Standing in the Doorway of Eternity

As you get caught up in emergency medicine, it s easy to forget that the people you care for and transport are human beings. We begin to think of them as cases or runs or some similar term. But they re mothers, fathers, parents, children, grandparents and more.

One of the greatest things about EMS is the diversity of humanity we encounter. The best and most professional EMTs I ve met do the job because they love people. But once you lose track of this concept, the whole practice of EMS becomes mundane.

So take time to listen to your patients. Sometimes, you ll learn that they were a part of history or have experienced significant events. I ve had a conversation with a Jewish woman who was the only one in her family who escaped the Holocaust, a Japanese man who was interred during World War II despite the fact he was an American citizen, a former prisoner of war who was held for six years in a North Vietnamese prison, and many more.

If you re in medicine long enough, you ll encounter patients who ll become indelibly etched in your memory. And, on certain occasions, the memories of these patients will come to the forefront of your mind. This happened to me recently. While running some errands in an older part of a town near where I live, my mind began to wander, and I thought about a patient named Etta Mae Jones.

I met Mrs. Jones one evening in 1995. I was working the night shift in the ED, and things were pretty slow. The nurses were passing time by cleaning out a refrigerator, moving some furniture and dusting. I was working on some page proofs I had carried with me to work. At about 11 p.m., the EMS radio crackled and a monotone voice revealed that they were en route with an elderly nursing home patient who had a fever. The brief report was not uncommon; the nursing home was one block from the hospital, and anything more detailed would have been useless.

The crew rolled through the ambulance doors. They had obviously been asleep before the call. They took the patient to the assigned room, and I could hear them kindly and patiently asking her to scoot to the hospital bed. They walked past, pushing the stretcher, and dropped off the nursing home records as they walked out the door. As they disappeared, I heard them say that they hoped they wouldn t be seeing us again that night.

The nurses assessed Mrs. Jones and got her ready for me. I took a brief look at the chart and noted that she was 102 years old. I thought I knew most of the centenarians in our community, but I had never met her. We had only three patients in the ED at that time; one was 91 years old, the other was 95, and then there was Mrs. Jones. One of the nurses quickly calculated the average age of our patients as 96 years. They do silly things like that sometimes.

So I grabbed the chart and went to see Mrs. Jones. She was an elderly black lady covered with two blankets. She appeared ill. Her eyes were shut and her face was wrinkled from years in the sun and the effects of age. Her hands and fingers showed that her life had been one of hardship and toil. I was unsure about her mental status.

I walked up to her bed and quietly said, Mrs. Jones. Her eyes opened, and she focused on me. She said, Is you my doctor? I said, Yes, ma am, I m Dr. Bledsoe the emergency doctor. Dr. Wilkins asked me to take a look at you this evening. She thought for a moment and said, That s fine. I hope I didn t get you out of bed. I answered, No, ma am, I m up all night.

I quickly assessed her mental status. She told me her name was Etta Mae Jones and that she was from Nash, Texas, but now lived at the Pleasant Acres Nursing Home. She was 102 years old and was born in Vicksburg, Miss., in 1893 on a beautiful Sunday morning. I could tell that she was as sharp as a tack quite unlike the other two patients in the ED.

I learned that she had started running a fever several days before and Dr. Wilkins had started her on oral antibiotics but she had not improved. She said, I ve got the rigors, and they just won t quit. I took her history and listened to her chest. The whole right lung field sounded horrible with rhonchi and wheezes. I ordered admission labs, a chest X-ray and asked respiratory therapy to come and obtain a sputum sample for the lab.

I told Ms. Jones that she would need to be admitted to the hospital because she most likely had pneumonia. She looked me in the eye and said, Doctor, is that necessary? I have been on this earth 102 years, and I think this might be my time to pass over. I said, Don t say that. You ll probably outlive me.

She laughed a weak laugh and said, You don t understand. I buried my husband over 50 years ago. He was a cook in the United States Navy and died when them Japanese sailors sunk his ship. I ve buried all of my children and half of my grandchildren.

I asked, How many grandchildren do you have? She managed a weak laugh and threw her head back and said, Lawdy, I don t know. I kinda lost count somewhere along the way. I got a lotta grandchildren, great-grandchildren and even some great-great grandchildren but I don t knows how many.

