Sayed Tabatabai, MD Profile picture
Aug 3, 2019 23 tweets 5 min read Read on X
Everything about the hospital scares her.

The strange chemical odors, the uniforms people wear, the bed she’s in with all its buttons, the machines that beep around her, even the ones on her legs that squeeze-relax-squeeze throughout the night.

She longs for home. 1/
Home, for her, is many hundreds of miles away. Perhaps thousands.

Her children came to this country for a better life. Now she comes to be with them in the twilight of her years. They work so hard, they can’t always be with her here.

But no matter. She won’t complain. 2/
She speaks broken English. The doctors come in every day to see her. She understands perhaps every sixth or seventh word they say.

Sometimes they call someone on the phone to translate, who speaks her mother tongue. Sometimes they don’t.

She doesn’t want to be a bother. 3/
“Pneumonia” is what they tell her.

All she knows is it hurts to breathe. Sometimes she wakes up in a panic, coughing and gasping. The oxygen irritates her nose, but it helps. Her ribs ache.

Her grandchildren come to see her, filling her room with sunshine... 4/
Deep in her heart, she knows she is sicker than they tell her. They are using different words now..

“Idiopathic pulmonary fibrosis.”

It sounds important. Almost royal. She is too unimportant for such big words! She allows herself to smile.

But her children seem sad. 5/
Above all else, she doesn’t want to impose. Her nature is to nurture, not be nurtured.

The food is so bland. Her tongue was raised on cumin and coriander and saffron and paprika. Now it strains to taste anything.

Her nurse smuggles her a samosa one day.

She is delighted. /6
Her room makes her claustrophobic. The same four walls. The same TV.

She is becoming increasingly confused, and losing track of time.

One night she wakes up and finds blood dripping down her arm. She cries out, and is embarrassed to learn she has dislodged her IV. 7/
She offers to help clean the sheets but her nurse only smiles and tells her it’s okay. She apologizes profusely.

Her mind wanders more frequently now. She finds that her memories are vivid, real.

Sometimes she can’t tell if she’s awake or asleep.

This frightens her. 8/
One night she wakes up short of breath, only this time she doesn’t get better.

Her nurses are there quickly, reassuring her. They put a special mask on her. It hurts her nose and blows air into her face very hard. But it helps.

She is wide-eyed with fright, and sobs. 9/
They move her to a new room. It is less drab than the old one and larger.

She has her own nurse now. There is a couch and her children are spending every moment with her.

She cherishes them, but is also embarrassed at being such a bother. She tries to shoo them away. 10/
Her confusion is becoming worse.

She is mortified to realize she is having bouts of incontinence. Her daughters help her because she is too ashamed to ask a stranger, even one as kind as her nurse.

Sometimes she lies in bed and rambles in her mother tongue. 11/
She sees the house where she grew up. It is real to her. She runs through every room. The smell of breakfast in the morning greets her. She sees her parents, and her siblings.

But the vision slowly fades, and she realizes she’s back in her bed, tethered with tubes. 12/
They’ve inserted tubes in places she could never have imagined. It feels like her dignity is being taken away from her, and she can’t fight it. Her strength is waning.

She is tired, so tired.

She resents what they won’t tell her.

She knows the unspoken truth. 13/
Once, when she was a young mother, she almost lost her son in a busy market. She turned her back on him for a moment and then he disappeared.

She ran through the market, screaming his name and pleading with strangers.

Mercifully, by the grace of God, she found him. 14/
The memory comes flooding back to her, and becomes her reality.

She screams her son’s name, thrashing in her hospital bed. Her son is there and tries his best to reassure her, as tears stream down his cheeks.

The nurses give her medicine and she feels the panic subside. 15/
She is becoming less and less responsive. She is dimly aware of hushed conversations taking place. She catches snippets of words here and there.

She used to play Scrabble with her family, and some of these sound like words her children would make up and insist were real. 16/
One day, without fanfare or ceremony, she realizes that Death is in the room with her.

He sits in the corner of the room, pensively observing her. He doesn’t scare her, but she knows who He is.

She begs with Him for more time. What will her children do without her? 17/
The nurse sitting at the station outside notes an alarm on the cardiac monitor.

Small runs of an unstable rhythm.

The patient’s son notices that his mother’s breathing has become more shallow. She is sweating. He moves to her bedside and tenderly wipes her brow. 18/
Death walks to her bedside and gently takes her hand. She feels the old panic of losing her son in the market, but He reassures her.

No one we love is ever truly lost.

She is a child again and remembers her home, and being held by her mother.

Her eyes close. 19/
Several nurses run into the room with a crash cart in tow, but her son gently shakes his head. “Let her go in peace,” he says.

He gently brushes her white hair from her brow, and remembers how she would do the same for him when he would get sick.

And he weeps. 20/
The hospitalist dictates his discharge summary. “Patient with progressive hypoxia and worsening delirium.”

He pauses, idly scratching his chin.

“Required 1:1 sitter and restraints. Oliguric renal failure despite IV fluids, Foley. She went into cardiopulmonary arrest.” 21/
He finishes, “Family decided to proceed with DNR status. Time of death 7:14PM.”

He hangs up the dictaphone, takes off his glasses and rubs his eyes wearily. Then he scratches her name off a list and moves on to his next dictation.

The night is young.
(In loving memory of my grandmother. Not a day goes by that I don’t think of you. Every time I set foot in the hospital, every single day, I say a prayer in your name.

I wrote this for all the stories we never get to hear, and all the patients who never get to tell them.)

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