She Hums

She was a young thirty, short red-brown hair, a small nose—cute, freckles inhabiting her round face, an ocean of blue in her eyes.  She was a wonder, beautiful, but pale and thin, a reed, the cachexia of late stage mitral valve disease.  Yet she exuded estrogens.  In heart failure, she was sexy.  How could I help but notice: I was a junior resident in surgery, twenty-six, and had my own hormones to deal with.  I was restrained.  She, married for six months, sat next to her husband.  A contrast, he was over six feet, dark, wavy black hair as thick as winter fur, handsome too. 

Breathing was not an easy in-out for her as she answered my questions.  Short of breath so that she could not complete a sentence.  “Why did you wait so long to come to a doctor,” I asked.  She hummed, no tune I knew, before answering.  “No money.”   Before every answer, a hum.  The hum, I believe, a means to gather her thought and her breath.  She was so much like a small bird, protected by an eagle.   

Those were the days, the fifties, before Medicaid became available, when patients came to the wards of teaching hospitals for free care.  The surgical wards, male and female, at Mt. Sinai were forty beds, spread out over a room the size of a football field.  In the center of the room, standing guard, were the oxygen tanks, green soldiers, five feet tall, ready.  On the male ward, I remember making rounds at midnight, seeing an eighty-five-year-old man, an inhabitant of the hospital for weeks, each night, rising up from his bed, slumbering to the oxygen tanks to chat with these men in Italian.  A hospital Hamlet. 

The nurses station located at the entrance to each ward was the general headquarters for the caretakers: the center of action and orders for doctors, aides, orderlies, and nurses.  The nurses, what visions, almost fifty years later, I still have of those women.  They worked their butts off—nurses still do; they were the ones who sounded the first alarm when a patient worsened—nurses still are the first to know.  What I love to remember was the time the nurses had for the patients, empathy, kindness, generosity.  And I admit to adoring—in retrospect I didn’t notice, until it stopped—the attention paid when I approached the nursing desk.  Even as an intern, nurses stood, greeted me with cheer. 

The forty beds in the ward were close, three feet apart, on either side, shielded from the next cubicle by beige curtains, a thin solitude when drawn.

The curtains were always open except when patients were being examined by doctors or cared for by the nursing staff.  In the two years I spent on the ward service I never heard a complaint about the accommodations.  The patients were grateful for the excellent medical care and the compassion of the nurses.

Two days after admission she hummed her way to the operating room.  The anesthesiologist told me the last he heard from her as she received the Pentothal was a faint hum.  The senior surgeon that day was Ivan Baronofsky, the Baron to all who feared or loved him.  An excellent technician, one of the early cardiac surgeons, he knew what to do.  The operation of choice back then was a mitral valvuloplasty, done closed - blindly.  Baron placed a suture around the atrial appendage, the door to the left atrium and the mitral valve, the valve that controlled blood flow from the lungs into the pumping chamber for the body, the left ventricle.  He then cut off the appendage above the suture, inserting his finger into the heart.   The valve opening was less than his finger tip, not the normal four square centimeters.  By pressure applied to the fused valve Baron was able to force open the valve to almost normal size. 

When I saw her in the recovery room, her color had improved, pink now, hiding all the freckles except those about her nose.   When I asked how she was doing, she answered, no hum, “my chest hurts.”  On the second post operative day she returned to the ward.  On the third post-operative day, the day her drainage tubes were removed, her husband appeared.  He asked how she was—her head.  “She says her head hurts doc—every time I ask how you feelin’, I get the same answer, ‘terrible headache’.”  “Why her head?”  I, not having a clue why a patient should have a continuous headache after heart surgery, said, I’ll check it out.”  I asked her endless questions about her headaches.  “Did you have them before?”  “Yes, the last month or two, since I got really sick.”  If the headaches were connected to her heart disease, why was she still having them?  She was making a fine recovery, now out of heart failure, breathing freely, no humming when she talked.  

On the sixth day after operation I saw her on early morning rounds.  What a smile, exuberant, sly too.   “No more headache doctor. I am in love again.”  

“With life?”—a tyro question. 

“Yes, and with my husband.”

Late that night I spoke to the evening charge nurse.  She had noticed that the husband stayed well past visiting hours, curtains drawn.  The nurse had heard a quiet humming from behind the curtains.  Then a louder hum.  These noises, I heard myself the next night.  I was young but not stupid.  I didn’t peek.

On the tenth post-operative day I discharged her.  She smiled goodbye, yet another, different smile, so full—though I tried, I could not duplicate.  And then she leaned over to me and hummed.