Clinical, Featured, Internal Medicine
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The Doll

No one had told her how difficult the fight after COVID would be. It swept through New Orleans’ African-American community like the infamous tempest, and few had lived to tell the tale. Precious few people had expected her to survive at the ripe old age of 86.

But New Orleans is resilient, and so is she.

And here she sits, upright in bed and COVID negative, breathing perfectly normally and gazing owlishly up at her doctors. She is slightly demented and isn’t fully oriented to her surroundings, as usual, but is pleased to have visitors. She doesn’t know that the doctors look at her with somewhat preoccupied eyes, knowing that she is waiting for acceptance to a nursing home and ready to move on to the next patient.

Three days later, she is still in the hospital. Her body, so weakened by the virus from days of lying in a hospital bed, cannot bear the burden of working with physical therapists. She no longer qualifies for skilled nursing and case management is struggling to place her in a custodial nursing home. She is dimly aware that she is in the hospital and was very sick — but something feels off. Did she just get to the hospital yesterday? Or was it months or years ago? Her mother died recently, she tells the doctors plaintively as her eyes brim over with tears at the memory. Are you sure? Yes, she replies uncertainly. That must be right. She knows because her sister came by yesterday to cheer her up and brought her childhood dog. The doctors look at each other skeptically — visitors haven’t been allowed on the wards for weeks.  They try to re-orient her and help her feel more comfortable being in the hospital.  But how can this sterile hellhole of confinement, where she is somehow completely isolated but has no privacy, even compare to her own home? 

The doctors first notice her doll two days later. She cuddles it in bed as a nurse feeds her an Ensure (she likes the strawberry ones). Her legs hurt terribly and she is tired of the constant lights in her room, the unrelenting beeping of the IV pole, the frequent sounds in the hallway that make her afraid that an intruder is about to enter her room. She can’t remember how long she’s had the doll, a freckled thing with blond braids in a dingy red dress. Sometimes she calls it Stanley, sometimes she just calls it “her baby.” Regardless of the name, the doll is a welcome, familiar piece of home in this stressful new environment. Suddenly, she feels her body start to slide down a precipice and she screams in fright, clutching her doll like a lifeline. The doctor tries to tell her that she’s only elevating the head of the bed to help her drink better, but how can that be? She seizes the doctor’s hand, eyes wide with terror, and all she can say is, “Don’t let me fall.”

After another two weeks, her surroundings hold little interest for her. She was moved to another room recently — for more sunshine, a nurse tells her cheerily as she comes in to give her morning medicines. It’s nice, she supposes, but they lost her doll during the move. She takes an indifferent sip of Ensure. Her meal tray untouched, she paws forlornly out of habit at her side, at the place where her doll should be. She drifts dispassionately on the incessant stream of visitors that float in and out of her room — physicians, nurses, social workers, physical therapists. She blandly accepts their updates and requests: Let’s try to take our medicine. Try to drink some shakes for us so you can gain back some weight, okay? We’re still having trouble finding a nursing home for you to go to, so just sit tight for us, okay? She meanders through the haze of physical pain, the ignominy of losing her home and independence, the mental debility that keeps her from fully recognizing the family members who she misses in her heart of hearts. She doesn’t know that a nurse is calling the doctors right now saying, “She used to take off her clothes and try to wander the hallways … but now she just kind of sits there.” She doesn’t know that the virus has completely shattered her mental baseline and that her doctors are watching her slowly slip away into herself, into what they know to be end-stage dementia.

She’s gazing out of her window with unseeing eyes when the doctor enters her room and hands her a new doll. As she regards the caramel skin and strokes the dark curls — so much like her own — a glimmer enters the eyes from which the virus had stolen all warmth. “She’s beautiful,” she exhales, and a fleeting spark of pure childish pleasure animates her face. And for the first time in weeks, as she embraces the doll tightly to her bosom, her face is alight with something akin to peace.

Image credit: skylight by Dean Hochman is licensed under CC BY 2.0.

Kshama Bhyravabhotla, MD Kshama Bhyravabhotla, MD (2 Posts)

Peer Reviewer Emeritus

Tulane University School of Medicine

Kshama Bhyravabhotla is a Med-Peds intern at Tulane University in New Orleans who is passionate about underserved patient care and teaching. When she's not at work, she can be found watching Atlanta sports, discovering good street art and live music, and alternating between eating her way through the city and running the calories off.