Mrs. Hernandez is a ninety-two-year-old Spanish-speaking woman, originally from Mexico, with high blood pressure and high cholesterol, who arrived in the emergency department of the hospital where I’m a fourth-year medical student.
Her right arm and leg were weak, the right side of her face drooped; her speech was slurred, and she seemed confused. Her CT scans showed that a blood clot had blocked her middle cerebral artery, in the area of the brain that governs language. Mrs. Hernandez was a stroke victim.
Mrs. Hernandez is also my abuela.
I’ve called her Mommy Chuy since I was able to speak. I was fortunate to grow up close to my grandparents; they lived just down the street. My sister and I always looked forward to our slumber parties with Mommy Chuy and our abuelo. Their house was a place of joy and laughter, of playing games and being downright silly. Sometimes we snuck out of our house to walk over and make cookies with Mommy Chuy. She always showed us unconditional love.
A fiercely independent woman, she never asked for help and actively resisted being treated her age. She loved gardening, mending knick-knacks and taking care of her home; we had to hide the stepladder so she wouldn’t use it to climb up and organize the top closet shelves.
When I got the call about my abuelita, I raced to the emergency department. Even amid my shock, my medical training kicked in: What are her symptoms? What medications is she on? Does she take them every day?
And though my training allowed me to picture the worst-case scenarios, it also enabled me to stay composed as I stood there at her bedside along with my parents, my sister, my uncles and my abuela’s two best friends.
“Unfortunately, Mrs. Hernandez arrived too late for us to safely give her tPA, the clot-buster,” the ER resident told us. “But we can do a mechanical thrombectomy to remove the clot.”
“Do we know it will definitely help?” asked my dad, a physician specializing in allergy and immunology.
“It will restore the blood flow, but her recovery will depend on how much blood loss there’s been to that area of the brain.”
“If it’s her best chance at recovery, we have to try,” my mom said firmly.
Thankfully, the procedure was successful. As the radiologist showed us the before-and-after images of my abuela’s artery, I traced my finger along it, relieved to see its branching white lines restored.
As they wheeled her to the neurology ICU, she was awake but still intubated. It was a shock seeing my strong, capable abuela unable to express her wants or needs and too sick to understand her surroundings.
This brought home to me how fragile life is, and how quickly things can change. I felt helpless, thinking, She’s my abuela, and she’s had a stroke.
Luckily I was able to spend a lot of time with her in the ICU that day. My family and I watched telenovelas with her, told her stories and looked at photos from her younger years, remarking on how guapa (gorgeous) she’d been as a teenager. We weren’t sure if she could understand us, but we kept on speaking to her as if she could.
Despite my family’s attempts to stay optimistic, I feared the worst. Given her age, I worried that she’d never walk or speak again. All we could do was wait and hope.
Finally, after more than twenty-four hours she was extubated. We gathered around her bedside, scarcely breathing ourselves, to see if she could talk.
“Cómo te llamas?” my mother asked.
“Maria,” she answered.
It was a moment of joy. We finally felt real hope. Maybe, just maybe, she’d be able to return to her spunky, joyous, independent life.
But when I came back to see her later that night, she was no longer speaking. She only looked at me with pleading eyes. I felt devastated. How can this be, when just hours ago she was talking?
“I love you,” I told her. I left, feeling heartbroken.
On my way out of the hospital entrance, my mom called my cell phone.
“Your grandma is asking for you!” she said excitedly. I raced back upstairs to the room.
“I love you forever,” my abuela said–as we’ve told each other my whole life. I went home filled with hope once again.
The emotional roller-coaster continued. Every day, my elation that my abuela could talk, my sadness over her loss of independence and my worries about the future swirled together in my mind.
Amid all the stress and strain, I used my medical training to advocate for her. I pestered the nursing staff: “Make sure you ask if she needs to go to the restroom, because if you just say, ‘Do you need anything?’ she won’t tell you.” “Please keep the blinds open during the day, and turn the lights off at night, to decrease her risk for delirium.” “Make sure you come running if her bed alarm goes off, because she won’t ask for help before getting out of bed.”
It’s been ten months since my abuela’s stroke. With the help of family and friends, she’s getting better and better. She’s living at home again, with my uncle. The most lasting impact of her illness has been that her children worry more about her, but she’s back to enjoying her active and independent lifestyle.
Growing up, my abuela taught me how to be a woman of independence, strength and faith. Now that I’m a medical provider, she’s teaching me about the miracle of resilience in the face of illness. I see how the love she’s given to others throughout her life has created a tribe of people who have surrounded her with love and strength on her path to recovery.
In the future, I know, most of my time spent at a bedside will be as a physician rather than as a family member. But I know, too, that witnessing my grandma’s illness will remind me that the “Mrs. Hernandez” in front of me is someone else’s abuela.
Te quiero para siempre. I love you forever.
Amy Engler is a fourth-year medical student at Baylor College of Medicine and is overjoyed to be continuing her training as an internal-medicine resident at her home institution, in hopes of pursuing a career in primary care. “Writing has always helped me process experiences, and during medical school I’ve found it especially important to understand how my interactions with patients have shaped my training. I’m thankful to report that my grandmother is doing very well since her illness last summer.”