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What Lies Beneath

What Lies Beneath

Changing Places

The Truths of Being a Patient

Johnston, Michelle MBBS

doi: 10.1097/01.EEM.0000657652.27171.54
    doctor as patient

    Recently I had the occasion to explore the patient's perspective a little more intimately than usual. Like so often, it is the experiences we do not want that offer us the greatest education.

    I fell sick not long ago. Quite sick. The sort of sick that won me lines and drugs and wristbands and blood pressures at two in the morning. The sort of sick where the thought I might not recover came screaming into my hallucinating head in the coal dark of night.

    “Will I be OK?” I asked my doctors. “Absolutely,” they said. In The English Patient when Katharine asks Almásy whether they will be all right, he says, “Absolutely,” but she says, “‘Yes’ is a comfort; ‘absolutely’ is not.”

    The problem, of course, with being a writer is that it adds another dimension to the way one experiences things. It brings the whole thing up threefold. The first is in the reality of it all: the happenings that must happen, the medicines, the observations, the merry-go-round of meals that are missing the merry.

    The second is understanding as a doctor what we put our patients through: the words we choose, the connections we forge between caregiver and patient, and the chance to observe the way the imprecise nature of medicine and pathology leads to thousands of possible decisions, with so few of them black and white.

    The writerly third, however, is where you really get to explore things because writing is simply paying uncanny attention to things, events, sensations, meaning. It is the uncovering truths by noticing the tiniest details. And, oh, were there a lot of details to notice.

    Disembodied Heads

    The strange phenomenon of febrile hallucinations for a start: disembodied heads in carefree conversation with each other, ignoring me entirely. This was the delirium of raging cytokines and bacterial toxins and synapses in reactionary panic. Why did my brain do that? I wondered if it were the two grams of ceftriaxone being pumped into me daily. I worried I wouldn't have a bacterium left alive in my body or perhaps just a few hardy souls, loyal to the resistance, hanging on white-knuckled.

    I know we contain multitudes. Humans are nothing without bacteria; we have more of them than us. I wondered if I would be more human now? Would I lose weight from the great biomass extinction? Where had they all gone? Had the last good ones abandoned their posts guarding my blood-brain barrier like centurions, leaving me a little loopy?

    I also learned that I was troublesome to get drips into. I'd always boasted about having good veins as though life was a kind of vessel contest. Turns out I was wrong. I would apologize endlessly, saying “I must have unusual valves or something,” and reassure those who came at me with tremulous hands and ever-smaller cannulae that I would be the Empress of Hypocrisy to be critical of a few missed drips. Digging with long, sharp, cold metal through febrile skin is searing, though, and your body remembers the trajectory of the attempt, like keeping the score.

    A Good Purge

    I had my first CT scan. The sensation of contrast filling your throat as it enters your veins is like a warm drowning. Blessed are those who warn their patients this will happen. Bacteremia somehow focuses behind your eyes, stretching your optic nerves. You don't want to look anywhere but straight ahead. I'm a train, you think, just keep rolling forward.

    Fluid shifts are peculiar. Some parts of you get pudgy while your lips and tongue become so desiccated that they stick together, making your words come out funny. Food tastes like ash, IV pumps scream for attention all night (they are needy beasts and do not want anybody to sleep if they don't), your mind begins to narrow and can think of little but what is going on between your four gruel-colored walls.

    So many other details: the opioid anesthesia of daytime TV in every room seeping into everybody's brain, the vulnerability of the hospital gown, the conversations your team have outside your room, discussing your electrolytes and trends and immunological cascades as though these things weren't intimately part of your complex human existence, and the almost magical power of gratitude.

    Because, of course, this was the mightiest. I made several Faustian bargains while on the inside. I looked at my life in context during this unexpected topple from being invincible to being tiny and dependent. And, no surprise, my promises were no different from any others' in that situation.

    Illness like that focuses the mind, gets rid of all the extraneous stuff like a good purge. Family, loved ones, doing good, being a better doctor, finding ways to be kind in every single moment, taking nothing for granted, finding a way to wall off the rage I feel at the horrifying injustices in the world as though I, myself, am an encapsulated bacterium, living—yes, a cliché, but, oh, so true—in the glory of the moment of this short, terrible, terribly funny, ridiculous, joyful world. Oh, and buying one's nurses chocolate.

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    Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novel Dustfall, available on her website, She also contributes regularly to the blog, Life in the Fast Lane, Follow her on Twitter @Eleytherius, and read her past columns at

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