She motioned me closer and whispered, I don t know what to think of these young uns today. They shoot each other, never get married, have babies when they is still kids. They don t care about nuthin and nobody cares about them. I shook my head in agreement.

Figuring she wanted to talk I asked, So you never remarried after your husband died in World War II? She said, Oh gosh, no, doctor. When I married, I married for life. My husband may be dead but we is still married. I said, I guess you have seen a lot in your day. She said, Well, I have seen some some good, some not so good.

I learned that she was the granddaughter of two slaves given their freedom by President Lincoln in 1863. They fled Mississippi for Texas to avoid persecution. She told me about the Great Depression. She said, Oh Lawdy, them days were tough not just for us colored people but for the white folks as well. She told me that her father never wanted her to go to school because he needed her help on the farm. She had 11 or 12 kids she wasn t quite sure but three died in their first few years. Being an inquisitive doctor, I asked her what killed them. She said, I don t know. The Lawd just called them home early. I call them my angels.

She remembered discrimination and the Ku Klux Klan. She said, I always went to the bathroom at home before I went anywhere because I was not going to go into the colored bathrooms. She spent more than 30 years working for a nice white lady doing housework. But her employer died, and she was too old to hunt for another job. She also told me that she had never been in the hospital until 1955 and that was to have her appendix out. She said that her surgery was at this hospital.

I decided she needed to rest, and I needed to get back to work. I ordered her old chart from medical records and flipped through it. She was in amazingly good health mainly outpatient tests and a hospitalization for a kidney infection. I noticed her chart said Volume 2. Out of curiosity I asked the clerk to check with medical records and see if there was a Volume 1.

Within a few minutes the medical records clerk arrived with Volume 1. It was a testament to the history of medicine in the South. The doctors and nurses notes were made by ink pen in sometimes exquisite cursive handwriting. The doctors ordered drugs in drams and grains. I noticed that it was frequently noted that Mrs. Jones was moved to and from the annex.

I asked one of the older nurses (who had worked at the hospital for 30 years) about the annex. She said, Well, that was gone when I got here, but the annex is where they kept the colored patients. They would roll them across the street for surgeries and X-rays, but the rest of the time they stayed there in an open ward in the annex. It had heat but no air-conditioning. She said that colored nurses worked in the annex and occasionally a white nurse would have to work over there (for which she got time-and-a-half in pay). I asked, What happened to the annex? She said, Oh, they tore it down years ago to build the doctors building.

The admission lab results came back. Mrs. Jones was quite sick. Her whole right lung field was consolidated. We increased her oxygen. I spoke to Dr. Wilkins and wrote the admission orders. I went back to the room.

Mrs. Jones was again asleep. I touched her, and her eyes opened. I said, It is just as I thought. You have pneumonia, and we need to put you in the hospital so we can give you some potent antibiotics. She said, Don t go to that trouble. The Lawd has told me that he is ready for me to come home and I don t want to keep the Lawd waiting.

I knew she didn t have a Do Not Resuscitate form on the chart. I looked her in the eyes and said, You re sick, and I need to ask you a few difficult questions. If you were to quit breathing or if your heart were to stop, would you want us to start CPR and put a breathing tube in for you to breathe?

She said, Oh Lawdy, no! That may be a hard question for you, but it ain t a hard question for me. I have lived a good life. I have outlived most of my family. The Lawd is callin me home, and I am ready to go. Doctor, I m just tired … oh so tired … I m just tired.

I looked at her and said, Sure, I understand. We can t send you back to the nursing home. You re too sick. But we will make you comfortable here. Do you have any family here? She thought and said, The granddaughter who takes care of me moved to Georgia. It s just me, although I have a few kinfolks here and there.

I noted in the progress notes her desire not to be resuscitated and wrote the DNR order. Before long, the staff from the floor came to get her. As she rolled past me, they stopped, and Mrs. Jones said, Thank you, Doctor, for waitin on me. I m sorry to have troubled you. I said, It was no trouble. That s my job. I wish we had more time to talk. I hope you get to feeling better. She nodded her head and gave me a knowing look as they pushed her through the doors.

Three days later, I saw her obituary in the paper. Her funeral was evidently one of the largest in town in the past several years. In addition to more than 100 direct descendents, she had numerous friends and fellow church goers. The final sentence of the obituary said, Etta Mae and Willie Ralston are now together for eternity. I smiled and thought, That is as it should be. After all, they are married.

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