Mistakes

In the fall of 2018, The Nocturnists put out a call for a story about mistakes. I wrote this for them and was selected to share at the Brava Theater in front of an audience of 350 people. Here is a link to a recording of the story as well as an interview with Emily Silverman, who runs The Nocturnists and is one of my favorite people.

You may notice that the transcript and the recording are not the same…that’s because I was nervous. Sorry.

Three Mistakes

My college experience started on a bad note. I went to college in LA, about 40 minutes from where I went to high school. After my first night sharing a room with total strangers, I got a call to go back home because my dad was going to the hospital. They had called an ambulance and I was to meet them there. When I got there, a nurse pulled me aside and told me he died. The linoleum floor was reflecting the fluorescent lights and all I could think was that I didn’t make it in time. He had a heart attack and died at age 50. I was 18 years old.

Fast forward two years. It’s a warm sunny day in Los Angeles when my mom brought up the idea of having surgery. I had just finished my sophomore year of college and I was home for the weekend. She wanted to lose weight, she said. And she had tried all the typical things. Every fad diet and every workout program.

She’d been a bit overweight my whole life, but I never really noticed. My brother and I were both ambivalent about the surgery. We didn’t know what bariatric surgery was about. She explained to us what it looked like and where she would get it and asked “do you think it’s a good idea?” Of course I agreed. My brother did, too. You see, my mom was an OBGYN in Mexico, before she moved to the US. She once delivered 13 babies in one night! And she understood the risks of the surgery. We trusted her, as we had our whole lives. My mom moved to this country so that I might have a better life. She came here speaking little English, leaving her family and her career to find safety and a better future for me and my brother. And so she did research and she picked the best hospital in the area, with a surgeon who had a great reputation. And she had the surgery. That was mistake number one.

In the days after the surgery, her recovery was slow. She had to give up her beloved coke zero and was having a hard time keeping liquids down. Ordinarily, she was sharp and funny. She had a sailor’s mouth and spoke a million miles an hour. But she was in pain and she wasn’t herself. So, we went back to the doctor’s. We waited 30 minutes in an exam room when a tall young man in scrubs and a white coat walked in. He was a beacon of hope and confidence. I explained that she had recently had a sleeve gastrectomy and that she was in a lot of pain. He listened and nodded. “Let’s get her some fluid and make sure she’s not dehydrated” he said. “This type of pain is normal for patients who have recently had a bariatric procedure” he said. He gave me new medications to help her with her nausea and gave me instructions on how to manage her pain. The nurse came in and hung a bag to my mom’s IV and I felt like I had done my job.

I felt relieved that this was normal. The doctor even said so and we trusted him. That was mistake number two.

After a day in lab at my summer research job, ever the pre-med student, I was headed home to help my brother, who had been there all day. We were taking turns taking care of her. My mom was laying on one couch in her baby blue two set pajamas, and I was lounging on the other. She was still feeling nauseous and in pain, but the medication seemed to be helping. Even though she wasn’t feeling great, I was looking forward to spending some time with her. I didn’t often get a chance to go home and when I did she would spoil me with homecooked food and we’d spend hours talking. My mom had a policy where she wouldn’t lie to me if I asked her a direct question, so we often talked about relationships and school and work in a way that felt raw and unique to me.

She got up to take a shower and I flipped the channels.

A few minutes later, I heard a loud bang from the shower. I bolted up and ran over to the door. I knocked. No reply. I knocked harder. Still no reply so I cracked the door and called out “estas bien?”

Nothing.

I opened the door fully, and saw she fell and was lying in the tub, the shower curtain pulled from its rod. I grabbed the towel next to me and covered her:

“Are you alright?”

“Yeah, I’m okay.”

“Que paso?”

“No se. Me cai”

And then she started mumbling things that didn’t make sense. It lasted for a while and I was terrified. I called my uncle because I didn’t know what else to do. We decided to call 911. Better safe than sorry, we thought.

I finished dressing her and tried to help her stand again. I thought of all the times she had showered me and dressed me. It felt foreign to be on the other side, especially in this home.

She was making a little more sense now and I felt kind of foolish for calling 911 but also grateful that they were coming and that my uncle was coming and that I wasn’t alone anymore.

“Help is coming mom, you’re okay. Everything is going to be alright. You fell in the shower but you’re okay. I’m right here.”

“Gracias, gracias, gracias” she said.

The EMTs arrived, painting my neighborhood in blue and red. They took her to an ER that I unfortunately already knew. It. I didn’t want to go back there but my uncle and I chased the ambulance as they made their way across town.

In front of the ER, the double doors of the ambulance split at the seam and burst open. Out came my mom on a stretcher, only one of the EMTs, the one who had assessed her in the living room, was on the bed performing CPR. Fuck, I thought. They wheeled her through the sliding double doors and into the trauma bay where I could see the fluorescent lights and linoleum floors.

My uncle and I sat in the waiting room and waited for news. We waited for my brother to arrive. We waited for something to hold on to. We waited for hope.

The doctor came and spoke to me. They were able to get her heart beating again and she was on medication to control her blood pressure and heart rate. They had done some imaging and told me that she had what appeared to be a ruptured small intestine. She also had what he called dark spots in her brain. He said she might not make it out and that even if she did, she might not be the same person she was before. We were to wait for her to stabilize before an emergency surgery.

I went back and told my uncle and my brother. They put us in a small room labeled “quiet.” It seemed clear that this is where they sent the families of the patients who died because there were fake plants and brochures for funeral homes in plastic stands.

