CHAPTER 2: To Leave or Not to Leave?

“Never really said too much
Afraid it wouldn’t be enough
Just try to keep my spirits up
When there’s no point in grieving”
“Light On” by David Cook

It was a Friday morning on Nov. 21st, 2008 when I woke up feeling exhausted. “Of course I’m exhausted, I’m a medical student on a surgery rotation” I thought to myself, “all med students are exhausted right?” I slowly dragged my body out of bed, and looked in the big square mirror I had leaning against the wall in my room (because I had no one around to hang it on the wall for me). Why is my face looking puffier today? DAMN! My face is swollen! I examined my reflection in the mirror more closely and saw that my lips and eyelids were especially swollen to about twice their size. I sat on my bed and started crying. Now, the tears were not just because I saw my face swollen. It was a multiple of factors that caused me to cry that morning, one of which was fear, because I had no idea what to do. Should I still go to work? Should I call in my attending and take the day off? But then what? I will be trapped here in my apartment alone not knowing what was wrong with me. So I finally decided to attend the morning lecture for students/residents, and maybe ask some of the nice interns for their advice or see if they have a doctor that they recommend for me to go see.

Thankfully, after washing my face and applying some makeup my face looked more normal, but I was sure people would still notice (or at least I could easily tell it was not my normal face). I made it to the hospital and kept my head down while I walked to the elevator; I did not want to scare anyone with my abnormally puffy face! I still secretly hoped one of the interns or students would notice though, so they could help me decide on what to do. As I was waiting for the elevator, one of my favorite interns came with his breakfast in hand. He greeted me and immediately followed that with “you look tired today Nancy.” well no kidding! By the way, this is one of my favorite statements to hear from people (sarcastically speaking). It is usually a nice and polite way of saying “you look like hell today” or even, “dear God! what made you think you should come out in public today!” Anyhow, today I was glad I received that comment, because I took it as my opportunity to tell the intern what was going on and ask for his advice. (I will refer to this intern from here on out as Dr. Fine).

After all, I was scared. I felt alone, and I did not have my family and closest friends around to run to for help. No, I was on my own in Florida, after I had made the unwise choice of moving down here to do my third year rotations leaving everything familiar behind. I thought it would be an exciting adventure…Living somewhere new, meeting new people, and being so close to the beach! However, I should have listened to the saying that “home is where the heart is.” I had left my heart stranded, confused, and divided somewhere between Georgia (and the south) and Arizona, and because of that reason I never felt at home in Florida-not even for a day! In fact, I was counting down the days to when I would leave that wretched place.

After listening to me, Dr. Fine suggested that I talk to the doctor who was actually giving us the lecture that morning. He also reassured me that whether it’s an allergic reaction or something else then I will most likely just be given some steroids to bring the swelling down. My other option, Dr. Fine said, would be to go down to the hospital’s ER and just talk to the ER doctor there after lecture was over. I liked the second option better mainly because I knew all the ER doctors and staff since I had already completed that rotation months earlier.

Lecture was torture that morning (even more so than usual); I do not remember paying attention to any of it. I just wanted it to end so I could leave. One of my friends sat next to me, and asked me what was wrong; when I said “nothing I will be ok” she replied quietly “yeah right!” But she let it go, probably sensing that I did not want to talk about it then and there. Honestly, I was just feeling vulnerable that morning, and I was sure that if I tried to talk about it I was going to break down into tears, which was something I wanted to avoid at all costs. I also hate the feeling of not being in control, and that day I could tell that I was not in control of anything!

Lecture over. I take the elevator down, this time with another one of the nice interns (whom I will call Dr. Blessing because of all her help to me that morning). She too asks if I was tired or something along those lines. Man, I must have truly looked terrible that day! At any rate, this time I could not hold it in anymore, and I started crying right there in the elevator as I explained to her how I had no idea why my face was swollen, and I did not know if I really wanted to go to the ER or not. Dr. Blessing immediately said that she will come with me to the ER and talk to the doctor herself, and that I should not worry. I cannot express how much I appreciate what she did for me, but from that point on that day in the ER she pretty much took care of everything I needed. She stayed with me until I left the ER at 11:45 AM (keep in mind, that Dr. Blessing had just ended her night shift at 7AM…went to morning lecture…and was probably ready to just go home and crash in bed by the time lecture ended at 8:15AM! But she refused to leave me despite my many attempts later on at telling her that I was ok.)

Once I made it to the ER with Dr. Blessing, things moved pretty fast. We both talked to one of my favorite doctors, who thankfully had the morning shift that day (Dr. Comfort). He thought that I did not really need a neck CT scan since he suspected it was just an allergic reaction, which was what I thought as well. I had been on my surgery rotation since the beginning of November, and I had to scrub in multiple times a day, so I explained to him that maybe I was allergic to the scrubbing detergent or gloves or…?

However, that morning I had also noticed my right neck vein was visibly distended. This was the most concerning thing to me, and I did not see how it could be explained by a simple allergic reaction. So upon the insistence of Dr. Blessing and me, Dr. Comfort ordered the neck CT scan.

While we sat waiting for the CT tech to come get me, I was joking around with Dr. Blessing about how I am going to end up having a brain tumor or some kind of weird case that they can present later on at one of the morning lectures. You see, paranoia and hypochondriacism are the two most common traits among the oh-so-intelligent human breed of medical students and residents. Well, as it turns out I did not have a brain tumor but I sure did have a tumor ha! Ok universe, lesson learned…I will never ever joke about things like that anymore, or will I?!

Shortly after the CT scan was performed was when I found myself standing in Dr. Melodrama’s radiology room. He had so graciously agreed that I be present in the room while he read the scans, and he treated me more as a colleague than as a patient. I realize that it was an exception he made for me since I was a med student, and I thank him for that.

After the finding of that nasty anterior superior mediastinal mass (which basically means a tumor/mass in the area behind the breastbone and above the heart)—things started to get more ridiculous. All I wanted to do was get on the next available plane and fly home, but Dr. Comfort was concerned and did not want me to leave the hospital. Something else had showed up in my scans that Dr. Melodrama read as a thrombus in the left neck vein (thrombus = blood clot). Dr. Comfort was explaining to me the risks of flying while having a blood clot that could dislodge at any second, and go to my brain causing some serious damage (or what we call in the medical field a stroke!) Of course I knew all of that, but I did not care; I wanted to go home to my family as soon as possible. I did not want to be admitted to a hospital in Florida, and certainly not THIS hospital where I knew practically half the medical staff.

I could see it in Dr. Comfort’s eyes that he really did not want to let me go, he was worried about me almost like a father worries about his daughter. However, I was his patient, and patients have autonomy. It is this autonomy that allows patients to leave the hospital AMA (Against Medical Advice) by signing a paper indicating that they have listened to the doctor’s explanation of why it is necessary for them to stay in the hospital and what the risks of leaving are, but they still choose to leave at their own will. That was what I chose that day; I decided to leave the hospital AMA…

But when Jesus heard this, He answered him,
"Do not be afraid any longer; only believe, and she will be made well."
Luke 8:50