It’s 5 a.m. when I gently knock on Amy’s door and enter to wake her up.
“Hey Amy, I just wanted to check in on you and see how you are doing.”
Without even opening her eyes, she nods at me and then rolls over to her right side, baring her back for my stethoscope, ready for our morning routine.
I met Amy on the first day of my trauma surgery rotation. She had been hit by a car the day before in a suicide attempt and had presented to our ER with a left pelvic and hip fracture. Her orthopedic surgery was the first surgery I ever scrubbed in on. Following the procedure, she was promptly transferred to the trauma service and I was assigned to follow her progress.
“Amy will be a good, straightforward case to start with,” the chief resident told me. “Teenagers with that kind of orthopedic trauma heal really quickly. She’ll probably be out of here in a week or so.”
Thirteen days later, the point when most patients with her injury would be home walking with minimal assistance, and Amy had yet to get out of her bed. She even started to get bed sores from sitting in the same exact position day after day.
“If you don’t get out of bed, you could get really sick from infections,” I told her, failing to keep the frustration out of my voice.
The first couple of days after I met Amy, I had been full of energy and optimistic about establishing a rapport with her despite her sullen silence. After a week, she still had not warmed up to me. She refused to answer any of my questions, barely cooperated with physical exams and even took to turning up the volume of her TV when I entered her room. I would have taken it personally except that she was just as stubborn and guarded with all of her care team. In addition to refusing medications and all imaging studies that we requested, Amy could often be heard yelling at physical and occupational therapists to leave her room and leave her alone.
After two weeks of this, we were all frustrated. Here was a healthy teenager who got herself hurt, and despite the efforts of the orthopedic surgeons, the trauma team, the nurses, Psychiatry, OT, PT, and even chaplain services, she was simply refusing to work with anyone. With a full service and lots of patients who were recovering from worse traumas and with better attitudes, I found myself growing more and more frustrated with Amy day by day.
Why can’t she see that we we’re here to help her?
Why isn’t she even trying to get better?
It wasn’t until I caught myself muttering that last question under my breath while leaving her room that I realized that I had made a classic mistake. I was angry at my patient over her lack of progress when I should have been trying to understand what she was thinking, what she was going through, what was holding her back.
That afternoon, I went back to visit Amy. I asked if I could just sit and hang out for a bit. She shrugged her shoulders, ignored me, and turned up the volume to “SpongeBob”.
At the second commercial break, she turned to me with an accusing glare.
“If you’re just here to tell me what to do or to judge me, you can just leave,” Amy said. “I’m not ready to move and I know you can’t make me.”
“I’m not here to do any of that, and I’m sorry if that’s how I’ve made you feel,” I told her. “I just want to help you get better, so you can go home and get back to your life.”
She turned her gaze back to the TV, but after a moment, she turned it off.
“I don’t have anywhere to go,” she quietly said.
I waited for her to continue, not wanting to say the wrong thing.
“My foster mom doesn’t want me back and my adopted mom wants nothing to do with me,” she said. “If you guys make me leave, I’ll have nowhere to go.”
“What about the plan with your boyfriend’s parents?” I asked.
“That’s not going to work out,” Amy said. “He just told me yesterday.”
I didn’t know what to say. I didn’t want to overstep my role as a medical student and promise or imply anything about her discharge when I honestly had no idea what would happen to her. At the same time, I knew that this was a rare opportunity to really talk to her.
“I’m so sorry. That sounds like a lot to deal with, but I want you to know that we are here to help you. We’re on your team,” I told her. “Your case manager will help you find a place to go, and we won’t discharge you until that’s worked out. In the meantime, we want to make sure you can walk on your own again. It’s really important to get out of bed and try, but you’re right, we can’t make you. But I’ll be here to help you if you want to try.”
She wasn’t convinced, but after that conversation, she finally warmed up to me. The next day, her case manager visited her to talk about her options and to reassure her that we would not discharge her until she had somewhere to go. In the following days, she started working with all of us as a team. She took her medications, cooperated with all of our exams and even started working with PT.
Two days before I rotated off of the trauma service, Amy’s nurse told me that she had walked from her bed to her door for the first time with the help of PT. On my last day, I stopped by her room to say goodbye. She was out of her bed and sitting in the chair working on her spirometer when I entered.
“The physical therapist said that I’m doing a lot better. He even said that I might be able to walk down the hall in a couple of days,” she told me. “If you have time, could you come and walk with me?”
“Absolutely,” I promised her.
It took another week, but she did it, and I was able to be there and cheer her on. I knew that she still had a ways to go before she was ready to be discharged. I also knew that as it stood she would most likely be discharged to a homeless shelter. As a medical student, however, my role in all of this was limited, but I realized during the month I worked with Amy that while limited, my role could be valuable. I couldn’t set her bones, I couldn’t find her a place to live, but I could be her advocate, lend her my support and be there to walk with her when she was ready.