A determined young lady, Elisa was going to be the first in her family to finish college. Her parents had made significant sacrifices to help her achieve this dream. In fact, they stopped paying for health insurance to save for tuition. I offered our social work services to assist with coverage issues. Elisa declined, saying she could not put her family further into debt.
Home for the holidays, Elisa was a college student, who arrived in the ER with severe abdominal pain. After blood draws, radiological tests, specialist consults, and an invasive diagnostic procedure, we finally learned the source of her pain: cancer.
My patient was veiled in layers of heavy black cloth from head to toe. I could see blood staining her white socks as I waited impatiently for a female Arabic translator. Slowly, I told the patient and her sister that I was worried about her pregnancy, and would need to do a pelvic exam. As feared, I soon saw that she had a miscarriage. “Can I see the baby?” she said, gesturing to the container I discreetly covered with a clean towel. “We need to take him home for burial,” the sister added. I hesitated. A 12-week fetus wasn’t an easy image to prepare someone for. I laid it on clean gauze and explained, “It’s very early. It won’t look like a baby.” My patient nodded and held out her hand. At the sight of it, she shrieked, then clutched the fetus to her chest and began to pray.
Cheryl was a cancer survivor, recovered drug addict, HIV carrier, and devoted mother of 3 kids. At age 35, she had been cured from cervical cancer after surgery and radiation therapy. However, due to treatment-related fistulas, she had been in and out of the hospital for most of the year. I was taking call for the gynecology service the last time her family brought her in, delirious and with black, sticky stool oozing from an opening in her unhealed abdominal incision. She needed wound care and close monitoring in the intensive care unit (ICU). I called my attending and paged the ICU team simultaneously.