The test referral reads: “Hand weakness. Carpal tunnel syndrome?”
With the patient, I proceed through the history, the examination, the testing.
It soon becomes clear their condition is much worse than carpal tunnel syndrome. Instead, it is a motor neuron disease, a group of rare, progressive, neurodegenerative disorders.
The diagnosis will be unexpected. Devastating.
I’ve started asking women about their grief. Today, I was taking a medical history from a colleague, and she told me she had lost twin girls. They were stillborn. I asked her to tell me how it happened.
It was one sad accident after another. She couldn’t feel her babies moving at 38 weeks and then went into labor. She’d been told that she would have an elective C-section at 36 weeks, but for some reason her caregivers changed their minds. By the time she was in the labor and delivery ward, the babies didn’t have a heartbeat.
Laurie Donohue, MD, a longstanding colleague of mine, died October 24, 2024. We were a year apart in family medicine residency, both practicing at Brown Square Health Center, an FQHC (Federally Qualified Health Center) in Rochester, New York. We worked together for years, maintaining adjacent clinical practices. For several years we shared an office and often bounced clinical situations off each other, or shared challenges and support. Both of us had dedicated patient panels, and we seldom saw each other’s patients. I loved working with Laurie; her calm and steady presence balanced me in so many ways.
Seven-and-a-half years into cancer treatments and two months before he died, before we knew he would die, my husband insisted on hooking up the new dishwasher in our old kitchen. No plumber would be paid when he could do it himself. The doing it himself wasn’t the hard part; it was the getting back up. I came home from my nursing work to find my beloved lying on his back on the wooden floor in front of the dishwasher.
I found out during Monday morning sign-out that the CCU patient I’d cared for over the weekend had died. We’d rounded on him the previous day, and he’d been making slow but steady progress. We were able to wean his balloon pump, the pressors, and then in combination, his sedation and oxygen requirements. He’d been extubated for over twenty-four hours.
Left alone, feeling a tenuous thread stretching taut skin over adipose tissue and tender flesh—pink, vulnerable womb empty; umbilicus severed; blood dried and brown. Perspiration beads on my brow, my breasts are heavy with milk. The letdown eases the waning contractions, starts to erase my recent memory of pain.
I tiptoed into the slippery hallway of the hospital near Dublin where I’d stayed for three weeks as a baby, trying to find some answers as to why I had been there. I still expected to be reprimanded by sisters—what nurses are still called in Ireland—with raw faces and pursed lips.
The walls were awash in institutional sea-foam green. My boyfriend at the time took a picture of my frightened face, the flash bleaching me out to only dark eyes.
I want to remember this.
In six weeks, I graduate from nursing school. I learned the fundamentals. I learned the requisite skills. I learned the “why” and the “should.”
I also learned about self-care. Actually, I learned a lot about it. Insomuch that my classmates and I were sick of hearing of it. We heard it so many times.
My classmates have been an inspiration for me. Our passion and collective drive are astounding. We are invigorated. We are excited. We want to help.
Although my training, in both internal medicine and nephrology, was excellent, I was lamentably green for some time when it came to the practical aspects of medicine. I did, however, learn one lesson early on.
One day, I rose from my office chair to greet a new patient who walked in slowly, supported by a cane and holding the arm of a much younger man, who helped her into her seat before taking his. To me, she appeared to be “old,” because in those long-ago days I thought of anyone over sixty-five in such terms.
When the walls of his failed heart collapse, he suffers a damaging heart attack. He lacks any blood flow, so the EMTs declare him dead. Shocked, he fluctuates between slightly dead and more dead. The ambulance volunteers bring him to Northern Westchester’s cath lab.
Unafraid, he sees The Light. He meets Moses carrying tablets down Mt. Sinai, greeting newcomers going up. Relatives weigh his mitzvahs: pro bono work with clients, sick friends, nursing home visits. The judge calls his wife to the witness stand. She says, “He should live.” They await the verdict.
I am trying to move the language from forever to this moment, in the aiport departure lounge. To loosen up on declaring “You’re always” and “You’re never” and instead say “Right now you are …”
I might think I know what’s coming, but I have no idea exactly what it will look like and when it might happen. For now, the “what ifs” are not dormant, but also not dominant. Regardless, an illness becomes an uninvited third person in a two-person marriage.
