Scene from the ED

This is a couple paragraphs of creative nonfiction I jotted down during the last writing group based on an experience in the emergency department.

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When I entered the room I could tell something was wrong by the way the husband stood. There was an air of aggression, the kind that made me want to send him out and pry the poor woman for domestic violence. He hovered, leaning forward, arms across the chest. But when I looked at her, I could see that she was seeing down a row of mirrors. She was afraid, but not of him. He was picking up on some unspoken sense between husband and wife; he raised his haunches to protect her.

She had been crying. She struck me as the type of patient who puts on make-up before showing up at the emergency department, and tonight, she looked a mess. The skin of her hands were white and taut with worry. Her gown was strewn across her shoulders. There was blood on the sheets, in splotches.

I got a translator. Oh, there are times when my Spanish would suffice, even for those in distress, heaving in chest pain, speaking in one-word sentences. But here, I already knew I needed help. It was not a question of diagnosis; I already had a gut feeling, and later I would learn that she did as well. But this was the kind of thing you have to do correctly, the kind of thing where a misstep would ruin everything. The interpreter was curt, dressed in a white coat, looking more formal than I did in my scrubs. When she herself realized the diagnosis, she started shifting weight on her legs. But I anchored her down, forced the conversation down meandering paths.

We talked, and over talk, we bonded; her husband softened, the interpreter clicked in the background. I learned of her life in Mexico, her two children, her faith, and her job. Then I probed a little deeper, and I learned of her prior and her fear that this was a repeat miscarriage. I held the timber of my voice. I had to ease her in, I did not want to couch ambiguity, and yet I did not want to lay things bare.

The attending did the exam, and I was disappointed in him. Two traumas had arrived; there was a stroke code, a STEMI, a waiting room full of patients. He had to go, without even a parting word. But I knew my part. I sat on a stool, kept my gaze on the patient and her husband, and chose my words carefully. I could not tell whether the diction carried through the interpreter. But to this day, in these situations, I focus on the tone and arc of my voice, the lilt of the phrases, the gestures, the facial expressions. I hope these cross cultures - over not only race and ethnicity, but the vastness of experience, gender, age, hope and fear into some common ground where cold medical dogma and the emotion of loss coincide.