Timing.

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.