I do not look at the chart before I go into a room. I walk in cold. I enter with no idea who is going to be in there or why. In that very first second, before anyone speaks, I try to guess what the story is, who the people in the room are, and why they are in my emergency room.
Here-maybe it would make more sense if I showed you.
I draw back the curtain and step into Trauma Room Two. My eyes scan quickly about, gathering as much information as they can.
There are three people in the room.
For a brief second, I intentionally do not look at the patient lying on the hospital bed, not yet. Two people accompany the patient, a man and a woman. The man sits on a hard plastic chair pushed back against the room’s wall, staring quietly ahead. I start with him. I know if I can just look closely enough, the story is there.
I study him. He is in his late forties. He wears a jet-black business suit. The fine fabric lies starkly against a bright, white, collared dress shirt. The dress shirt is pressed and starched and clean. He shifts slightly in the chair, and the red silk tie around his neck catches the light just so, drawing my eye to it. Small square gold icons fill the tie in an exact and set pattern. The knot at the top is tied with perfect precision and symmetry. This means something. I look more closely.
On his left wrist, he wears a Rolex. The bands are polished silver and cradle an oyster-white face on which three hands mark the time, the smallest of which ticks along, second by second by second. The outside of the watch face is meticulously trimmed in gold and clearly asserts to all who see it that this man’s time is expensive.
As I observe, he moves his wrist a fraction of an inch, and the whole thing explodes into shimmers, sparkling magnificently from just the weak fluorescent lights overhead. It dawns on me that his watch alone costs more than the car I drove to work this morning. I cannot help but think, “This man is nothing like me.”
I have learned I have to be careful with people like him. A single misstep in our interaction can easily result in a long string of complaint letters. But it is OK. I have done this enough that it does not frighten me or anger me or even annoy me. It is just a dance I have to be conscious of in this room. I make a mental note to be careful, and then continue my study.
Atop his head sits black hair with just a dusting of silver—executive hair, I believe it is called. It is thick and full and glowing with virility. Every strand is carefully combed into place. His hair shines nearly as brightly as his watch.
He lifts his head just slightly to look at me, and I notice a tiny cluster of hair is out of place. Just above and behind his left ear, the small bunch breaks from the linear strands around it, twisting up in disarray. It is not much, but it is there. On a man like him, it is nothing and everything at the same time.
Something is wrong.
His face is clean-shaven, the skin healthy and bright. Two black, sharp, crisp Italian eyebrows sit above pale blue, intelligent eyes that read me in a glance, as quickly as I read him. A strong jaw cuts the angle of his face into the space of the room around it. He does not need to smile for me to know his teeth will be perfect and symmetrical and white.
Under each eye hangs a faint dark circle. He has not been sleeping well. I am guessing, of course, but it looks to be more than just work fatigue. Perhaps a struggle outside of work has started to spill over into what must be an all-consuming drive for achievement. Or perhaps it is nothing other than the tracks left on him from another successful merger. I cannot tell—not yet.
It is strange to see someone like him here, even if he is just accompanying the patient. I am an ER doctor in a small emergency room, in a small hospital, in a small town, in the middle of nowhere. I can’t help but wonder how a man like him ends up in an ER out here so far from the city. He does not have the look of someone who has come to hunt or fish, and he is definitely no wheat farmer. But something has pulled him here from far away, something that could not wait. I look closer.
The lines, curves, and circles of his face come together into an expression that is hard, at first, for me to read. I can sense he is a master at controlling what his face reveals. But my job is to read faces and bodies as well as he reads the stock market. In the curve of his mouth, I read frustration. In the angle of his brow, I read anger. In the tilt of his head, I read even a trace of fear.
But there is something else—something he does not want anyone to see. He hides it so well, after so much practice and time, I almost miss it. In fact, I am sure I would have missed it when I first started out, 41,422 patients ago. But that was then.
There, like a single, delicate, fleeting strand woven through a cloth of steel, is a tenderness and a sadness. What it is doing inside a man like him—I cannot comprehend. I can see why he wants to—no, why he has to—hide it in his world. He works to obscure it in the glint of his eyes and the shine of what must be a string of brutal successes. But still it is there.
Now that I see it, I see it clearly. It has blindsided him like a flash flood in the spring, sweeping him off his feet and tossing him down a canyon from which he cannot escape. He is drowning in this maelstrom of sadness, and no amount of money, power, or rage against the universe can make it abate.
An empty chair sits next to him.
One chair over is a woman.
She is slightly younger than the man.
I cannot see her face; her body is turned partially away from me.
She is resting her elbows on her knees, looking at the screen of her phone. She cradles it lovingly like a newborn. Marvelous red nails stand out against a white-and-gold iPhone. Her fingers are long and elegant like those of a famous pianist or a brain surgeon. She taps and slides the icons on the screen with elegance, as if they are servants being sent to do her bidding.
