It was a difficult lumbar puncture. After multiple unsuccessful attempts to tap her spine and draw out any cerebrospinal fluid bathing her spinal cord, I patted the patient on the shoulder. “I’m sorry. I need to ask for help.” She nodded and kept a brave face despite the half-hour of anguish I’d put her through while my needle scraped between crusted bone trying to slip in and suck out a few milliliters of fluid. She had come to us already with terrible pain in the back and legs and a curious radiographic image, but there is only so much technology can tell us, and cerebrospinal fluid discloses secrets an MRI is blind to.
We ratcheted the bed up high. The patient was repositioned from lying on her side to sitting up with her legs slung over the bed, slouching forward with her feet on a chair, pushing her knees into her abdomen. To prevent her from tipping forward and off the bed, the senior resident kneeled in that same chair and embraced her. Behind her, the physician assistant traced the patient’s spine with iodine, numbed it again and began to sound her back with an extra-long needle. I managed the bedside tray, passing medications, syringes, new needles. With the early morning light through the blinds, we must have painted a busy Renaissance scene.
I had never seen a patient and a doctor embraced so awkwardly for so long. The senior resident’s legs were flexed up behind him against the back of the chair, and his knees were pushed widely into the seat straddling the patient’s feet. He was leaning forward, and she was leaning forward – their weight a balanced stalemate. After 30 minutes, his thighs started to tremble from the strain.
The patient was in so much pain, and what we needed to do to help her was hurting her all the more. At a moment like this, having been lanced so many times, most people cry out, “Have you gotten it yet? Are we almost done? How much longer?” But she didn’t ask that. The only question she asked through the whole procedure, in fact, at the very peak of her pain, wasn’t about her at all. She felt the senior resident struggling, hugged him tighter and asked, “Are you OK, Doctor?”
In the time of COVID, doctors and other health care workers have been under considerable strain. Many have fallen ill; some have died. Countless others have had their careers in subspecialties or research derailed to defend the public against this pandemic. Institutions gave lip service to our peculiar plight, but when we raised our voices they were often met with reprisal, and our sacrifices have been spun for social capital in tweets and Instagram shots by PR departments of hospitals and government agencies. Grinding down in trench warfare, our gallows humor has gotten darker, our hours longer and our fuses shorter. I had gotten angrier and never really noticed it, though the signs were everywhere. I had begun to doubt if my faith in the fiduciary trust that is the bedrock of doctoring could withstand the abuses this pandemic had heaped onto a profession already beleaguered by the mechanization and commoditization of medicine into the industry of health care.
But here was this patient who must have felt tortured, and the only thing she asked was, “Are you OK, Doctor?” I had told her that I needed to ask for help, but I did not realize it was going to come from her. I didn’t realize that awkward embrace between patient and resident – both tired, both aching, both in search of healing together – would make my anger feel small. The patient’s question stretched that anger into a dimension of humility I had not felt in a while, and looking almost in wonder at that awkward embrace, I realized I was gazing at a symbol of the trust patient and doctor still share despite everything this crisis has put us through. It is a blessing that those we care for care about us in return.
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