One cold February morning during my third year of medical school, I walked through the entrance of the rural hospital where I was doing a nine-month rotation, and made my way to the nurses' station. Feeling the warmth return to my face, I set down my coat and bag and hung my stethoscope around my neck.
The charge nurse, Barb, waved me to her computer.
"Kristie, you have a patient."
She shuffled through papers, grabbed a blank chart and placed the patient's admission note on top. When she saw the name, her face fell.
"Ah, it's Peggy."
I sighed. I had met Peggy three weeks earlier when she'd come to our urgent-care clinic. A sturdy woman of sixty with a broad, smiling face and a stoic air, she had complained of severe abdominal pain.
It had been diagnosed as metastatic pancreatic cancer.
"She was admitted through the ER this morning," said Barb. "She's got a cellulitis in both legs." A glance through the chart told me that the ER physicians attributed this cellulitis, a skin infection, to undernourishment and edema.
Feeling a sense of foreboding, I walked down the hall to Peggy's room.
I had three months left in my rotation; I very much feared that Peggy wouldn't survive that long.
Entering the room, I was shocked at how much she'd changed. Three weeks ago, she had been a vibrant, bright-eyed woman with a hearty laugh; today, her face was pale and thin, her eyes lifeless. Her legs were swollen, red and weeping pus. A small tube in one nostril snaked down to a bag of liquid nutrition at the bedside.
Trying to hide my dismay, I greeted Peggy with a hug. She showed me a funny video that she'd saved on her phone. Then I examined her, doing my best to act calm and to keep my voice from betraying my distress.
A quiet, pleasant-faced man came into the room--Peggy's husband, Jack.
"Cold enough for you?" he said.
"Thirty below yesterday," I answered with a sigh. "Every morning I'm grateful when my car starts."
"You're young--you don't remember the cold winters we used to have," Peggy said.
Our pleasantries were shallow, but comforting. It was indeed one of the coldest winters on record; here was one thing that we could talk about without having to pick and choose our words.
With the exam complete, I walked back to the nursing station to dictate my note. As I did so, I overheard one nurse telling another about a camping trip she was planning for the spring.
The tears that I'd kept in check crept to the surface, and I blinked them back. For Peggy, I knew, there would likely be no spring.
That afternoon my pager beeped. A patient was in labor here at our hospital; her physician had called from a clinic twenty minutes away, asking me to notify her when the patient's cervix was completely dilated.
I examined the patient, then conveyed the message that she would be ready to push soon.
Back at the nursing station, Barb flagged me down.
"Peggy's feeding tube is clogged," she said. "Her nurse is in her room. Could you go down there and see how they're doing?"
I went back to Peggy's room and joined her nurse and Jack in manipulating a small brush that had been inserted into the tubing to break up the obstruction. Peggy watched in silence. We made little progress, and the mood was dismal, but we all tried to stay positive and come up with suggestions for unclogging the tube. There was nothing else to do.
The intercom on the wall beeped loudly, and we all jumped.
"Kristie--we need you in OB right away," said Barb's voice through the speaker.
Hastily, I handed the tubing to Jack.
"I'll get back as soon as I can," I said, then rushed down the hall to the OB department.
The patient was ready to push, and the doctor had arrived. Ten minutes later, I helped to deliver a beautiful baby girl.
After mom and baby were stable and comfortable, I went to complete my notes.
"Dr. Brown is in Peggy's room, helping to de-clog her feeding tube," said Barb.
I returned to Peggy's room. She stared blankly out of the window as her doctor worked the small brush.
Seeing me, he paused.
"The tube will probably need to be replaced," he said. "But there's no rush to do it this evening. We'll have all of her medicines held, unless--"
"Did someone have a baby?" Peggy interrupted, looking at me expectantly.
"Yes." I smiled at her. "All went well."
"Boy or girl?"
"A perfect girl," I said quietly.
Dr. Brown and I waited, but she didn't speak again, just smiled thinly. Perhaps she was wishing that she could be the mother down the hall, just starting out with a new baby, rather than a woman suffering from terminal cancer and an obstructed feeding tube.
I wished that she would talk--maybe reminisce about when her children or grandchildren were born. A few birth stories would have been a welcome distraction.
I found myself hoping desperately that Peggy would somehow find comfort within herself. But she seemed far from resigned to the reality of her illness and impending death.
I need to accept wherever she's at, I reminded myself. Her life is her own, and she needs to grieve in her own time. But her time is slipping away so quickly....
Later that evening, before leaving for home, I went to Peggy's room to say good night.
She glanced at me quickly, looked down at her hands, then mumbled something. It might have been "I'm ready to die."
"What was that, Peggy?" I said, taking her hand in my own.
"I'm afraid to die," she said distinctly.
She looked straight at me, her eyes clear and tear-free.
"I am too," I said quietly. The words left my lips before I knew it, and before I realized just how true they were.
I sat with her and held her hand a while longer, and together we looked out the window at the cold, snowy world outside.
About the author:
Kristie Johnson is a fourth-year medical student at the University of Minnesota; she hopes to go into family medicine. She is married and the mother of two girls, and her interests include reading, spending time out of doors and playing with her daughters. "I have been interested in writing, especially fiction and stories, since earning an English literature degree in college. I have always been impressed by authors' ability to inspire readers by sharing their stories." This is her first published story.