Metanarrative
Raisa Khan
This story’s first chapter begins in a hospital room that is glaringly bright, enough to make you squint. Shadows of what look like several people’s heads seem to peer down at me as I lay flat, shielding my eyes and quivering chin with my non-IV hand. I don’t know what these towering shadows are doing, but I do know they are all scarily focused on me. One of the shadows rubs my arm, saying they’re all here to take care of me. My eyes adjust, and another shadow resembling my father says something about school. I start crying—I realize I had missed my second-grade class’ trip to the zoo.
The chapter picks up again in high-chroma, like being greeted by all the crayons in a newly opened box. I have more yellow paint on me than on the construction paper strewn on my bedside table, but I have succeeded in my rendering of a savannah landscape. One of the shadows-turned-person walks in; his name is Mikey and we’re friends now, friends who high-five. I let Mikey listen to my chest with his funny ear tubes that look like licorice, and my plushie zebra—aptly-named Debra—lets him listen too. In return, Mikey listens to my story of Debra’s transcontinental escapades (complete with illustrations) and how Debra and I are going to the zoo once out of the hospital. Mikey says to say hi to all the zebras for him, and, a few months later, I do. This chapter ends with a Kodak photo my mother took: me, gleefully relating Debra’s origins, and Mikey, listening intently to the wild tales of a six-year-old.
The next chapter of this story begins in a dimly-lit ICU room; the chapter title is tinged fluorescent yellow. The room is warm, its thermostat maxed for its singular patient, and heated further by more than half the unit’s staff inside. The atmosphere is deceptively frenetic as everyone falls into their roles—overlapping in time and space, the flurry of activity surrounding the patient includes vitals, airway management, medications, fluids, documentation, nutrition, and more. Our patient is silent, but we hear him in the clear, decisive tones of the monitors in the room. This registers in my mind parallel to my concentration on my own task: I unfurl bright yellow roller after roller of Xeroform and help with the patient’s dressings, only exiting the room to return with armfuls more. The smell of petroleum jelly and that distinct acridity of electrocautery cuts through it all, pervading the air. A single bright light, almost a spotlight, is above the patient and the physicians at bedside, continuing the extensive escharotomies begun in the trauma bay. Illuminated above them are the writhing wisps of smoke that escape suction. Not two hours after the patient’s arrival to the unit, the last of us step out, peeling off our plastic gowns damp with sweat and stuffing into the trash any stray empty gauze wrappers.
Outside the glass of that heated room, my view of the patient—still known only as “Trauma India”—is finally unobstructed by the multitude of hands attempting to care for him. I cannot help but think that I have been unable to gather a history from him directly. What I know of his story flashes through my mind: my attending for my surgical rotation notifying me that we had an incoming patient with >90% total body surface area burns just before the trauma team activation announcement. The EMS radio report about attempted suicide by self-immolation, as witnessed by bystanders. Glimpses of upper extremities, already in severe contractures, and a leg, the flesh torn due to full-thickness burns posteriorly. Emergent escharotomies performed on nearly every portion of the body, almost mummified in places. Stabilization following the first and second cardiac arrest in the trauma bay. Now, in the ICU, covered by a bear-hugger, numerous lines, ventilator circuit tubing, and gauze.
Between the lines of his story, I can discern the reality that remained unspoken by every member of his care team: the non-survivability of this level of injury. Rather, the reality everyone acted on was that our patient came to us with a heartbeat. That alone was our imperative to do everything in our power—this book was not yet closed. Looking down at my scrubs, stained yellow where the Xeroform had seeped under my gown, I was reminded of my hospital stay as a child. Despite his ophthalmic injuries, did he feel our presence as faceless silhouettes hovering over him? What drove him to want to end his story, to no longer want to tell it—had he felt there was no one who wanted to hear, read, or know it? I have to wonder if he could feel our fervor to ensure that story continued, even for just a while longer, that we listened to the story told by his still-beating heart and his laboring lungs, that every intervention was an attempt to make clear our intention to keep listening.
The next chapter is in a primary care office. I am completing a PHQ-9 depression screening with “Anna” when I notice her bouncing knee, averted eyes, and fidgeting fingers. I remember Xeroform and zebras and school trips and—I sit down opposite Anna to listen. She relates becoming a character in the tale of her illness, a peripheral narrator of a plot written by her diabetes rather than her own will. I am audience to an author whose narrative has been wrenched out of her neuropathic hands by her A1C, reduced to a player on a stage set by constant finger sticks and pill organizers. How does one reclaim the story told by the body as one’s own again? As Anna, my preceptor, and I form a plan that addresses her mood and blood sugar, I realize that this is the question the story of medicine is dedicated to answering by listening to a hurting storyteller.
My own story is still unfolding as I begin residency; the stories I have been entrusted to carry within mine will always have a chance to continue so long as there is someone to listen.
Raisa Khan is a PGY-1 in the Med-Peds program at UMass Baystate. She has always found solace and joy in storytelling of all forms, from between the stacks of her local library to crying (happy and sad tears) while watching Kung Fu Panda. Her exploration of the humanities has led her to places both whimsical and poignant; she hopes to discover more of her own and others' hearts through future creative endeavors.
