Changing Places

Recently I had occasion to explore the patient’s perspective a little more intimately than usual. Like so often, it is the experiences we do not want that offer us the greatest education.

I fell sick not long ago. Quite sick. The sort of sick that won me lines and drugs and wristbands and blood pressures at two in the morning. The sort of sick where the thought I might not recover came screaming into my hallucinating head in the coal dark of night. ‘Will I be okay?’ I asked my doctors. ‘Absolutely,’ they said, but they forgot I was a writer. In The English Patient, the Booker of the Bookers, when Katharine asks Almásy whether they will be alright, he answers ‘absolutely,’ but she responds ‘yes is a comfort, absolutely is not.’

The problem, of course, with being a writer is it adds another dimension to the way one experiences things. It brings the whole box and dice up to three-fold. The first is in the reality of it all; the happenings that must happen, the medicines, the observations, the merry-go-round of meals which are only missing the merry. The second time is understanding as a doctor what we put our patients through; the words we choose, the connections we forge between care-giver and patient, and the chance to observe the way the imprecise nature of medicine and pathology leads to thousands of possible decisions, with so few of them black and white. The writerly third, however, is where you really get to explore things; writing simply being paying uncanny attention to things, to events, sensations, meaning. It is the uncovering of truths by noticing the tiniest of details. And, oh, were there a lot of details to notice.

The strange phenomenon of febrile hallucinations for a start: disembodied heads in carefree conversation with each other, ignoring me entirely. This was the delirium of raging cytokines and bacterial toxins and synapses in reactionary panic. Why did my brain do that? I wondered if it were the two grams of ceftriaxone being pumped into me daily. I worried I wouldn’t have a bacterium left alive in my body; perhaps just a few hardy souls, loyal to the resistance, hanging on white-knuckled. I know we contain multitudes. Humans are nothing without bacteria – we have more of them than us. I wondered if I would be more human now? Would I lose weight from the great biomass extinction? Where had they all gone? Had the last good ones abandoned their posts, guarding my blood-brain barrier like centurions, leaving me a little loopy?

I was ‘troublesome’ to get drips into. I’d always boasted about having good veins, as though life was some kind of vessel contest. Turns out I was wrong. I would apologise endlessly, saying ‘I must have unusual valves,’ or something, and reassure those who came at me with tremulous hands and ever smaller cannulae, that I would be the Empress of Hypocrisy to be critical of a few missed drips. Digging with long, sharp, cold metal through febrile skin is searing though, and your body remembers the trajectory of the attempt, like keeping the score.

I had my first CT scan. The sensation of contrast filling your throat as it enters your veins is like a warm drowning. Blessed are those who warn their patients this will happen.

Bacteremia somehow focuses behind your eyes, stretching your optic nerves. You don’t want to look anywhere but straight ahead. I’m a train, you think, just keep rolling forwards.

Fluid shifts are peculiar. Some parts of you get pudgy while your lips and tongue become so dessicated they stick together, making your words come out sounding funny. Foods tastes like ash, IV pumps scream for attention all night (they are needy beasts and do not want anybody to sleep if they are not), your mind begins to narrow and can think of little but what is going on between your four gruel-coloured walls.

So many other details: the opioid anaesthesia of daytime TV in every room seeping into everybody’s brain, the vulnerability of the hospital gown, the conversations your team have outside your room, discussing your electrolytes and trends and immunological cascades as though these things weren’t intimately part of your complex human existence. The almost magical power of gratitude.

Because, of course, this was the lesson that was the most mighty. I made several Faustian bargains while on the inside. I looked at my life in context during this unexpected topple from invincible to tiny and dependent. And, no surprises, my promises were no different to any others in that situation. Illness like that focuses the mind, gets rid of all the extraneous stuff. Like a good purge. Family, loved ones, doing good, being a better doctor, finding ways to be kind in every single moment, taking nothing for granted, finding a way to wall off the rage I feel at the horrifying injustices in the world as though I, myself, am an encapsulated bacterium, living – yes, a cliché, but oh so true – in the glory of the moment of this short, terrible, terribly funny, ridiculous, joyful world. Oh, and buying one’s nurses chocolate.

About the author

Dr Michelle Johnston is a consultant Emergency Physician who works at an inner city hospital. Mostly her days consist of trauma and mess. Also, she writes.

Learn more