A Hand to Hold

By: Ally Waldron

I first met her in the ICU where she was recovering from a suicide attempt. Her wrists were painted in a web of silver scars that trail up to her elbows. She clung to her mom’s hand as if when she let go, she might drift away in a sea of hospital sheets, tubes, and leads. She is deemed a good learning case and is assigned to me, a second-year medical student on my internal medicine core rotation.

After spending probably too long pre-rounding on my first patient, I knock on her door, still rubbing hand sanitizer into my hands. I walk in to see her lying on the floor next to her bed, clutching her tangled white hospital sheet to her chest. Her sitter quickly reassures me that she did not fall but was feeling anxious in her bed and was more comfortable on the cool floor. She is breathing quickly, nearly panting, similar to how she was breathing yesterday when I met her in the ICU. I reminded myself her chest imaging was clear and she has been saturating well on room air. The team ultimately attributed her tachypnea to her severe anxiety. 

I push a chair out of the way and sit down on the floor next to her. I ask her how she is feeling and she tells me she is very anxious and that the feeling of the cool, hard floor was calming her a bit. I tell her I am sorry she is feeling so anxious and ask what I can do to help. 

She pulls her hand out from under the sheet and reaches toward me, “when someone holds my hand, real tight,” she says, “it sometimes helps.” 

I reach forward, fold her hand between both of mine and ask, “what kind of things do you do to feel calmer at home?” She says she listens to music. I tell her we can turn some music on for her if she would like. Her hand is shaking, sandwiched between mine, but she nods. She takes a few slower deeper breaths and I let us sit in silence for a few seconds. Her pulse is racing against my fingertips, but reassuringly, I can feel it is regular. I try to calm my own body and send a sense of ease through my hands. My watch lights up with an alert and I notice the time.  I still have two more patients to see before rounds start in 15 minutes. I need to hurry or I will be late. 

I ask about the abdominal pain she mentioned yesterday. And she tells me she has a “ball of hurt all over” in her stomach, but also in her mind. I ask her if she is having trouble breathing and she tells me “yes, when I get anxious, I feel short of breath and I am very anxious in here.” I slip my hand from hers briefly to listen to her lungs. She is breathing quickly, but I do not hear anything abnormal in her lungs. I loop my stethoscope back around my neck and reach for her hand again. “Your lungs sound good” I tell her. I get her chatting about her favorite music as I palpate her abdomen with my free hand and it is soft, non-distended, and mildly tender in all four quadrants, same as yesterday. 

“When will my mom get here?” She asks. I tell her I spoke to her mom this morning and she is on her way over from the coast now. I take a few seconds to watch her vitals on the monitor before meeting her eyes again, “I am sorry, I have to go, but I will come back down after rounds.”

For a moment, I am afraid I will have to repeat myself because she tightens her grip on my hand. Then her hand falls away from mine and she pulls the sheet to her chin, laying her head back down on the floor. I ask if I can tuck her back into her bed, but she tells me she feels safer on the ground. I look up at her sitter and we shrug at each other, a silent approval to continue doing the one thing comforting her amidst so much uncertainty. She lets me slip a pillow under her head at least and I stand up to leave. “I will be back after rounds,” I tell her, “think about what music you might want to listen to.” I pass my senior resident just outside her room on his way in to see her.

I see my next two patients and am halfway back to the workroom when the intercom scratches to life overhead. “Code Blue. 5 West. Room 511.” I barely process it and keep walking, rehearsing  my presentations for rounds in my head. It repeats “Code Blue. 5 West. Room 511.” 

I was just in that room. I spin around and burst into the stairwell. I fly down the stairs, thinking it must be a mistake. I run the rest of the way down the hall when I see the blue light flashing above the door and people running from all directions into her room. 

I turn the corner into her now crowded room. At some point she made it back into her bed, though her sheet remains crumpled on the floor where I left her. The code team leader says, “someone get on the chest.” Having lost IV access, a nurse starts an intraosseous line in her shin. I catch a brief glimpse of her face before they bag her. My senior resident starts compressions and the sound of bones beneath well-intended hands is one I will never forget. 

I have this strange urge to yell out: “Wait! Her mom is coming in to hold her hand. I was going to turn on music for her. Wait! She likes it better on the floor.”

I cannot stop staring at her left arm flopped over the side of the bed, her empty hand bouncing up and down with each compression. There is blood leaking out of the IV in her hand. The code leader calls out for others to do compressions to relieve tired hands. 

I pull my gaze from her empty hand and release the tight grip I have on my own upper arm. I will  have four small bruises there tomorrow from my own fingertips. I step forward towards the line of people waiting to do compressions. I remember being too afraid to look at her face when I stepped up onto the stool.  The thought of further connecting the horror around me to the young woman I had been getting to know terrified me. I wanted to hold onto the image of her sitting on the floor telling me about her favorite music instead of what I might see if I glanced away from my hands centered on her chest. 

It goes on for 52 minutes. Two rounds of tPA, ten rounds of Epi, and 13 shocks. 

The code leader calls it. Time of death 9:22. Her mom is still on her way in to hold her hand.

My head is buzzing. My shoulders burn. Sweat drips down my stomach. My hearing is muffled and my ears feel like they are full of cotton. The chaplain comes in to say a prayer, but I do not hear a word. I clench my jaw in an effort to hold back tears. The blood is still dripping out of the IV in her empty left hand, but now it hangs motionless. 

She died. 

I left her lying there on the cold floor. I turned around and I walked out when all she wanted was someone’s hand to hold. But I was in a rush. And then she died.  

My residents tell me the first time is always the hardest. The first code is the one that sticks with you forever. They say it gets easier each time. My attending reminds us of the unexpected nature of the code and says there was nothing more anyone could have done for her. But I cannot help but think he is wrong. There was more that could have been done. I could have stayed with her that morning. I could have stayed there on the floor and held her hand for just a few more minutes. I tuck this knowledge away and carry it with me as a reminder to always take the opportunity to reach out and hold a patient’s hand so that I can say with certainty there was no more that could have been done. 

Ally Waldron is a third-year medical student interested in pediatrics. Throughout her clinical rotations, she has meticulously kept a journal of clinical experiences to help process difficult moments. She wrote about this moment during a IM core rotation that she often thinks about and remembers vividly as well as has been noted to have changed the way she interacts with patients and her role as a training clinician.