Month/Day/Year

Audrey DuBose

My eyes were darting from the clock to the chart, then to Mom, then back to the clock (always to the clock). The second hand was jackrabbiting away - forty-seven seconds too long of our forty eight-second (and counting!) visit had been spent answering my “Happy Birthday!” greeting. He mentioned something about a party that evening, but I was preoccupied, mentally rehearsing the checklist of questions I had to ask. At three minutes in, we’d only gotten as far as review of systems. Wait, did I ask about allergies? At seven minutes in, my eyes remained fixed on either my screen or the clock, but never the child - except during his physical exam! I had to present, of course. At eight minutes in, I got a long-winded explanation of his favorite foods. My eye started twitching. At ten minutes in, I hurried to my foot-tapping preceptor’s office.

I presented. “Work on improving efficiency.” My other eye started twitching. Next well-child exam has been roomed. Rinse and repeat. 

Of the things I recall from that encounter, the names of this sweet boy’s friends - who he was so eager to celebrate with that night, who he was so eager to tell me about – shamefully weren’t among them. I wish they were. My memory of that brief visit is colored by misdirected frustration with him for lack of brevity, but also with myself. Outpatient clinic is a pressure cooker, and however transiently, my priorities shifted from patient care to performance. And did he notice the difference? Did it matter?

Later, more gutting than an overly-wordy history or flawed assessment is self-inflicted moral injury of identity confusion - shedding some of the bright-eyed idealist that led us here. Sometimes I lose little bits of her.

***

A drawl told me she was an out-of-towner, but then again, at a tertiary care center, our patients hailed from all over the rural South. I wish her name weren’t lost on me, but I do remember how fragile she looked in her hospital bed: I raised my eyebrows when she agreed to a game of gin rummy, as if merely entertaining my nervous invitation would be enough to exhaust her (either the blue volunteer polo and ill-fitting khakis were uncharacteristically compelling that day, or more likely, she pitied me). Had I known then how to make a clinical assessment, that “sick or not sick” distinction, she would’ve been sick sick sick. Even if I’d known then about the pathophysiology of malabsorption in CF patients, and about heightened energy requirements and low body weight, I still would’ve thought she looked close to death.

So soon thereafter, when I’d heard that she’d died, I’m not sure why I was so struck. Regardless, the unbridled devastation floored me. Illness had long been an unwelcome stranger in my family’s lives, and at that time, I was grieving one parent while halfway towards losing the other – but still! So affected I was by the death of a girl I’d known for less than ninety minutes, with whom the topic of conversation was limited to who’d deal the cards next.

What I couldn’t shake was her birthday. Month, day, year - same as mine. We were pink, summer babies brought into the world screaming for air but with two quite different sets of lungs. Rural vs suburban. Sick vs not sick. Patient vs (future physician). Parallel timelines, but two roads that diverged seemingly from that muggy day in June onwards. Why should she have been damned with sticky airways and unmet milestones? Why should she have known terror not of shadow creatures lurking in closets or underneath beds, but of airborne pathogens setting up house and brewing chaos? Why should she? Why shouldn’t I have? 

Month day year. What a terrifying privilege it is to confront your mortality from a safe distance. What a privilege it is to wield it as a call to action.

In my undergraduate Spanish coursework, I learned about the “se me” accidental reflexive, a neat grammatical structure with a tendency to mind-boggle English-hardwired brains. It’s used to express unintentionality: what in English is the object becomes the Spanish subject, reassigning it blame and softening personal agency. “Se me perdieron las llaves” is not “I lost my keys,” but rather, roughly, “My keys lost themselves on me,” or more simply, “My keys got lost.” Perhaps not to native speakers, but to this learner trying to wrap her mind around the construction, it has this nifty, convenient, guilt-absolving connotation. 

Sometimes I lose little bits of her. Sometimes she gets lost on me. Better, right? But no - the guilt is a glaring, desperate reminder of that moral injury, of infidelity to that call to action. Even scarier than that terrifying privilege is a brief lapse in faithfulness becoming total abandonment of principle.

In writing this, I remembered her name: it’s fitting, shared by a Live Oak-smothered, charming little town in the deep South, with people with lovely lilting accents, thick as hers. Chokingly humid and sunny. 

The name reminds me of home, of her, of me. Sometimes I lose her. She gets lost on me. With another game, though – not gin rummy, this time, maybe something akin to hide-and-seek – I’ll find her.

We’ll meet again.