.”
Well, he’s just an intern, I think to myself. Easily excitable. I draw back the curtain, and we enter the room.
A woman is sitting on the stretcher, a gown covering her torso. According to the chart, she is twenty-four, but she looks twice that. Clearly, she’s lived life hard. She is also incredibly thin. I know the type, someone who spends what little money they have on something other than food.
“Hello, Ms. Jackson, my name is Dr. Wright. I’m the supervising doctor working with Dr. Harrison in the ER today. What brings you to see us?”
Ms. Jackson doesn’t say a word. She just lets her gown fall, exposing her chest.
One thing is immediately obvious: She only has one breast. Her left breast is conspicuously absent. Instead, there is a crater where her breast should be. It’s about the size of a child’s fist, 8 cm by 6 cm if I had to guess. No surrounding skin redness and no bleeding or drainage; that’s good. But there’s something else about it that I can’t put my finger on, so I draw closer to get a better look. As I do, I can see a pink, spongy-looking material that moves back and forth with her breath.
Her wound goes all the way down to her lung! And something else seems to be moving beneath the lung, something that seems to be beating…
Holy shit, I think. That’s her heart.
I stare, dumbfounded, at the wound for several seconds.
Ok, get a hold of yourself, I think. Ms. Jackson and Ryan are both looking to you. Be the damn doctor here. Do something. Say something. Anything…
“How did this happen?” I finally compel myself to ask.
“I’ve been injecting here for a while,” Ms. Jackson says, not making eye contact with me. “Skin popping,” she adds.
“How long has it been like this?” I ask.
“Oh, probably about two or three months.”
“What made you come see us today?”
“Well, I was riding the bus when I noticed a scab. I picked at it, and it started to bleed, so I wanted to come get it checked out.”
Jesus, I think to myself. This girl wore a hole through her chest, and the only reason she came to see us was she had a scab.
“All right, Ms. Jackson, Dr. Harrison and I are going to do what we can to take care of you. You’re going to need some bloodwork and some imaging. We will also see what we can do to help repair this wound. Does that make sense?”
Ms. Jackson nods her head.
“What questions do you have for us?”
She doesn’t say anything, just sits there.
“Ok,” I say after a few seconds of awkward silence. “Dr. Harrison and I are going to step out and put some orders in so we can get started.” We excuse ourselves from the room.
“Her family history…” Ryan says when we get into the hallway.
Typical intern. “Ryan,” I say, “That’s not important right now. I’ve been doing this for a while, and that is the craziest thing I’ve seen.”
“Well…who do we even call for this?” Ryan asks, turning red. “Plastics? Cardiothoracic?”
“Shit, Ryan, I have no idea. Let’s just put in some orders. We’ll start with plastic surgery. God, the people in this city,” I add, shaking my head.
I sit back down. Damn, I think. Still have seven notes to finish and need to get the ball rolling on this. So much for family time.
Something nags at me, though. Maybe I was too hard on Ryan. “What was her family history?” I ask.
Ryan is quiet for a moment. “Her stepdad got her hooked on the stuff when she was sixteen. Then he pimped her out to get money so they could both get high.”
I stop what I’m doing. What Ryan has said hits me like a gut punch. It figures an intern, trying to be thorough, would have gotten that detail. That detail that, while completely irrelevant to the medical care we’re about to give, provides that poor girl with some humanity.
Here I was, annoyed that she was roomed near the end of my shift, cutting into my family time. But look at what her family had done to her. That poor girl never had a chance.
I shake my head. “Ryan, I’m just glad she made it to us where we can help her. Why don’t you go back in and ask if she’s in any pain.”
I open her chart and click “Start new note.”