The Edge

Isaac de la Bruere '22
Isaac de la Bruere ’22

Written by Isaac de la Bruere ’22

A river of sweat is slowly trickling down the small of my back, gathering tributaries from the rolling hills formed by my scapulae. My collared shirt is damp in several areas, even though I have an undershirt on today. The heat and humidity are unforgiving at this time of day. I adjust the stethoscope around my neck as we walk into the intensive care unit (ICU). A blast of cool air greets me. There are fourteen beds, each one supporting the form of a human being in various states of consciousness and positioning. There are no individual rooms, or even curtains between the patients. Only intravenous stands and banana bags of medications and saline.

We approach the patient we have come to examine. His chart reveals concerning lab results. It is clear that his marrow isn’t producing cells effectively and that he is life-threateningly anemic, but it isn’t clear why. As we near his bed I see scleral icterus, or yellowing of his eyes. There are no friends or family to be seen.

My eyes dart to the screen situated by his bedside displaying his vitals. His heart is beating at 117 beats per minute—compensation for the lack of available red blood cells to carry oxygen to his body, and he is respirating at a panicky 38 breaths per minute. He opens his eyes as we take our places around his bed. It must be a strange scene for him: four foreign doctors staring down at him and speaking solemnly in unintelligible phrases. We attempt to ask permission to touch him. He slowly lifts up his shirt. He doesn’t know what we want, but he seems to have an implicit trust in the mystique of our English and the glow of our bright white coats. Doctors are revered here, and foreign ones often more so.

We check his conjunctiva and the palms of his hands—all ashen-colored. Textbook signs of severe anemia. We listen to his rapid heartbeat and the murmur, which our preceptor says is the product of turbulence generated by his lack of circulating blood. It’s my turn to sound for his liver, which I do by scratching on the patient’s abdomen and chest with the bell of my stethoscope pressed to his belly just under his ribs. Even I can tell the liver is swollen.

Finally, our teachable moment is ending. We thank him in Thai and wai him. I follow the urge to put my hand on his shoulder and squeeze his fingers. I want him to know that he is not just a lesson for people in white coats from a distant country. I want him to know that I am praying for him to get better. He smiles and nods his head, and for a moment the solemnness of the moment melts away. I follow my group out of the ICU. It’s only when my preceptor says that he hopes the kid makes it that I realize I might have just interacted with a dying man. That the touch of my stethoscope on his chest, my fingers searching his ribs, my hand clasping his while I thanked him for allowing us to learn from his body—all of these fleeting moments might be part of the last things this 25-year-old son, brother, father, cousin, friend, mentor and human being would experience in this life.

As future doctors, we swear an oath to do no harm; to shield people from death and injury as long as we can. The man we had just met was standing on the edge, and for those brief moments we stood there with him. And it dawned on me that this was both one of the greatest responsibilities and greatest privileges of a career in medicine.

Read more posts from the UVM Larner College of Medicine/Nuvance Health Global Health Program on the Global Health Diaries.

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