Hallowed Ground

"Baby I've been here before, I know this room, I've walked this floor, you know I used to live alone before I knew you. I've seen your flag on the marble arch, and love is not a victory march, it's a cold and it's a broken Hallelujah." - Leonard Cohen, "Hallelujah"

As I reached into my treatment bag, I felt her eyes on me. Her daughter and son were detailing the events of the night, medications gone bad, lost sleep. Her breathing was fast. "I think she has a fever." I quickly took my stethoscope, thermometer, alcohol wipes, disposable covers and blood pressure cuff from my bag and laid it out. With what I hope are always soothing hands, I felt the patient. "She's hot, that's for sure. Has she been in and out of alertness?" I mentally rehearsed the phone call to the patient's attending physician, or assistant, knowing that it is often hard to explain from the field that gut feeling that a patient is worsening and may need to be transported.

"Ma'am, your vital signs indicate your infection may be returning," I said to my patient, who by now had pulled the covers over her head. "Your temperature is elevated, your respiration is fast, and some of the hallucinations your daughter is reporting may mean that your infection has worsened and you need another course of antibiotics. You'll need to be seen at the ER, as soon as possible." "I'm not going back to the hospital. I'm not." "I'm sorry ma'am. You can't take that chance. If for no other reason than I've gotten attached to you." I tried to inject some humor into the situation. She was having none of it. And with that, I swabbed my equipment, re-packed, gave instructions to the family, and slipped out. Signs and symptoms evaluated, reported, decision made, life saved. For now.

When I got to my car, I took a sharp deep breath in, hoped for the best, and reviewed the email I had received yesterday, from the daughter of a former patient. He had passed over the weekend. Driving down the road to my next patient, I cried. Then I got it together before I walked in the door. That's the prime directive in health care: Get it together before you shake the next patient's hand. They need you, and they need you strong. In that moment, nothing else matters. Solve the problem in front of you.

I am learning to take time, because what else is there? These back bedrooms of the dying that I am in, these incredibly intimate spaces of people who were last week strangers, where nothing is hidden and there is nothing left to hide and shame is discarded because it no longer fits. This is hallowed ground. When I clasped her hand and said goodbye and touched her cheek because it felt good to her and I could do no more, she said, "I love you." "I love you, too," I said, and meant it. And this is Hallelujah.