Daniel Becker
Once the tube is out it takes her a minute to turn blue and relax. Another minute to lose her pulse. I learned as a student to feel the difference between the pulse in my fingers and the pulse at the patient’s wrist. Or thought I learned. When you listen for a heart to stop you start to hear heart sounds that might not be there. Like waking up at night thinking you heard something then listening to the dark to be sure, not quite convinced either way. Weak sounds, S1 and S2, valves closing. Slow and slower, regular then irregular, then almost nothing…then who knows? The monitor is off in her room but on at the nursing station. One screen shows every heart in the unit. I don’t want to sign the consult note until the line stays flat. Erratic electrical activity went on for a few minutes is an understatement. She’d be gone for most of the screen then come back for a complex or two then go away again.
I watch the blip travel left to right then arrive at the edge of the screen and imagine it turning a corner out of sight and getting lost until out of nowhere it finds itself and comes back the other side. Several nurses stop what they’re doing to watch too. We’re quiet until someone says you can discharge her from the monitor. No one has any better ideas.
About the poet:
Daniel Becker practices and teaches general internal medicine and palliative care at the University of Virginia School of Medicine, where he also directs the Center for Biomedical Ethics and Humanities. Alas, part of his job is the subject of this poem.
About the poem:
“The patient in this poem is a collage of patients.”
Poetry editors:
Johanna Shapiro and Judy Schaefer
7 thoughts on “Consult”
whew. Thanks.
Wonderful writing Dan, just wonderful. I think all of us physicians have been there at one time or another.
This is so beautiful and peaceful. Ambiguous. I’m not sure if I understand it, but it leaves my imagination open to all sorts of possibilities. Death. Life.
Thanks, Danny.
It is as good as ever.
Thank you for writing Daniel.
I have worked in palliative care and am grateful for your articulation of experience relating to the transitional nature of death.
I currently work in remote places, a long way from a heart monitor. Nevertheless, your piece reminded me of the passing of one of my patients. It was an expected death, but there was still a large family — it seemed like half the village — waiting for me to pronounce him dead with my stethoscope and expertise. I had some of the thoughts you bring to light here, half a world away.
Danny is my mentor. Wonderful to encounter his work.
Beautiful. Thank you.