“Hi-my-name-is-Nisha-I-am-a-medical-student-I-am-going-to-ask-you-some-questions-before-Dr.-James-comes-in,” I said in one breath, so fast that the words almost slurred together. I had gotten into the habit of saying this phrase quickly, before that concerned, confused look that often appeared when I walked into an exam room could spread across the patient’s face. Yes, I know I’m just a student, I tried to convey in that rushed, almost apologetic introduction. I know I don’t have that much to offer you. The two women in the room looked at me and, just as I expected, the younger woman seemed to relax a little when she heard the words before Dr. James comes in, satisfied that she would soon be seeing a real doctor.
As I walked over to take a seat, I glanced at the two women in the room. The younger woman looked about forty. Her face appeared tired, stressed, and maybe even a little frustrated. The older woman slumped in her seat, her glasses threatening to fall off her face. She looked scared.
“What brings you in today?” I asked.
“Well…” the younger woman replied, glancing over at the older woman. She began to tell me about the phone call she received from her mother’s nurse at the assisted living facility. The nurse, she said, had become worried after seeing large amounts of blood in her mother’s stool earlier that day. As I began to construct a differential diagnosis in my mind, I turned to the older woman.
“Could you tell me if you experienced any pain when—”
“WHO ARE YOU?”
Startled, I glanced at the younger woman and then back at her mother. “I am a medical student here for the week. I am going to ask you a few questions before Dr. James comes in.” She looked terrified. I wasn’t sure as I stared at her whether I had ever seen someone look that scared before, at least outside of a movie. I hesitated, unsure of whether or not to go on.
“She has dementia,” her daughter told me. “She has good days and really bad days. Today hasn’t been the best. She doesn’t remember it is my birthday.”
“WHO IS SHE?” the woman demanded again, this time looking at her daughter.
“A medical student. It’s okay. She’s just asking some questions.”
There was a pause after she said this as the three of us looked at each other. The younger woman still looked tired, the older woman still looked scared, and I am sure that I looked uncertain as I attempted to register the statement She doesn’t remember it is my birthday. Maybe it was the matter-of-fact tone she used when she said it, or that birthdays have always been a grand affair in my family, but the words left me feeling sad and empty. As I gathered my thoughts and prepared to continue with my questioning, Dr. James swung open the door and walked into the room. I scurried out of the “doctor chair” and over to the wall, making room for him to sit down. It was clear to me as Dr. James began to question the younger woman that he had been taking care of these patients for years.
“Given her age,” he said after gathering the story, “I don’t think I would recommend a colonosc—”
“Help me. It hurts so bad.” Although the older woman’s previous exclamation had startled me, this quiet, desperate, frightened plea caught me completely off guard. The words were drawn out, her voice shaky. It was a painful sound to listen to, like long pointy nails scratching on a chalkboard. It was the kind of sound that gives you goosebumps, sends shivers down your spine, drives you to instinctively reach up and cover your ears. The kind of sound that makes you desperately want to do something to help, and makes you pray that you will never in your life be in that much pain. She looked directly at Dr. James and pleaded again “Please help me. Please.”
“I’m trying to help you,” Dr. James replied calmly, patting her knee with a comforting smile and then continuing to explain the options to her daughter.
The older woman then turned to her daughter and muttered another frantic plea. “Please help me. It hurts.” The younger woman absent-mindedly patted her mother’s knee while continuing her conversation with Dr. James, giving me the impression that she had heard these pleas so often from her mother that they had turned into background noise.
Finally, the older woman turned to look at me, wide-eyed, helpless, and afraid. “Please, help me. Please.” I started to feel panicky. I had no idea what to do. I wanted to cry. I looked at Dr. James and the younger woman as they continued to converse, then turned back to meet the older woman’s desperate gaze again. I felt like I was going to explode under that wide-eyed, unwavering gaze, and finally I burst out “What’s hurting her? What’s happening to her?”
“We’re not sure. She won’t tell us when we ask. She’s been doing this for a while now,” her daughter replied to me in that same matter-of-fact tone. She doesn’t remember it is my birthday. She’s being doing this for a while now. I imagined as I stood there, drifting in and out of the conversation between her and Dr. James, how much grief she must have been through. How many times had she been forced to stand there helpless while her terrified mother begged her to make this horrible pain stop? What had it taken her to get to a point where she could talk about it all with such detachment?
I won’t. I won’t ever go through that, or put others through that, I thought, feeling rather desperate myself. If I’m ever diagnosed with dementia, I’ll find some way out.
Dr. James stood up to leave, bringing my wandering mind back to the exam room. As I turned to follow him, I heard a voice behind me: “I love her.” Dr. James and I both turned around. “You love your daughter? She is pretty great. Today is her birthday you know,” Dr. James said with a smile to the older woman.
“No,” she said. “I love her.”
There was a pause as all of us realized that she was pointing to me.
“I love her.” Her tone was different now. She sounded less desperate. Her voice was stronger, like she was finally sure of something. She rested her pointing finger back in her lap, but kept her eyes fixed on me.
“Weird,” her daughter said with an uncomfortable laugh. “I haven’t seen her do this before.” As she helped her mother up and pushed her towards the door, the older woman grabbed my arm. Her icy fingers closed so tightly around me that I was worried she would never let go. What is going on? I thought. What do I do? This is horrible. It’s all so horrible. I don’t know what to do. None of this makes any sense. Dr. James, maybe hoping to avoid a scene, gently suggested that I walk the women to their car in the parking lot.
“Really, she never does this,” her daughter told me apologetically as we approached the car, probably sensing my discomfort. “It’s okay,” I replied, feeling like I myself was in a daze. I’m not sure exactly how we got her into the car or how I got my arm out of her icy grip. All I remember is her continuing to say those strange words, I love you, as I shut the door behind her.