Debrief: One Night In Emergency

He was a likeable fellow, early thirties, very thoughtful and humorous, and kept me smiling with a constant stream of jokes the whole time I was treating him.

That night, he had come in with a painful left foot that needed X-Rays and a cast.

We built good rapport with one another fairly quickly, trading stories and chemistry jokes. He even got to hear the circus arts vs medical school dilemma from my early teenage years. He then told me of his journey as a professional clown for years, touring the world, eventually being an individual act, and then exploring acting as a career and now, writing. Amused, I assured him that I would purchase his novel if ever I saw it in a bookstore. What an exciting journey he portrayed indeed!

I glued his wound back together, bandaged it and put his foot in a plaster cast.

Hobbling out of emergency with his crutches, medication and a brand new plaster cast, he quite loudly announced in front of the whole department so that I could hear from our staff base where I was sitting, "Your compassion and healing has been exemplary!"

With a cheeky grin spread across his face, he left the department.

...

Later that shift though, in stark contrast to that experience, I encountered her.

This girl, who was just about as old as I was, had come in for "self-inflicted lacerations to her lower legs". 

I hadn't yet met her at that point but I heard what all the staff were saying about her.

"Did you see the number of scars on her arms and her legs?"
"She's done cuts with a razor blade in a crosshatched manner this time, it's not going to be possible to suture that up."

I knew she was coming to short stay for the rest of the night, where I was in charge. A plan was put in place for her, she was to be reviewed by plastic surgeons in the morning, and for me this meant that I didn't really have to see her at all or manage anything at this stage. So she was moved, and I tended to my other jobs instead.

7.30am, I get a call that plastics didn't think she needed surgery, that the wound could just be cleaned, steri-stripped and bandaged, and that the nurses could easily deal with it if I had other jobs to do. I relayed this to her nurse, who accepted the job without complaint.

I went back to the staff base and sat in front my computer again.

"Self-inflicted lacerations to her lower legs."

To be honest, triage doesn't give patients much of a personality with the 4-10 words they use in their descriptions on our tracking list.

All night, she had been just a name on my screen, which is something I must admit has occurred a lot more frequently now that I am a "busy" intern. Third-year-medical-student me would have been so ashamed of how I allowed this to happen. Third-year-medical-student me would not have been put off by frequent presenters to hospital and was always innocently bright-eyed, looking to bless a struggling patient at whatever cost. 

I hesitated for a moment as I read that once more, and finally got up to tell her nurse that I would dress the wounds myself. 

As I set up to dress the wounds in her cubicle, I got to have a good glimpse of her arms and her legs. Believe me, that I am in no way exaggerating when I say that there was no part of her limbs that was not covered in some sort of self-inflicted scar. There were countless slashes all across her arms and legs, in different lengths and depths, healed into a myriad of colours - some a deep purple whereas others were as white as snow. 

I cannot imagine anybody being able to take a good look at her, gaze at her skin that was so far beyond what it ought to look like, what it once used to look like, and not feel a deep pang of compassion for her. 

I gently asked her if she wanted to talk about why she did it this time. 

She quietly shook her head, continuing to observe my actions in the cubicle. As I looked at her and waited to see if I would get any further response, she had this look in her eyes that spoke more clearly than anything she could have audibly mentioned. 

"How could you understand? Young, well-dressed, happy doctor like you, how could you ever know anything about my pain?"

And to be honest, she was probably right. 

I wasn't born into a low socioeconomic area. I grew up with great opportunities before me to attend a private school and pursue any university degree that I could get myself accepted to. Even now, I often receive compliments to further boost my self-confidence regarding the way that I look and the way that I act. I come from a loving and supportive family. I know that there are people I can call right now who would immediately attend to my needs if I was struggling with even half of what she was going through.

I have never walked in anything close to the shoes she had been walking in all her life. 

And for the first time since I started work, I felt so inadequate as a doctor not because I didn't know enough academically compared to my peers and seniors, but this time simply because I just could not fix her problems. I hated that I would eventually send home a bandaged version of a girl that was just as broken as the one that walked into emergency bleeding all over her trousers in the middle of the night. 

I regretted not being someone who was more inspiring, who was courageous enough to look her in the eyes and really tell her that she was so precious and important, and that it was not too late to be who she dreamt she would be. I wished so hard that I was bold enough to tell her about the reason I am who I am today - a God that know her by name, adores her so much and whose heart broke each time she cut herself like this. 

With a head full of thoughts, I cleaned her wounds slowly, praying quietly for the peace of a young girl and the healing of her emotional wounds as my hands were laid upon her. I bandaged up her injuries, and sent her on her way afterwards. 

Expressionless and numb, holding on to what was left of her bloodied belongings, she left the department.

...

"Stir in me a love that's deep

A love that's wide, a love that's sweet

And help me Lord to never keep it to myself

Cause there's no fear in love."