Clinical, Featured, Palliative Care, Pediatrics
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Year One

The following manuscript was submitted to the May 2017 Mental Health Themed Writing Contest.


Author’s note: This narrative is a fictional account.

“Goddamn doctors,” says a voice down the hall, slightly muffled through the curtain of the exam room where I lay. “What now?” comes another voice and they both grow louder, batting back and forth gripes. “They make the worst damn patients, know exactly what’s wrong with them and exactly what to do and you’re not doing it quick enough.”

The voices float toward me and I wonder, “What about medical students? Why leave us overeager short-coated kids out of the equation?” Armed with just a smattering of medical tidbits, we become dangerous to ourselves and others.  The diseases, symptoms, syndromes bob earnestly at the surface of our brains, but we have no real skills yet to diagnose and treat.

That’s why I’m here. I know deep down as I lay on the table, tense from trying to conform my curved back to the rigid table beneath me, and maybe too from that nagging what if that brought me here. So I look upward, try to hook my gaze on the tiled ceiling as I did during the years of sunny afternoons spent in the orthodontist’s chair counting the tiny pinpricks and jagged lines of texture that mapped my discomfort in beige. But the tiles here are flat and smooth; my gaze slips right off and falls to my abdomen where the examination continues.

The sonographer, not unfriendly, presses the ultrasound probe against me. I picture what’s below the indented skin, the last few ribs spreading from the sternum, pairs of long oars splayed from either side of a skiff. The probe inches down my abdomen tracing the aorta whose palpable pulsations seem to worry only me, not my friends, who spend their days in cubicles and offices where no one considers even fleetingly the hardiness of their aorta, not my husband who worries about nothing large or small. They fix me with dubious silence when I mention the possible presence of an abdominal aortic aneurysm, a ticking time-bomb of the gut. They say I’m young, healthy, fine. But they don’t feel it, thumping that causes my hands to jump at night when I lay them across my belly, the beat of my inner drummer, playing punk rock rather than a jazz brush beat.

First came the war stories from older students, those already on their clinical rotations: a man brought to the emergency room with abdominal pain, crashing fast. Triple-A, the speaker said with gravity. Abdominal aortic aneurysm, another translated. Rushed off to surgery, his wife trailing behind, calling out ‘I love you’ and ‘be strong’ and ‘I’ll be there when you wake up.’ “Did he make it?” someone else asked, and I felt weak when he shook his head.

Then anatomy lab, where more than one cadaver harbored an aorta gray-pink in death and ballooned out like a snake that had just swallowed a small rodent whole. Finally physical exams, practicing pinching into the belly, moving our fingers slowly, carefully, deeply toward the center, searching for the edges of the vessel and making sure it was less than five centimeters wide and out of the realm of concern. At night in bed my hands would return to my own abdomen and dig into my skin and brush up against the edges of my own great vessel, wide, frighteningly wide, in the few seconds before they fluttered back to my sides.

So I lay here, shirt pulled up, my bare skin cloaked in the sonographer’s maddening silence as she stares at the dancing light and shadow on the screen. Finally she speaks. Looks mostly fine she says. Just need to check one thing. She leaves the room and returns with another woman wearing scrubs and a badge that says MD. She barely glances in my direction as the sonographer plops back down in front the screen, points, reinstates her probe, and points at the screen.  Yet I recognize the voice when she finally utters, “Yeah, fine, totally normal,” then turns to me and asks, “What did you come here for?” I stammer, waves of relief diluted by sheepishness at having even thought an aneurysm might be budding inside, explain that I’ve been examining patients and noticed that my pulse was so strong, got worried. I watch her eyes drop from my face to the T-shirt that I have tugged back down, see them take in the name of the medical school emblazoned there. She knows.

I’m a hypochondriac wannabe doctor, a cliché. These students, she scoffs, coming in here thinking they have everything they read about, wasting our time when we already have too many scans for one day. And I don’t know which words she delivers with her voice, which with her eyes, but I get them all and I hop off the table, scurrying toward the elevators.

A week later the phone cuts through my stack of textbooks as I hunch at the kitchen table. A second passes before I pick up the call, another before I register who it is: the man who lives in the apartment next door. He and his wife are middle-aged, new to the area, our partners in a regular exchange of polite banter and evening chats outside on our balconies, but never before voices on the phone.

Right away I know something is wrong. Don’t want to bother you, but it’s my wife, he says. I’m worried. Stomach pain, getting worse, and I wanted to discuss it with someone with medical knowledge. My mouth opens in a gentle reminder that I am no doctor, but he is faster, assuring me that he knows, knows, but still could I please just offer some advice? And I concede, because now I am worried, too. I start asking about the pain: where exactly does it hurt, when did it start, does it spread anywhere?

Triple-A flashes in my mind and I quash it just as quickly. The wife is older than me, yes, but she is not male and not a smoker. Hypertensive? I assume not. I am determined not to fall into the trap of picking the answer most recently on my mind, will handle this logically, as a competent professional. I run through my standard list of questions about pain, searching, hoping to latch onto a telltale symptom. But nothing is specific, nothing points unequivocally to any of the problems that swirl in the medical pool where I have just begun to dip my toes. I offer one last question, any back pain? He says, actually yes, there has been some, and again I think of a rupturing aneurysm of blood spurting everywhere, inside, bathing all the organs with its spray, painting the town red. But my pride still smarts from my over-worry about my own aorta; I will not make the same mistake twice.

I’m not sure, and I tell him so. You could take her to the ER, I say, make absolutely certain it’s nothing and maybe get some medication for the pain. But on the other hand, you risk wasting your whole night waiting there, sitting in a cloud of sick. So maybe not, I say, maybe wait and see if it gets better. If it gets worse, then you can go. Yes, he says, this is good advice, thank you. I hope she feels better, I say, because banal pleasantries are all I have to offer.

I can’t seem to settle back into my studies, so I make my way to the car and point it toward the grocery store. By the time I return, my husband’s car is there and he meets me at the door, distress carving lines I’ve never seen in his face. It’s the woman next door he tells me, she was in so much pain they called an ambulance. I saw them take her on a gurney, working on her, him running behind crying. Never hear a grown man wail like that. My hand is at my mouth in disbelief and it won’t let out the words I want to scream: what happened, how is she, is she okay. He sees my questions scrawled in the humid air and says he doesn’t know anything more.

The sun goes down and we move to sit on the balcony with beers, books, small talk as is our custom, yet somehow it feels wrong. Inside we set our drinks on the table, settle on the couch, then hear a car door slam. In synchronized silence we move to the door. He stops short as I move to slide it open and his hand closes over mine. I look down and take in the stoop of our neighbor’s shoulders, the shuffle-slap of his feet as he moves slowly — so very slowly — across the pavement. I relax my grip on the door, wrap my fingers around his, and hold them tight.

Rebecca E MacDonell-Yilmaz, MD, MPH (2 Posts)

Fellow Physician Contributing Writer

Rhode Island Hospital/Brown University


Becky is currently a fellow in pediatric hematology/oncology at Hasbro Children’s Hospital/Brown University in Providence, RI. She completed her residency in pediatrics and fellowship in hospice & palliative medicine at the same institution. She received her BA and MPH from Dartmouth College and her MD from Stony Brook University School of Medicine. Her work has been published in Pediatrics, Annals of Internal Medicine, Journal of the American Geriatrics Society, and The Huffington Post, as well as on the blogs Kevin, MD and Mothers in Medicine. Her personal blog is entitled The Growth Curve (www.thegrowthc.com). She lives in Rhode Island with her husband and two sons.