A Sign of Weakness

The patient was alone in a double room. The light in the room was golden, the late sun of the July evening slanting through the high window. The face that turned to me as I knelt at the bedside was curiously unwrinkled. Her skin had a stretched and polished look, her features strangely immobile, the entire effect disturbingly like a doll’s face. Her chest rose and fell, but her nostrils did not flare. Her mouth was a tight puncture in the centre of her face. Only her eyes were mobile, following me as I moved.

‘What seems to be the problem?’ My voice had taken on a strange quality: tight, almost strangled.

‘Are you my doctor?’

‘I’m the doctor on call,’ I explained.

‘I can’t breathe.’

I looked at her for a minute.

‘What do you mean?’

‘I can’t…catch my breath.’

I thought, but nothing brilliant came to mind. ‘Are you feeling dizzy?’ I asked.

‘No. Just. Short of breath.’

I watched, counting. They were quick, shallow breaths, about twenty-eight of them to the minute.

I bent over her and placed my stethoscope on her back. I heard air moving, in and out, and a faint, light rustling, like clothes brushing together in a darkened closet. ‘I’ll be right back,’ I said, and left the room to find her nurse. A few minutes later the nurse reported back to me. ‘Eighty-nine per cent.’

‘Is she on any oxygen?’ I should know this, I thought. I’d just been looking at her.
The nurse shook her head.

‘Put her on two litres and check again.’

Ten minutes later the nurse was back. I was in the doctors’ workroom, looking up ‘scleroderma’ on the Web.

‘Ninety-one per cent.’

‘That’s better,’ I said hopefully.
The nurse shook her head. ‘Not on two litres. Not how hard she’s working.’

‘You think she’s working hard?’

The nurse smiled thinly. ‘Do you want to check a gas, Doctor?’

I smiled back, genuinely relieved that someone was willing to tell me what to do. ‘That’s a great idea,’ I said. ‘Can you do that?’

‘No. But you can. I’ll get the stuff.’

An arterial blood gas is a basic bedside procedure – the kind of thing third-year medical students are encouraged to learn. It involves sticking a needle into an artery and drawing off three or four ccs of blood. The reason a doctor has to draw it is that arteries lie deeper than veins. Even the relatively superficial radial artery – at the wrist, the one you press when checking a pulse – lies a good half-inch deep in most people, and sticking a needle in it stings more than a bit. I was not at that time very skilled at procedures – the arterial blood gas was about the limit of my expertise – but to my relief I had no trouble getting it: bright red blood flashed into the syringe. The patient bore this without a grimace, although by now I wondered if the skin on her face was capable of expression at all. Her eyes regarded the needle in her wrist.

‘How are you feeling?’

‘A little. Better.’

I pulled the needle out, held a pad of gauze to her wrist.

She subsided into the bed. ‘But still. Short of breath.’

I watched her. Twenty-six, twenty-eight. Shallow, the muscles at her neck straining with each one.

‘I’ll be back in a bit,’ I said, rising with the syringe in my hand. ‘Call if you need anything.’ But it’s a sign of weakness, I echoed to myself. I hurried on down the hall, the echo following.