Part 1: Values
When I was ten years old, I learned that you breathe faster when you can’t fully inspire. I knew nothing of inspiratory drive, PCO2, or hypoxemia, but when each breath only gives half as much air as you’d like, you panic. You choke. Despite the mysterious tubes that the doctors and nurses placed in my nostrils, I panted. Each shallow expiration sounded unrecognizable as it jumbled with the raspy wheezes, and was profoundly unsatisfying.
It was my third day of hospitalization for difficulty breathing. Before my admission, I had a “cold” for a few weeks that did not improve. Occasional throat clearing and a bothersome runny nose became hacking coughs yielding thick yellow mucus, a stabbing sensation in my chest with each inspiration, and more frequent use of my albuterol inhaler than ever before. What I now know to be bacterial pneumonia superimposed on a viral upper respiratory infection was a mysterious constellation of ailments aimed at upending my young life.
“Why is this happening?” my mother asked the physicians and nurses repeatedly, worrying that she had somehow brought this upon me. “We thought his asthma had been well controlled. Why is he still so sick?” The clinicians were never able to give a clear reason beyond stating that my symptoms were likely worsened due to my underlying asthma.
The hospital overwhelmed me. The hum of cardiac and respiratory monitors beat on incessantly. My sleep was disturbed by the nondescript clamor of nurses, doctors, and other hospital staff persisting through the night. The itchy tugging sensation I felt whenever I moved my left arm, where my IV access had been placed, irritated me the most. My dimly lit room was never quite dark enough for me to sleep well and never quite bright enough to feel fully awake. I wanted nothing more than to go home.
I had lost count of the number of school days I had missed. Will Mrs. Moy make me submit all my homework at once? I would remain in the hospital for four more days before being discharged. However, my disposition towards the hospital began to morph. Subtle, unconscious thoughts became new unexplored ideas. Through this process of change, three sentiments prevailed:
Collaboration
Doctors, nurses, and respiratory therapists entered my room unannounced daily. They poked and prodded, disturbed my shallow sleep, asked mysterious questions, and vanished. One morning, a respiratory therapist came to visit me. I attempted to sleep on my side, with a few pillows tucked underneath my head. It was easier to breathe in that position. It was too early, and I wasn’t in the mood for another visit. My mother laid quietly asleep in the reclining chair a few feet from my bedside.
“Good morning,” the therapist said.
I ignored her, shifting in my bed to a different position, making it clear that I had heard but chosen not to reply. Despite my attitude, she introduced herself and guided me through the therapy process. At one point, she applied a painful amount of force to my upper back, and I began to cough up globs of mucus. To my surprise, I could breathe a little easier after the visit.
“Everyone here wants to see you improve,” my mother stated, having somehow observed our interaction. “That’s what we’re all hoping for, but you need to be more cooperative and less rude.”
As much as I hated to admit it, she did have a point. The frequent visits and constant attention from members of the medical team began to remind me of my mother, who remained at my bedside each day, adamantly refusing to leave. Of my father, who took every break from work to visit me and give my mother a chance to go home. The clinicians clearly wanted to help. Perhaps this group of strangers and my family were not so different after all.
Safety
One night, I woke to panicked nurses and residents at my bedside. They were detaching the wires that connected me to the monitoring machines. I was wheeled to a different hospital unit, where I received continuous albuterol overnight. I was terrified. Despite this, the team of physicians, nurses, and hospital staff did all they could for me. The residents listened to my breathing hourly, remembering what I had told them on prior visits and asking if I had improved, worsened, or remained stable. I chose to believe in that team.
“You are going to be alright,” my mother said, gripping my hands, her voice somewhat drowned out by the gentle hum of the albuterol nebulizer. I could tell she was forcing herself not to feel alarmed for my sake.
I noticed a small comfort. My mother trusted the medical team, and I wanted to trust them too. Each breath was raspy and occasionally interrupted by fits of coughing; my hands were tremulous, which I later learned was a side effect of the albuterol. Despite this, remembering the steadfast attention and dedication of the medical team strengthened me to believe I was in good hands. I felt safe amidst the chaos.
Power
Before the hospitalization, I had been short of breath for several days. This coupled with my asthma had ensured that I grew accustomed to difficulty breathing. Uncomfortably gasping for air had become the new normal.
After the night-long albuterol, I started to improve. With each day, I could take more deep and fuller breaths. I would sigh in relief as I noticed less pain with each inspiration. I felt more than relief. I felt powerful. The steadfast care that I received, coupled with my mother’s unwavering attention, resulted in marked improvement. The team of clinicians that I had placed my trust in had not only facilitated the process of recovery but also empowered me to not fear the disease process.
I was too young to understand the pathophysiology of asthma, pneumonia, and respiratory distress. However, I found that I was no longer afraid of these mysterious symptoms. To a young boy like myself, it felt satisfyingly rebellious to think that I had been so ill just a few days ago and would recover. Thanks to the people supporting me, I would overcome.
Part 2: Aftermath
Fifteen years later, on August 1st, 2021, I stood awkwardly on stage, facing 200 of my classmates and their loved ones. It was a scorching hot summer day, and beads of sweat dripped down my face mask. Names were called, and I held my breath as mine drew close in the alphabet.
“Esewi Aifuwa.”
I gulped before shyly extending my arms as the person standing behind me draped a white coat around my right arm and slid my left arm through the other sleeve. It didn’t quite fit, but I hoped it would soon. I took a moment to take in the surrealty of the moment. For how many years had I hoped for this day? I walked past the first few rows and turned left toward my seat. I stood up a little straighter than I had just moments before.
We recited the Hippocratic Oath. As I repeated the words, I wondered to myself. What exactly is my oath? What did I hope to accomplish for my future patients and for my practice? In that moment, pondering the many experiences that led me to this day, three sentiments came to mind.
Image credit: Tools of the trade by a.drian is licensed under CC BY 2.0.
Medical Student Contributing Writer
New York Medical College
Esewi Aifuwa is a fourth-year medical student at New York Medical College with a passion for writing and research. He aspires to a career in Hematology-Oncology. Outside of medicine, he enjoys weightlifting, video games, movies, and spending time with friends and family.
