September 2011 – Maria Yang, MD

It was 4:38pm and the consult pager beeped. The attending psychiatrist sighed with displeasure. That pager always seemed to go off during those last few minutes at work.

The resident returned from the phone call and reported, “It sounds like there’s a young woman who just got through surgery. She’s in the PACU (post anesthesia care unit) and won’t stop crying, no matter how much pain medication she gets. Surgery is asking for help.”

The attending looked at his watch and grunted. “We don’t have to do a full consult now. We can patch things over for the night and finish up tomorrow.”

His legs were long and the tassels on his loafers swished with each step he took. To keep up with him, the resident was almost running.

When they arrived in the PACU, the nurses looked up. As they put their heads back down, they wordlessly pointed to the other side of the room.

Laying in the gurney was a young woman who was sobbing. Her breaths were irregular, choked. Tears flooded her flushed cheeks and plastered locks of hair to her face. The hospital gown was too big for her and she was somehow slumped in a reclining position.

The attending approached and wrapped his hands around the railing of the patient’s gurney.

“My name is Dr. Tom.”

A new wave of tears washed over the patient. Shoulders quivering, she put her hands over her face and nodded at him.

“We’re from the psychiatry service.” He tilted his head to gesture at the resident standing behind him, who nodded and offered a meek smile. His speech was cool, clipped. “The surgeons say that you’ve been upset since the surgery. What happened?”

“I… don’t… know,” she sobbed through her fingers, her voice thin and strained.

“Are you feeling sad?”

Uncovering her face, she nodded. She raised a limp hand and wiped her eyes.

“Are you feeling scared?”

“I’m… so alone,” she blurted between gasps. “No one is here. No one is taking care of me.”

“Uh huh.”

The resident glanced at them. The patient looked distressed and the attending looked bored. The resident shifted uncomfortably.

“Miss, can I ask you a question?” Dr. Tom turned and cast a knowing glance at the resident: Pay attention. Here comes a clinical pearl.

The patient nodded, her red eyes still welling with tears.

“Were you sexually abused when you were a kid?”

The resident felt her breath catch in her throat.

The patient’s chin began to quiver. She tore her eyes away from the attending and buried her face in her hands. After choking on a few gasps, she mumbled, “Yeah.”

“Okay,” Dr. Tom said, leaning back and releasing the gurney rails. “Some people feel alone and scared after surgery. We’ll ask the nurses to give you more pain medication, that’ll help you feel more comfortable. We can talk more tomorrow morning, maybe about ways you can feel less lonely while you’re here.”

The patient nodded, sniffing.

“So we’ll see you tomorrow. Good-bye!” He flashed a toothy smile, waved, and walked away.

The patient looked at the resident, who waved weakly before turning to catch up with the attending.

Once out of PACU, the resident blurted, “Why did you ask her about sexual abuse?”

“Borderline personality disorder. They often have a history of sexual abuse. Her presentation was consistent with that diagnosis.”

She opened her mouth to say, No, I meant why did you ask her about it at that moment? Couldn’t it wait?

Instead, she heard herself say, “Oh. Thanks.”

“No problem,” he said, flashing that toothy smile at her. “Now you know what to ask when you see a similar patient in the future. Have a good evening!”

She watched him walk away and wondered if she had done the right thing.

My stomach lurched when I saw him.

He was leaning against a brick building, his fingertips gripping the walls as if they alone were holding him upright. His head swiveled back and forth in animated conversation.

He was standing alone.

He looked exactly the same as he did before I left Seattle for New York: Matted hair, unwashed skin, lopsided smile.

During my last year of residency, I spent one day a week working at a shelter. He unexpectedly appeared there one afternoon. Staff told me that he was an occasional visitor for the past fifteen years. When winter descended upon the city, they saw him more often. He disappeared during the dryer months.

Wary of psychiatrists—he had spoken to several in his lifetime—he kept our first meeting short.

“Would you be willing to come back next week so we can talk again?”

He shrugged.

To my surprise, he appeared the next week. And the week after. And the week after that.

He told me about his immigrant parents. He told me that he was an avid reader. He often had a copy of the local paper or a library book tucked under his arm when he came to the shelter. His vision was poor, so I’d often see his face inches from the pages. He squinted. He told me about the wooded grove he slept in, though would never tell me its exact location. He showed me the toiletries he kept in his duffel bag, including the razors he used to shave his face without any water or cream.

He never told me what happened that made him homeless. He never told me who he spoke to when he was alone.

Several months before my departure, I told him that I was moving to New York City. The lopsided smile blossomed on his face.

“I used to live there,” he said. The smile withered and his expression darkened. “Be careful. There are a lot of people there. It’s not a safe place. Especially the subway platforms. Make sure you always hold onto the columns in the subway stations.”

To demonstrate, he stood up and dug his fingertips into the walls of the office as if they alone were holding him upright.

Three years have passed and I have returned to Seattle. Three years have passed and he remains homeless with limited to no options for supportive housing. Three years have passed and the only things he can hold onto are the walls along the city streets.