Sickness Sonata

Mvt. I

I always glance at my notes before I knock, but you never know what you will encounter when you open that door for the first time. Those clinical words won't tell you if her smile will warm you like a candle as you enter, or if she will barely spare you a glance as she writhes in pain.

She smiles cautiously when I greet her by name. Immediately, I notice two things: 1) her head is bald, as expected in the aftermath of chemotherapy, and 2) Wimbledon is playing on the television screen. I pull up a chair next to her bed and introduce myself. She tells me the story of her illness, but I can see the clues in the canvas laid out before me. The way she spits into a cup by her bed, unable to swallow her own saliva. The thin frailness of her arm as she reaches for the remote attached to her bed. After I finish my exam, I glance at the clock, and decide to ask her about tennis. She lights up when she talks about watching tennis and soccer. She's a huge fan of Nadal. She tells me about her childhood in Colombia, where she was teased for being "male" because she liked playing sports. I tell her about my own childhood as a competitive tournament player, training every day and missing out on school dances and birthday parties. We watch Azarenka serve an ace. When I stand up to leave, I promise to visit her again on Monday. Before I go, I help her open the window blinds. The room becomes soaked with morning light, and I wonder what is the Spanish word for sunflower.

Mvt. II

I ask her how she's feeling today. It's the same question I ask every patient, but there is a smidge of guilt when I realize I care about her answer on a more personal level, more so than the man I visited before her. She smiles but her shoulders are slumped. The scope on Friday came back normal. I saw it for myself on the screen that day, almost wishing there was an ulcer or something we could point to as the definitive cause of her pain. I tell her we're still waiting for the biopsy, but she tells me she is trying to accept that this may be the new normal. This inability to eat. This pain that roils her stomach. The bareness of her bones. She tried to force down the bites of too-salty chicken for dinner last night, but it all came right back up.

Today, she is rooting for the Spaniard, the 14th seed Muguruza, up against the number one seed, Kerber. It's a close match, 4-4 in the third set. I haven't followed professional tennis in years, so she tells me about the girl's tendency to succumb to nerves and choke on the big points. My mouth twists when I tell her I had the exact same problem. As the camera pans to Conchita Martinez in the stands, she mentions her sixteen-year-old son to me for the first time. She is worried about his health, too. She used to be overweight, until the cancer ravaged her body. She says a boy his age shouldn't already have elevated lipids. The clinician within me is automatically listing all the risks with childhood obesity, but I know this isn't the time. She tells me she tries so hard to force down those queasy bites of hospital food, because she wants to live long enough to see him graduate from high school.

Muguruza pulls ahead to a double match point. In that moment, we forget that we are a medical student and a patient in a hospital ward. Throwing up our hands, we groan when the Spaniard loses the next two points in quick succession. Deuce. We wonder if history will repeat itself, if Kerber will hold serve and Muguruza will fall to her pattern of slipping focus the closer she gets to victory. But instead of falling, she rises. Ad Out. Muguruza returns the serve with precision, and Kerber's shot sinks into the net. We erupt into whooping cheers and high-five each other as the Spaniard roars in victory. When I say goodbye, she smiles as she thanks me for taking care of her. She tells me she hopes I won't see her again. Because we both know that only bad things will cause our paths to cross once more.

Five days later, Garbine Muguruza defeats Venus Williams 7-5, 6-0 in an upset to win the Wimbledon championship.

Mvt. III

Sometimes the chart is an excavation, an expedition through layers and layers of time. I pull up the new consult's patient record and click through the pages in bewilderment until I realize she's been here since April. I trawl through the notes, trying to follow the medical narrative that reads like a downward spiral. Every procedure attempting to correct one problem has been followed by a litany of new problems.

When I visit her in the ICU, she is curled up in bed with her eyes closed. Her head is also bald and her body just as frail, but this girl is in her early 20's. When I gently ask the patient if I can examine her belly, her eyes barely flutter open as she lifts up the edge of her hospital gown. I observe the line of staples like a railroad track across her skin, the tube that goes straight to her stomach, the bandage around her surgical wound wet with blood.

My fellow and I both agree that the cause of her blood loss is from her surgical wounds, and we decide that there is no reason to put her through an upper GI scope when the cause is obvious. But the other teams are insistent. The surgeons say she's too high risk for them to operate on her again. They are fixated on the possibility of an ulcer, even going so far as to document a history of peptic ulcers that is readily refuted by the patient's mother. We finally agree to scope her on Friday, partly out of the desire to finally put this matter to rest.

Goosebumps raise across my skin when I see the inside of her stomach. Everything looks horribly wrong. The pool of bloodied gastric fluid is almost black. The lining of her stomach is covered with pale raised speckles, a trypophobe's nightmare. The camera swerves up to look at the tube that passes through her skin. A giant bulging blood clot hangs on the end, and as we attempt to pull it off, fresh blood trickles down the tube from the source: her surgical wound.

The atmosphere is grave when our team reconvenes in the call room after the case. One of the third-year medical students observes aloud, "That's the worst scope I've seen so far." The third-year fellow who assisted with the case has seen much worse in her 6 years of post-graduate training, but acknowledges the direness of the patient's condition.

"Poor thing," she says. "She's not going to make it out of this hospital alive."