Red Herring (I).

I sat in the emer­gency room and flipped through a mag­a­zine. I wasn’t actu­ally read­ing; it was a way of dis­tract­ing myself from all the noise.

Three hours had passed. No one had seen my patient yet.

The nurses, bless them, were kind to my patient. They brought her food and noticed that she was tak­ing gigan­tic bites, but not swal­low­ing any of it. The pocket of food in her cheek expanded and des­per­a­tion stretched across her face.

You don’t have to swal­low it if you don’t want to,” I said, wor­ried that she would inhale the food. “You can spit it out.”

A nurse saw us and grabbed some paper tow­els. “Here, spit that out. I’ll get you some soup. You look like you’re strug­gling to eat that.”

My patient obe­di­ently spit out the wad of food and looked relieved.

Can you please doc­u­ment that in your notes?” I asked.

Of course. I’m sorry that no one has seen her yet. Do you want another magazine?”

No, I’m okay, thanks,” I said. She nonethe­less returned a few min­utes later with two mag­a­zines from last year.

Three hours ear­lier, I had shared a clipped account of her his­tory to the triage nurse and she sent us to the med­ical side of the emer­gency room. I sup­ported this deci­sion, as I wanted my patient eval­u­ated for med­ical con­cerns. That was the chief rea­son why I went with her. My patient would not be able to describe the prob­lem. She’d say she was fine.

Upon learn­ing that I was a doc­tor, the unit nurse pulled the emer­gency room attend­ing physi­cian away from a com­puter and asked me to talk to her. I imme­di­ately launched into my pat­ter, sum­ma­riz­ing why we were there.

I saw it hap­pen and almost wanted to laugh: Her fea­tures hard­ened. The mus­cles that allowed any pos­si­ble soft expres­sion on her face tensed up. Her face showed noth­ing but muted anger.

I don’t even know if I will see her. I’m going to go away now,” she said at me. As she was walk­ing away, I heard her mut­ter, “Why didn’t she go to psych?”

Dur­ing my entire time in the emer­gency room, she never came near us again.


My patient did not want to go to the emer­gency room.

But we have to,” I said, try­ing to sound calm. I wished I didn’t feel as fran­tic as I did.

I don’t want to go,” she said, lit­er­ally hop­ping from one foot to another. She wrung her thin fin­gers together and fear over­whelmed her face. Those sunken tem­ples seemed to sink fur­ther as she frowned.

I know you don’t want to go, but we have to,” I said, point­ing at the scale. “I said that you would have to go to the emer­gency room if your weight dropped below 100 pounds. Remember?”

Yeah.”

What is your weight today?”

99 pounds.”

And what did I say would hap­pen if your weight dropped below 100 pounds?”

I’d have to go to the hospital.”

That’s why we’re going to the hospital.”

But I don’t want to go to the hospital.”

We’re going to the hos­pi­tal. I’m com­ing with you.”

We sat next to each other in the back of the car.

You’re com­ing with me, right?” she asked, her eyes look­ing abnor­mally large in her head.

Yes. I am going to be with you until a doc­tor sees you. I want to talk to the doc­tors directly, too.”

I had writ­ten up a doc­u­ment that sum­ma­rized per­ti­nent infor­ma­tion about her: name, birth­date, diag­noses, med­ica­tions. I wrote down the details about how her weight had fluc­tu­ated over the past year, how she went to a dif­fer­ent hos­pi­tal just six months prior for the same rea­son. I wrote how she had needed two blood trans­fu­sions, how they had dropped a cam­era down her esoph­a­gus to look around for dis­ease. Except for mild inflam­ma­tion, every­thing was nor­mal. I wrote that I had reduced her psy­chi­atric med­ica­tions; she didn’t need to take so many. I wrote that she was fine, that her psy­chi­atric symp­toms hadn’t changed in months. I shared my fears that her symp­toms were due to med­ical rea­sons. I didn’t want the hos­pi­tal staff to fol­low the red her­ring that was her psy­chi­atric diagnosis.

Back in the emer­gency room, the nurse had asked her to take off only her shirt and put on the hos­pi­tal gown. My patient peeled every­thing off with no shame. As she pulled her­self onto the gur­ney, every­one saw her gaunt but­tocks through the gown flap.

The hours passed. The emer­gency room was busy. More gur­neys were pushed into the room and peo­ple were mut­ter­ing, scream­ing, upset.

She looked at me. I smiled with my lips, but not my eyes. We con­tin­ued to wait.


Part one of an ongo­ing series. Read more for