She was the same age as I was.
When I pulled back the screen, the smell of vomit assaulted my senses. She was bent over a gray pail clutched close to her chest, retching, though nothing came out.
"Hi, I'm going to be the medical student working with you today. How are you feeling?"
She tilted her head up and glared, "Bad."
I didn't know how to respond. The automatic response of practiced patient encounters took over, "I know that this must be really difficult, but I just need to collect some important information. If you wouldn't mind answering a couple questions, we'll do everything we can to make you feel better."
Grace* didn't say anything and for the rest of the interview, her mother responded for her.
In class, we are always taught to watch out for the "extremes of age." Order the extra tests to make the double and triple checks that the elderly and the neonates aren't infected with this or that rare bacterium. They have weaker immune systems and can't fight off the germs that are of no consequence to the general population.
The same warning doesn't apply to the recent college graduate who has had a clean record of health. 20-somethings, in the prime of their health, are supposed to be invincible. They are the ones who often come into the hospital because of alcohol overdose, and after a few hours of careful monitoring and blood tests, are given instructions to go home and sleep.
During the entire interview, Grace was hunched over the gray pail. The vomiting started six months ago for no apparent reason and it hadn't stopped. She had lost 15 pounds in the last six months, and you could see her shoulder blades shudder each time a heave started to build.
As her mother recounted the story that had been told many times to many other physicians in the area, to no avail, tears of desperation started to well up in her eyes. There was little I could do to comfort them. My reassurance that we will do everything we can to help rang hollow, even to me.
Grace was really sick, but she had been able to function outside of the hospital for half a year. We could help her no more by admitting her, and racking up thousands of dollars of bills every single day, than sending her home after assuaging her symptoms and trying our best to diagnose the underlying cause.
She was the same age as I was.
I wanted to tell her, "This is what you have, and this is how we can cure it."
But I couldn't. I didn't have the answer. I was only a medical student.
A few weeks later, a friend of mine died in a freak car accident, coming back from a wilderness spring break trip in Florida. There was no reason for the accident. The university had organized the trip, and the driver was a university employee. The accident happened in broad daylight, and Becky had been wearing her seat belt. Becky was in the prime of her life, one of the smartest people in her class, about to embark on a career at one of the most sought-after companies in the world. She also happened to be one of the most genuinely nice people I have ever had the chance to meet.
I struggled with her death for a long time. I didn't know how to accept it. Sometimes even now, I am surprised to find her photograph on Facebook and for a brief moment, allow myself to believe that she is still alive.
There was a running joke among our living group that Becky was "fierce," like the fiery curls that were beautiful on her even when she suddenly decided to cut them off one day out of the blue. And she was fierce. But you would never know it. She was that modest.
I always thought she would blaze her way through life, unhindered, with kindness. There was no reason why she never got that chance.
Helplessness is not something 20-somethings are accustomed to feeling. I don't think we understand mortality until we are confronted with it in the most unexpected circumstances. Learning about diseases from case studies that other doctors have already solved can sometimes be just a mental exercise. Though we always consider if there is enough reason behind a certain noxious procedure, we have yet to face the fear in our patients' eyes.
We have yet to learn how to treasure our own life and health.
*Grace is a pseudonym. All patient identifying information in the article has been changed to maintain patient confidentiality.