Her forearms are bare and hairless, but it is her biceps that stand out. They are small, solid, and precise, like an exclamation point stamped onto each upper arm. Biceps like that shout yoga, Pilates, personal trainers, green smoothies, and a lock on the bathroom door after big holiday meals.
Long brown hair is pulled back into a ponytail that falls gracefully to the middle of her back. A small silver clasp studded with diamonds traps the hair behind her head, holding it in place. It out-shimmers even the man’s Rolex.
She wears a light gold, silk shirt. There is a cutout in the top back of it. I can just barely see her upper spine under the skin. Each vertebra makes a small bump in the arch of her lower neck, and each one is the exact same distance from the one above and below it. There are no outliers, no overly large or overly small bones. Each rise in her skin is exactly the same size and distance from the other. Before this moment, I did not realize bones in a back could be so flawless.
The skin over the bones is a rich, deep tan. It glows from her vegan diet and vitamin regimen. As she taps her finger on the phone, little ripples appear in the muscles of her back. I cannot help but stare in awe of such royalty stopping in our humble town.
She, too, is obviously nothing like me.
On the floor by her feet sits a purse. Its handle is a bent half circle of bamboo attached with gold and silver clasps to the bag below. The bamboo is polished and smooth. The wood is a blend of browns. A creamy white winds through the handle, somehow offsetting the dark tones and grains of the wood.
The purse itself looks to my unsophisticated eye not unlike the color of a wet pack horse after it has crossed a deep stream. It is a different shade of brown from the bamboo. It is like no brown I have ever seen before. As I look more closely, I see it is a bright, full, radiant brown that I can only compare to the soil on the edge of town in the spring. Soil that is freshly turned and waiting for seeds to spring up from it with life. Silver clasps and bamboo buttons adorn the purse in a perfect harmony of style. But there is something else—something that strikes me as oddly awful, something that should never be.
The purse has fallen over. The perfect brown of its side rests against our faded linoleum floor. Its contents spill out under the chair, untouched.
My second is almost up.
Now, at last, I turn to the patient.
A man lies on the bed. The pointed toes of scuffed cowboy boots stick up like two sharp rocks in a field. Straw and dirt pepper them and have shaken off onto the sheets. A pair of old blue jeans covers the top of the boots. They, too, have brought pieces of the farm and fields into the ER.
The man is supposed to be in a hospital gown. All our patients are. But more often than not, men around here will refuse to take off their boots and jeans. Sometimes I walk into rooms, and cowboy hats still sit perched atop heads. It is just part of living in this corner of the world.
The thighs of his jeans are faded where he must wipe his hands when in the fields. He must be right-handed, as the right thigh is faded much more than the left. A thick, worn leather belt with a buckle the size of two fists holds up jeans on a waist that is much too skinny.
The belt buckle is a flat grayish silver with an image stamped onto the front. A bronco bucks wildly, and a cowboy on top holds on with one hand strapped snug to the horse and the other in the air for balance. His hat is spiraling off his head into the air above him. “Pendleton Round-Up Champion 1942” is etched across the top, and the words “Let ’Er Buck” are below. In an odd way, I realize he, too, is nothing like me.
The man lies shirtless on the bed. The hairs of his chest are gray. A tattoo of marines raising the flag at Iwo Jima is inked just above his heart. The whole tattoo moves up and down with his gasping.
I look to his face.
It is tired and worn and ready to stop fighting. I see that multiple rounds of chemotherapy have taken all his hair, leaving behind nothing but eyebrows. His skin sags, and there is no light remaining in his eyes. They stare blankly ahead. Drops of sweat gather and cluster on his brow as I watch. The end is near.
The man and the woman stand up to join me at the bedside. The woman stands on one side, her diamond-clad hand gently resting on the old man’s shoulder. The man who came with her stands on the other, his strong fingers lovingly resting on the thick skin of the old man’s sunburnt neck.
I look from face to face to face, and I am surprised to see tears falling on every single one. The tears roll past similar noses, shared chins, and pale blue eyes. The pieces fall into place before me.
A daughter and a son have come home to say good-bye to their father.
I watch as the brother and sister sit down on either side of the bed. The old man, still gasping for air, suddenly sees them. With a struggle, he lifts his arms. The brother and sister lean in against their father. He lowers his arms across their shoulders as if they are still children. They rest their heads against his, curling up against his bony frame while he pants and waits for the end.
Standing before them, it suddenly hits me.
I have made a terrible mistake.
They are all just like me.
Philip Allen Greene is an Emergency physician based in Walla Walla Washington. He is the author of the “Trauma Room 2,” a fictional account of life in an American hospital based on his experiences as an ER doctor.