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Thirty Below

Kristie Johnson

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.

Story editor:

Diane Guernsey




18 thoughts on “Thirty Below”

  1. Kristie, this is lovely- your unabashed candor describing unexpected emotions and insights as new life and impending death arrive simultaneously “on your doorstep.” To me, this is the essence of Family Medicine and the foundation of wisdom. You’re on your way to a remarkable career. You go girl!

  2. Dear Kristie

    Others have already commented so nicely that I really cannot add anything except my thanks for your gift of telling a story so nicely and so poignantly. Please stay the course – do not be mislead by those who say that medicine is just a job. The heart and soul of it all is embodied in your heart and soul. Thank you.

  3. Kristie, This is good to read – I am happy for you, and for your patients! I hope you keep on writing, to give glimpses of what’s going on within you. I loved how I didn’t know where the story was going, and how gracefully and powerfully it ended. Thank you.

  4. Kristie .. I’ve watched you grow through the years as you’ve progressed through your medical school education and I’ve shared with you often that I’ve found it amazing to be able to see you “grow” into finally becoming a doctor .. but I’ve never been able to formally share just what a tremendous physician that I’ve thought you will become.

    As you know only too well from knowing me for the years that you have had contact with me you are very well aware of all of the health issues that I deal with every single day and if I could have even ONE of my doctors who work with me have even one ounce of the compassion that I see in you that you will be directing towards your future patients it would mean the world to me. And, as I know only too well you are going to become a exceptional and caring physician and I can only be envious of the future patients you will be working with.

  5. Such a wonderful story, Kristie, thank you for sharing. I, too, did ROAD and had similar deep, human experiences. I nowdo broad spectrum family medicine in Northern CA. My passions are OB and hospice, and doing both helps to sustain me in my general practice. Having the juxtaposition of birth and death is powerful, and illustrates the great privilege we have in family medicine to help guide and witness patients and families through 2 of the most important transitions of life. Your presence at the bedside of both, and sitting looking out into the snow, is beautiful. Remember thor moment!

  6. I’m thinking of all the Peggy’s today who are being admitted or are looking out their windows. My wish is there are more, like you, Kristie, sitting with them, watching and listening even if there are no words or light to see outside.

  7. Such a fine piece it’s difficult to believe you haven’t been published before. I hope you’ll always find the time to continue writing. You may be interested in the Crab Diaries blog, written by a radiologist who also has an undergraduate lit degree, Miranda Fielding.

  8. Thank you for telling this poignant story. And thank you for being yourself – a warm human being. Being present is everything.

  9. Kristie, you conveyed your poignant story beautifully. May you continue to find time to write. No doubt it will keep you connected to your patients and what’s most important in life.

    How I look forward to reading Pulse each week. Not only are the submissions excellent, so are the comments. It’s the only place I hang out where cynicism and sarcasm rarely enter. Thank you all for creating this safe, sacred haven.

  10. What a lovely story, showing us humanity at its naked best, allowing two souls to understand each other perfectly over only a few spoken words.

  11. Thank you for this well written story. It eloquently describes the joy and sorrow in primary care. Your ability to share your honest feelings about and with patients will make you a better physician and a happier human being. Nice work.

  12. A well-observed and beautifully wrought piece, Kristie. Well done. I appreciated your observation about the easy nature of discussing the weather. Small talk is sometimes underestimated as a means for a moment’s respite.

  13. Kristie, congratulations on your first publication. I’m a writer not a medical person at all, and you have what it takes. The story is told with economy, honesty, and sensory detail. Somehow that small brush is haunting–everybody fussing over a little tube when there are such bigger questions. And yet, of course, even little tubes matter, and so do small moments of honesty between providers and patients. The “blockage” is swept aside with the “So am I” comment.

  14. Your story brings many of us to silence..something we need more of. The details and honesty with which you write is what draws us in. IT was an important story for me to read. Thank you for all you put into this piece.

  15. Thank you for a very touching piece. Do not ever lose your sensitivity to the patient. Too often medical school and residency ends up making the patient the enemy.

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