“Just give me some chest pains,” I silently implored, hoping the hospital admission gods heard my appeal. Before long, the familiar beeps of my pager rattled me back to reality—A new admission was heading my way. It was the last day of my subinternship, and, of course, I was on call.
“You've worked up syncope before, right?” My resident smiled at me; even he realized today was my last day. “This one sounds like it's straight out of the book, she'll go home tomorrow.” My experience on the wards had taught me that there is no such thing as a “textbook case.”
I entered Mrs. Ross'* room and was greeted by an elderly woman, clutching her rosary beads, deep in silent prayer. As I delved into her history of present illness, I quickly realized that individual patients can make a “typical” case anything but routine.
I began my interview. “What brought you to the hospital today?”
“I am here because God deemed it so.” Was that her chief complaint?
“Before you fell, did you feel the room spinning?”
“All I could feel was my Guardian Angel's presence.” Did I just rule out vertigo?
Besides observing her unrelenting faith, I also identified orthostatic hypotension on physical examination, allowing me to breathe a sigh of relief. “Fluid resuscitation and she will be back on her feet with a discharge summary in hand,” I thought. Comfortable with this diagnosis and treatment, I returned to Mrs. Ross' room to perform a mini-mental status examination.
“Mrs. Ross, I'm sorry to interrupt your breakfast. Do you mind if I ask you a couple of questions?”
My experience on the wards had also taught me never to come between a patient and her hot meal.
With a sigh, she graciously accepted. However, I soon realized that this would not be the textbook mini-mental I had read about and memorized. Mrs. Ross never took her eyes off her slowly cooling French toast.
“Can you remember the three objects that I asked you to recall?”
Her fists clutched her rosary, and she looked towards the heavens. Her eyes closed. “Oh, Guardian Angel! Guardian Angel, please allow me to remember those three words. Or, at the very least, make this kind young man leave my room so that I can eat my breakfast while it is still warm. I am not asking for a miracle.”
Her prayers were dutifully answered. I thanked Mrs. Ross for her time and returned after her French toast was done, making sure to arrive before her lunch did.
The hospital experience can strip a patient of the familiar comforts of the outside world. A hospital bed never can match the comfort of the patient's bed at home. Notions of privacy are shattered, as strangers ask for blood and urine samples. Home-cooked feasts are replaced with cafeteria meals. The least I could do was allow her the familiar pleasure of a warm meal!
As I walked home, I realized that I missed the hustle and commotion of the wards. There was beauty to be found in the chaos—you just had to look for it. A textbook case of orthostatic hypotension had the power to humble me. My memories of orthostatic hypotension forever will be intertwined with those of Mrs. Ross; orthostatic hypotension now has personality, faith, charm, and wit. I smiled as I thought of Mrs. Ross. She taught me that miracles come in all sizes; it just depends on how you define them.
Vikram A. Padmanabhan
Dr. Padmanabhan is an internal medicine resident, Massachusetts General Hospital, Boston, Massachusetts, and a recent graduate of the Albert Einstein College of Medicine, Bronx, New York.
