They Also Serve

    by Maureen Hirthler, MD, MFA

The sofa is all hard wooden edges and flat surfaces with rigid plastic upholstery. I smell the sickly orange odor of hospital grade disinfectant clinging to the frame as I shift in discomfort. Because I have wadded up the yellowed and cracked institutional pillow into a ball, my head has slipped off and my face sticks to the sofa as I try to sit up. My father lies critically ill in his hospital bed next to me, confused and frightened. I reach for his hand; he knows I am here.

I made a career out of sleeping in hospitals. Beds, gurneys, lounge chairs, and too many broken-down sofas to count — I’ve slept in them all. I never slept deeply, hearing the sounds around me — the nurses’ conversations, the beeping of the monitors, the whoosh of the ventilator. So many of these hours were spent waiting for the next call, the next patient, the next treatment. I was impatient; I wanted to do something, fix something, cure something, but the hospital ran at its own pace, and so I napped and waited. I listened to the rhythm of abnormal heartbeats, the agonal pattern of irregular breaths before death. I remained aware of when lab results were due, or when I could expect a reading from the radiologist.

Sleeping in hospitals began in my third year of medical school — night call. At two or three am, the resident would send us off to the call room — a nine by twelve space with a single lumpy bed, an attached bath, a phone, and no window. It was here that I first experienced the rock-hard mattresses, thin sheets, and plastic pillows of the hospital as I tried to get a few hours of rest or waited for the next page.

As a resident. I learned to sleep in a lounge chair in the ICU, cat-napping between emergencies, the cadence of the heart monitor my lullaby. I’d grab an hour on an ED gurney in a back hallway and listen to the nurses evaluate the patient themselves, trying to give me a few more minutes of peace. I’d curl up on the sofa in the Surgery Lounge between cases. I’ve slept in Endoscopy, the Neonatal ICU, the CT scanner, the lecture hall, and even the closed cafeteria.

During my time in Pediatric Surgery, there was no opportunity to sleep. If it did get quiet for a few minutes, I would slip away to the nursery, the hospital dark and quiet, and sit in a rocking chair, feeding a newborn until we both fell asleep. I would wake up without the baby but wrapped in a blanket a kind nurse had given me.

As an older Emergency Medicine physician, I didn’t sleep while I was working. Patients always arrived at two or three in the morning; I found interrupted sleep worse than no sleep at all.

        “They also serve who only stand and wait.”

                                                            Milton, On His Blindness

My father loved this quote. He tried to convince me that sometimes it was appropriate to do nothing; I didn’t believe him. Service was doing something; I was impatient and restless as a child, and no different as an adult physician. But some of his message got through; I remember as a fifth-year resident sleeping in the chair in the room of a young man dying from cancer of the gall bladder, for no reason other than not letting him die alone.

Now, retired from medicine, I view myself more kindly. I understand that my hyper-vigilance was a form of service, too, even if I thought I was only waiting to take action. The most important part of my job was being present. The doctor was right there if needed.  I wish I had seen this more clearly at the time.

At the bedside of my father, I experience another side of waiting. I know there is nothing for me to do. There will be no ventilator, no infusions, no chest tubes or Foley catheters. I make certain he is comfortable; that is all. The decisions are made. My touch — not my intellect, experience, or skill — is all that matters.

I can actually sleep on this creaky, smelly old sofa. I can listen to his breathing without anxiety. I can let go of my need to control life, to fight death. We are waiting together, in service to each other, for the next step in our lives. I can do this.

© 2015  Maureen Hirthler, MD, MFA

+ previously published on the author’s blog, Disentangling Time

A practicing Emergency Medicine physician for over twenty years, Maureen Hirthler also holds an MFA in creative nonfiction from the University of Missouri-Kansas City. Her work has been published in Hippocampus, The Intima, The Yale Journal of Humanities in Medicine, and elsewhere.