FOR MARY, WITH LOVE | Meghan Liroff
The unnatural light illuminates the hotel bathroom and I see my mom sitting motionless against the wall like a doll stored thoughtlessly on a shelf. Blood is smeared on the walls and dripping thickly on the floor; her forehead is gashed open.
My stomach sinks and my mind sees white for only a moment as it resets to access that side of me that is analytic and algorithmic. I run towards the trauma, my muscles now tense as I begin my studied approach to assessing the critical patient. “Mom!” I hear an unfamiliar voice yell—an echo of my now-split self. I distance myself from this reality and my terror; I’m not her daughter anymore; I turn doctor.
“Mom, want to come with me to Bogotá next week?” I asked. “I’m already packed,” she responded without pause. Travel had been an integral teaching tool growing up: my parents formed our bonds and our moral compasses while they showed us the world and kept us close-by. Each summer, we would pick a continent and rent a car not knowing what country would house us for the night; even snafus had solutions and the solving of them was half the fun. I grew to feel safe with unpredictability; safe in any country, safe in movement.
It was a natural progression that I evolved into an emergency physician. This allows me to keep moving: each day continues to be unpredictable as I manage the spectrum of human injury and illness: from life threatening penetrating trauma to nasal congestion. Each week is unpredictable but my irregular schedule allows me to travel. And now, I can take my parents.
My mom is seventy-two years old, slight, five-foot-three, with bobbed highlighted hair, and a French nose. She has a face that shows the deep lines of fearlessness. She goes to Mass every Saturday evening in Lululemon leggings with Forever 21 sweaters after an ACLU Chapter meeting and then berates my dad for requesting the senior discount at the movies.
She is definitely in for Colombia.
My mom wraps a printed scarf stylishly around her neck and we meander from the trendy modern art warehouses and Cartier watch displays, through pedestrian-congested air-polluted graffitied sidewalks lined with arepas vendors, arriving in a generous plaza built for the Catholic Church in 1547. Along the way, we pass a violinist playing Vivaldi and a trio of young women singing traditional creole ballads. It rains and we laugh with chattering teeth and waterlogged shoes. The night ends with a dance performance and we head back to the hotel, our senses intoxicated.
My body is not used to the altitude and I lie awake; the Colombian coffee is hot in my veins. I feel my mom toss and turn as well and I pull my legs away from her icy feet with an annoyed growl. She laughs softly. Finally, the bed sags and bounces as she gets up to go to the bathroom.
The bathroom light flicks on and illuminates the bedroom at a distance. It is sparse: only a bed with white sheets, a portable refrigerator-mini bar, and two lamps that cast jagged, eerie shadows. It’s a few moments later when I hear a sickening clunk on the tiled floor followed by a groan. I joke, “Are you dead?” I expect her to respond with something about the shampoo bottle, but instead, I hear a wet rattle: agonal breathing.
My pulse quickens as I leap from the bed. I see my mom sitting unconscious with blood everywhere. I depersonalize, I tighten, I see white, and then I transform into a physician.
This is a seventy-two year old female found down with obvious head trauma to left orbit. I lay her down. She’s unresponsive to voice. I perform a primary survey: airway compromised, breathing spontaneously, she is cool, clammy, diaphoretic with roving eye movements, her pupils are enlarged but equal, she has bounding carotid pulses. I performed a sternal rub to check her response to pain. I am running a resuscitation on my mom in a foreign hotel room. I passively think about calling 911 but I have no idea what that equivalent is.
I go through my differential: the list of possible etiologies of her current state. Hypotensive? I put her legs above her head for an instant 500cc bolus. I think of hypoglycemia. No glucometer here, but where could I find sugar?
After an eternity of fifteen seconds, she starts responding to me. Her speech is slurred, she’s angry at me. “Whaaaat”. Her tongue rolls with these seemingly unfamiliar words. She sounds drunk and annoyed that I had woken her up.
I ask her name, our location, and who I am, and she gets it all right. She is slowly improving. I cradle her head in my left arm and my right arm holds her legs high in the air like some awkward attempt at the Pieta. I look down at my patient. My mom. “Stay here. You need sugar. Keep your legs like this. I’m breaking into the mini-bar.”
And she doesn’t refuse. In fact, she giggles deliriously. I make her sip it slowly and she returns to her baseline mental status.
I urge her to go to the hospital. I am fairly certain she had an orthostatic syncopal episode or she was hypoglycemic, but I run through the orders I would have placed at work that would have ruled out devastating pathology: an EKG, a CT of her head at the very least. She is an elderly fall (she hates it when I say that) and I’ve seen these cases go badly.
I tell her that if she does have a brain bleed that I hadn’t done a burr-hole before and she looks at me askance. I stop myself from asking about her code status.
“No. I am not going to the emergency department. Absolutely not.” Her eyes are the eyes of my mom now, and I know that she’s back. She declines everything despite my urging and my discussion of risks, and when she makes a decision, she cannot be moved.
With that realization, my doctor-self dissolves and I become a scared kid. My shoulders crumple inward and I grow hot with sweat; waves of nausea make me sink to the ground. I lay beside her and I weep openly, welcoming the cool tile. My own response startles me. I see this—and worse—everyday, but when it’s your mom, it’s somehow different. I plead out of breath, “I’m not done yet. You can’t leave me!” She cradles me, reversing the roles of the sculpture.
“I’m okay, and I’m not going anywhere,” she says gently with a touch of amusement, probably a little surprised by this admission.
When the tears subside, we split the rest of the Coke between us. I then pull both sides of myself together and do hourly neuro-checks throughout the night, and after I repair her face with supplies from la pharmacia in the morning, we head out for another café con leche.
Meghan G. Liroff, MD is an emergency physician working out of metro Detroit. At this early stage in her career, she is focused on becoming a good doctor, healthcare disparities, and young physician education. Her favorite book is The Velveteen Rabbit. Find more of her publications in Pulse, Annals of Emergency Medicine, Journal of Emergency Medicine, Emergency Medicine News, and FemInEm. When not at work, you can find her either in a theater, or any place under an open sky.