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Tall Buildings

Dreading going in there. Know what you will say.  Your pain will be a ten out of ten. When I ask, “How are you?” you will say what you always say: “Terrible.” Your face will be a twisted snarl and you’ll cut your eyes so hard at me that I almost bleed.  I’ll ask you what can I do for you and your answer won’t be reasonable.  Or at least attainable.  That’s why I dread going in there.

Your family is tired. I have decided that they are tired because the only alternative explanation to them not coming to see you or see about you or call you or call about you is that they don’t care. I don’t like that explanation so instead I have decided that they are tired.

Tired of the exhausting marathons that you keep running in circles inside of your own mind. Tired of the short-lived glimmers of normalcy that you sometimes offer only to be smacked back into the reality of your never-quiet mind.  Tired of fighting you and fighting the bureaucracy of how to get you somewhere safe with virtually zero resources.  I know they are tired. Because it’s only been less than two weeks for me. And I’m tired, too.

And so each day I stand before your door on rounds. Secretly wanting to just keep on walking. Shadow boxing in my mind to get over my tired. And over my dread. And over my anger with my hands being tied snugly behind my back and, on some days, your hands being tied snugly down in restraints for your own safety. Your mind a cacophony of voices and poisonous thoughts that win over me and my little bag of internal medicine tricks. I don’t know what to do.

And so on this day, I just start with what my Mama always taught me.

“Good morning.”

“Hello.”

Something is different. Today, no scowl or lancinating eyes. Instead, you reach your hand out towards me. At first I look at it suspiciously, wondering if you intend to grab at me or shoo me away. I see the wrist ties near the rail of your bed from the corner of my eyes. But all you want to do is hold my hand. I am part surprised and part ashamed.

Hold my hand?

Me? I didn’t see that coming. Me? I was all business. There to just listen to your chest leaping with every thump of your dilated and failing heart, to interpret your engorged neck vein pattern, to look into your mouth, to inspect your swollen legs, and to review the orders. And in the midst of it all, to stand there taking your hand slaps and refusal to cooperate while sifting through my brain for a reasonable treatment plan marrying a terrible, end-stage medical problem to a slippery and elusive psychiatric illness.  With no money. And no family.

See? I was shadow boxing to be able to do that. Not hold your hand. You catch me off guard. I stop my busy-ness and let you hold it. I wag my finger at myself and say, tsk-tsk. Your patient is sick, Dr. Manning.

But I knew that before I came. Yet still, I felt tired. I feel your trusting palm, resting in my own. I sit beside you on the mattress and envelope it with my other hand. The room falls quiet as our feet dangle off of the edge of the bed facing the Atlanta skyline. I remember in that moment how beautiful it is. Especially from this room.

“Doctor?”

“Yes?”

“You can see the buildings all the way across town from this window.”

“Yeah.”

“The Marriott Marquis. And behind that is Bank of America.”

I look.  “You’re right.”

“How did they make such tall buildings?”

I pause for a moment, pondering the answer to that question. I’m not exactly sure. “I think they do it with cranes and big equipment. And people who aren’t afraid of heights.” I smile and for the first time in two weeks, you smile, too.

“I’m afraid of heights.”

“You are?”

Your smile dissipates and your expression grows distant.

“I am afraid. What will become of me? I am so afraid.”

You look at me with eyes so sane that I forget all of the diagnoses that compete with believing them. Your fingers tighten around my own. I feel more ashamed for shadow-boxing and dreading seeing you.

“Doctor?”

“Yes?”

“I’m tired.”

“I know.”

I sit in silence, rubbing your veiny and weathered hand. I’m tired, too.  We both breath in synchrony, yours more laborious from fluid, mine affected by growing emotion. I stare out of the window at The Equifax Building, the shiny cylindrical Westin Hotel, and the skycraping Georgia Pacific building.  Suddenly my eyes sting and my face feels warm. Because you are trusting me to help. I want to leap from one of those tall buildings with a single bound to save you.  But I can’t. Sometimes even when I want to, I can’t.

I’m not sure how they build those buildings. I also don’t know how to save you. My wings are tied and clipped. So are yours.

On this day, I will start by simply holding your hand. And shadow boxing to keep myself from giving up on you.

Kimberly Manning, MD, is an assistant professor in the Department of Medicine at Grady Memorial Hospital in Atlanta. As both a clinician and educator, she teaches pre-clinical medical students and residents and serves as residency program director for the Transitional Year Residency Program. She blogs regularly at Reflections of a Grady Doctor.

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