When my mom was moved to the ICU, we all breathed a sigh of relief. It felt like progress. I still thought she was going to get better. They let us into her room once the nurses and the doctors and everyone else had a chance to get caught up. She was intubated and had two IVs coming off her arms. They had her bed leaned back so her head was below her feet and she looked uncomfortable.

I felt a knot growing in my throat when I tried to form words. I was scared she wouldn’t be there for when I graduated college. That she wouldn’t see me to go to medical school or become a doctor. I was sacred she wouldn’t be there when I got married and that she wouldn’t meet my kids and help me teach them Spanish like she taught me. I was afraid of going back home without her. I was afraid that nothing would ever feel the same. I was not ready to lose her, to be alone.

Not long after, a light went off above her door. And then everything happened at once. A dozen people rushed in to her room and pushed us out. People were shouting orders, and someone began doing compressions. CPR again.

After a few minutes, the doctor came to me said that they could do compressions for as long as we wanted, but that there were no other medicines they could give her. There were no other options, he said.

This was it.

Perhaps it was the normal temperature of the hospital, but I felt so cold. My whole body was weak, and I felt cold and I felt numb. I think I was in shock. My mind was refusing to grasp what was happening, what my body was already beginning to process.  

And this wasn’t just about losing my mom. This was round two. My dad died at the very same hospital. I realized I was about to be an orphan.

While doctors and nurses were doing chest compressions, pressing down on her body over and over again, my uncle frantically called priests to come and absolve her of her sins. I come from a Catholic family and even though my mom had not been to church since my dad’s funeral, it felt right that my uncle was looking out for her eternal soul.

My vision was blurry from tears and I felt the eyes of every person at the nurses’ station focus on me. I leaned against the counter, unsure I could stand on my own. My brother wept silent tears next to me, shaking his head and occasionally pounding his fist on the same counter that was keeping me from falling apart.

I wondered if I should go into the room. If I should be there when the father gave my mom her final blessing and when they stopped doing compressions. A picture popped into my head. My dad. Lying on a hospital bed with a tube coming out of his mouth and a blanket covering his body up to his neck. His body was still his but somehow not. It was cold and his lips were dark and his eyes were closed. And he was dead.

No. I do not want to remember my mom that way, I thought. And I stood, glued to the spot, as tears now openly streamed down my face, knowing that this was the day my mom died and that there was nothing I could do. I felt like I was losing her and abandoning her at the same time. That was mistake number three.

She died. I was 20, my brother was 21. Her last words to me were gracias. Every day since, I’ve been without a mom. Without parents.

Now, I’m in medical school, and recently, I had my first shift in the ED at Stanford. As second-year medical students, we are offered an opportunity to practice placing IVs and getting ECGs. A friend of mine astutely summarized these ED shifts as an exercise in staying out of the way. As my first shift was coming to an end, a call came down that a patient was being brought in and was undergoing CPR. I was in the room and the nurse asked if I would help. It was my first time doing CPR on a living person and not on a plastic mannequin. His chest felt different. There was no metal click to let you know that your compressions were deep enough. When I looked to my left, I saw his belly undulating with each compression. When I looked to my right, I saw his face, covered in blood from the intubation. For about 20 minutes, we tried to revive this patient. And we couldn’t. He died that day.

All those mistakes, the surgery itself, the trip to the doctors, and standing outside while they did CPR, well they have haunted me for years. Being in that room when the patient died clarified a lot of things for me.  

I realized that the surgery may not have been a mistake after all. Don’t get me wrong, I would give anything to have her back, but I think the surgery was a way for her to take control of her life, as she always did. She divorced my dad when he wasn’t meeting her expectations, she sued Toyota and won when they sold her a bad car, she bought a house in this country that often crushes immigrants, she raised two kids to be strong and sensitive and driven. She was courageous and fearless and she saw this surgery as a way to move forward. And it went horribly, painfully wrong. This is not a common outcome from this procedure.

The trip to the doctors, though, where they gave her some IV fluids and sent her home, is harder to reconcile. I can’t help but feel that maybe that doctor, whose face and name I don’t remember, didn’t take us seriously. Maybe he dismissed her pain because she was a woman. Maybe he dismissed her pain because her English wasn’t perfect. Maybe he dismissed her pain because she was overweight and had an elective procedure. Maybe he was just tired or overworked or busy. But he sent us home. And my mom deserved better care. 

I know staying out of the room when they were doing CPR may not feel like a mistake to you. Every person I talk to always says something like: you were there for her when she needed you, you did everything right, and she wouldn’t have wanted you in that room anyway. Even my therapist says that. But for years, I felt like I abandoned her in those last moments. Her last words to me were gracias and I abandoned her.  

But my one shift in the ED taught me that they would not have let me in that room even if I wanted to be in there. And more importantly, it’s clear why I should not have been in that room when they were doing CPR on my mom. Medicine can end suffering, but it can also look a lot like assault. It’s violent and aggressive at times. And my presence there would not have helped anyone. I am glad that I do not have a memory of my mom in that light.

In my eyes, medicine can be a force for healing, for empowerment, for starting a new chapter, and for ending suffering. But it can be flawed. And it’s riddled with mistakes. I’m scared of making mistakes as a doctor, but I’m also glad I am on my way towards becoming the person that can bring someone back from the edge, someone who can hear someone else’s pain and do something about it. I have spent a lot of time agonizing whether these moments in my life are mistakes or not. And honestly, I’m not convinced it matters. I think what matters most is what we learn from these experiences. I’m still learning from mine. Thank you.