The chart said that she came into the Emergency Department after an overdose. An older woman, disheveled, who had been found down on the ground. She had a history of schizophrenia and not taking her meds. The Emergency Department stabilized her and then admitted her to psychiatry. On paper, she was like so many other homeless patients: chronic psychosis and layers of trauma buried under ICD codes that adorned her chart.
When I met her, I was a medical student on the first day of my inpatient psychiatry rotation. She was still speaking. Guarded but clear. She moaned in pain. Told stories that blurred into delusion. She pointed to the corner of the room and said, “That woman is stabbing me in the back!”
For patients with an altered mental status found down, a head CT helps rule out trauma. In a frail older woman, we feared blood on the brain. Instead, we found cancer. A mass. Advanced. Ugly. Metastatic. A body scan showed tumors everywhere. She had been stabbed in the back, but the weapon was a tumor, not a knife.
Psychosis steals a person slowly, invisibly. It rearranges meaning. It replaces memory with metaphor. Someone’s child eventually becomes a black box with a warning label in their medical chart. And when a person like her dies, it’s not just a medical event, it’s the closing of a story no one fully got to read. She needed more than chemo or antipsychotics. She needed restoration. A return to something we never had the blueprint for.
Instead, she grew quieter. Speech slowed. Screams gave way to silence. Eventually, when asked what day it was, she murmured, “I don’t give a shit.” She was still here. But where “here” was, we couldn’t follow. I rubbed her arm the last time I saw her, unsure if she could feel it. I didn’t want to leave her alone with the attacker in the corner.
I didn’t know her long, but she left a mark.
She believed she’d been stabbed. The cancer became a person with a knife. I wonder if that story gave her meaning or simply shaped the pain into something she could name. We never learned who she was before the illness. Whether someone came looking. Whether someone was already mourning her.
Not all loss is death. Sometimes, it’s watching someone vanish inch by inch, while the world still spins.
Sometimes, the hardest part isn’t that we couldn’t save her. It’s that we never really knew who we were trying to save.
Saachi Jhandi
Salt Lake City, Utah