TELEMETRY | Crystal Ralls
She asked me to take it off before I had even introduced myself. I had barely stepped into the room, still adjusting to the low hum of machines and the muted quiet of the floor, when she lifted the cord between her fingers and said, “The monitor. I don’t need it.” Her voice wasn’t irritated or demanding. It was steady, almost casual, as if she were pointing out something obvious that I had somehow overlooked. The telemetry leads trailed across her chest, thin wires disappearing beneath the loose hospital gown that had shifted off one shoulder. Above her, the screen traced green lines in slow, predictable waves, translating something essential about her into something we could read. I glanced at it reflexively. Sinus rhythm. Stable. “It’s just to keep an eye on your heart,” I said, the words coming out automatically, practiced enough that I didn’t have to think about them. Even as I said it, I knew it wasn’t really what she was asking.
She shook her head slightly, letting the cord fall back against her gown. “I don’t need it,” she repeated. There was no urgency in it, no fear, just a quiet certainty that made it harder to dismiss. I stepped closer, noticing the way the adhesive patches pulled faintly at her skin whenever she shifted, small tensions that would have been easy to ignore if you weren’t looking for them. “Is it bothering you?” I asked, trying to make the question sound practical. She adjusted the fabric at her collarbone, as if aware of how much of her body was exposed, how little of it felt like hers in this space. “It’s not that,” she said after a moment. “I just don’t like being watched.”
There are questions we ask because they’re expected of us, because they map neatly onto checkboxes and notes and plans. Any chest pain, shortness of breath, palpitations. And then there are the things patients say that don’t fit into any of those categories, things that hover just outside of what we are trained to respond to. I nodded, though I wasn’t sure I understood her—not fully. The monitor continued its quiet work above her, translating each beat of her heart into numbers and lines that meant something to us. Heart rate, rhythm, variability. It watched constantly, without asking, without explaining itself. It knew something about her that I didn’t, or at least it seemed that way. We are taught to trust that kind of knowing. It makes the body legible, something that can be tracked and anticipated.
“I can talk to the team about it,” I said, choosing the safest answer I could offer. There were reasons the monitor had been placed, reasons that would sound entirely appropriate if I said them out loud. Risk factors, precaution, protocol. None of those reasons were wrong. But standing there, looking at her, they felt incomplete in a way I couldn’t quite name. She nodded, as if that was enough for now, and let her hands rest in her lap. I finished the rest of the encounter the way I had been taught, moving through questions and exam and small reassurances, but the request stayed with me.
When I came back later, she hadn’t tried to remove the monitor herself. The cords still lay across her chest, the adhesive still fixed in place, as if she had decided that asking once was all she was going to do. “Did you find out?” she asked when she saw me. There was no impatience in it, just a quiet expectation. “Not yet,” I admitted. “But I’m working on it.” She nodded again, the same small motion as before, and for a moment neither of us said anything. I found myself lingering, aware that I didn’t have a clear reason to stay.
The monitor let out a brief, soft beep. I glanced up instinctively, checking the rhythm, the rate, making sure nothing had changed. It hadn’t. Still normal. Still stable. When I looked back at her, she was watching me, following my gaze to the screen and back again. “Does that mean something bad?” she asked. “No,” I said quickly. “It just…checks in.” The explanation felt thin even as I offered it. She gave a small smile, something polite more than genuine. “I feel like it’s waiting for something,” she said.
I thought about how often that was true, how much of medicine is structured around waiting—for a change, for a number to shift, for a pattern to declare itself. We call it monitoring, observation, vigilance. It sounds neutral, even protective. But there is always something underneath it, something unspoken about what might happen if we stopped watching. I almost told her that the monitor was there in case something went wrong, that it was a safety net. Instead, I said nothing. There wasn’t a version of that explanation that felt honest in the way she was asking for.
On rounds, her case moved quickly. Vitals stable. Labs unremarkable. Imaging pending but not concerning. The monitor barely came up, just a brief mention in the flow of information. “We can probably discontinue telemetry,” someone said, almost as an afterthought. There was a small nod of agreement, a shift to the next patient. It was an easy decision when framed that way, detached from the moment she had asked for it.
By the time I returned to her room, the leads had already been removed. The wires were gone, the machine above her bed dark and silent, its screen blank. Only the faint circular marks remained on her skin where the adhesive had been. She looked up when I walked in, her posture slightly different now, shoulders less guarded, the gown sitting more comfortably against her. “Thank you,” she said.
I hesitated for a moment. I hadn’t been the one to take it off. I hadn’t made the decision in the way it felt like she thought I had. But I nodded anyway, accepting the gratitude because it seemed easier than explaining the truth. “Better?” I asked. She took a slow breath, deeper than the ones I had watched her take earlier, and let it out gradually. “Yes,” she said. “I can rest now.”
I looked up at the monitor again, or where it had been active before. The screen reflected the room back at me now, a faint image of the bed, the wall, the two of us standing there. Without the numbers and lines, there was nothing to interpret, nothing to track. It felt exposed, like something essential had been removed. I realized how accustomed I had become to having that layer between me and the patient, something that translated her body into a language I understood more easily than the one she was speaking.
Later, when I sat down to write my note, the words came quickly. Patient requested removal of telemetry. No reported discomfort. Hemodynamically stable. Monitor discontinued. It fit neatly into the structure I was used to, clean and concise and entirely accurate in a way that felt insufficient. There was no place to write that she didn’t like being watched, that the monitor made her feel like something was waiting for her to go wrong.
The order itself was simple: discontinue telemetry. A single line in the chart, one small adjustment in a long list of tasks and plans. It looked like a conclusion, a resolution to something minor. But standing in her room, looking at the now-dark screen, it felt like the removal of something that had never really been for her in the first place. The monitor had been for us, for our reassurance, our need to see and measure and anticipate.
She leaned back and closed her eyes. Her breathing slowed. There was nothing marking each beat of her heart, no visual confirmation that things were still as they should be. Just the quiet of the room, uninterrupted. For the first time since I had met her, there was nothing between us.
Crystal Ralls is a fourth-year osteopathic medical student at Lincoln Memorial University DeBusk College of Osteopathic Medicine in Tennessee. She is pursuing a career in neurology with interests in traumatic brain injury, epilepsy and health literacy. Ralls has contributed to narrative and clinical writing focused on the patient experience. Her work often explores the intersection of clinical care, perception and the unseen aspects of illness. In addition to her academic work, she has developed patient-centered educational materials, including children’s health books aimed at improving understanding of complex neurological conditions. She hopes to continue integrating narrative medicine into her future clinical practice.