I have to be extra careful to think with my head and not with my heart. It can be hard not to let emotion take over. It’s almost easier not to know my patients.

As told to Shoshana Gross

“Hi, are you new?” The question was friendly, coming from a tall woman with emphatically auburn hair and bright green eyes.

“Yes. I’m Ayala Rubin.”

“Nora Connor, one of the X-ray techs. Welcome to the ER!” She smiled, as if delighted to see me.

Her warmth enveloped me, carrying me through the day.

I soon realized that many of my colleagues felt the same way about Nora. She’s perpetually cheerful and unruffled, which is why when she approaches with a worried frown etched on her forehead, I stare at her.

“Nora? Is everything all right?”

“I’m not sure.” She pauses. “I’m feeling… strange.”

I assess her. She looks the same as usual, but her breathing seems fast.

“You’ve come to the right place,” I assure her. “Tell me about it.”

“I’ve been short of breath lately, even when I’m not doing much physically… and my arm is kind of numb.” Examining her right arm, I notice it’s swollen.

“How long has this been going on?”

“A few weeks,” she tells me, and now I can hear that her breathing is labored. “I ignored it. Thought I was under the weather. But it’s not going away.”

“I’m sending you for a chest X-ray and some bloodwork,” I say abruptly. There’s no way to know what’s going on, but I’m feeling uneasy. I put in the orders and keep checking the patient portal to see the results. After scrutinizing the X-ray, I don’t even need to see the bloodwork numbers. A gray mass shows up starkly against ghost-white ribs. Nora is going to need a CT scan.

“It’s a tumor,” Elijah, one of the other techs, tells me, only two weeks later.

“Nora?”

“It’s too big to operate. The tumor was pressing on her trachea, so she couldn’t breathe. They tried to put in a stent to keep her airway open, but it bled too badly. She’s in the ICU on ECMO.”

ECMO? That’s serious. ECMO is extracorporeal membrane oxygenation, and it’s a machine that stands in for the heart and lungs when a patient can’t breathe on their own. A heart-lung machine pumps the blood out of the body, removes the carbon dioxide, and then the oxygenated blood goes back into the body. It’s like breathing, but without the air. And it’s not a simple procedure.

“Do you know if she’s seeing visitors?”

“I went yesterday. She doesn’t look good.” That’s the ER version of,  “She looks like she’s dying.” I decide to stay an extra few minutes after my shift and go up to visit.

Working in the hospital has its perks. I pass through the security doors, walking straight inside. Marlene’s at the front desk, and I know her from my previous stints in the ICU.

“I’m here to see Nora,” I tell her.

“Sure, hon,” Marlene says. “Room 202. I don’t need to give you directions.”

“I know my way around,” I answer wryly, and then hurry past flimsy curtains around semi-private rooms, the beeping of lifesaving machinery a steady background hum.

“Nora?” I say from outside the room. “Can I come in? It’s Ayala.” I hear a raspy assent from inside and enter. Nora’s propped up in her bed, the ECMO machine beside her. Gazing at her pale face and translucent skin, I try to hide my shock at her appearance.

“I know I don’t look good,” Nora croaks, and her lips twitch into a smile as she reads my mind. “Did you hear that the tumor is inoperable?”

“Yes,” I answer softly. There isn’t anything to say, and I don’t try.

“They’re going to have to take me off the ECMO in a few days,” she whispers. “I’m going to refuse further care. I know there’s nothing to do.”

“I’m sorry, Nora.” I reach for her hand and squeeze, hard. Saying goodbye to life is never easy, especially when there’s so much to live for. We sit quietly together for a few minutes, and then I need to leave.

“Goodbye, Nora.” I know I’m saying it for the last time.

She tries to smile with her trademark warmth, and something inside me breaks.

Nora lives five more days. The tech room feels empty, even with her replacement.

Two weeks later, I step into the next room on my schedule to meet my newest patient.

“Mrs. Rubin!”

It’s Rabbi Weiss, a neighbor from two blocks away. He’s a widower who lives alone. We’ve had him for Shabbos seudos, and he learns in Yaakov’s kollel for night seder.

“Rabbi Weiss!” I can feel my professional mask slipping. “What brings you here?”

“I’ve been having shortness of breath tonight, but I’m not sure why. I haven’t done anything strenuous. I also have bad chest pain,” he says, and I can see the fear in his eyes.

I concentrate on relaxing, and then order an EKG. I watch the screen, looking for subtle changes in the waveform of an EKG, which can indicate the patient is having a heart attack. I look back at Rabbi Weiss. I know.

“Rabbi Weiss, it seems like one of the vessels in your heart might be blocked,” I say as calmly as I can.

I’m not fooling him. It’s hard to process his raw fear and do what I need to do, but I pull myself together and tell the nurse to put him on a cardiac monitor and place an IV, while the tech attaches defibrillator pads to his chest, just in case I need to shock his heart. Hurrying to the unit secretary, I ask her to call a Code STEMI and alert the Cath Lab, where minor cardiac procedures are performed.

Within 30 minutes Rabbi Weiss is wheeled away by two orderlies, and I find the words of Tehillim tumbling from my lips, tears pushing at my eyes.

He’s looking stable, but my hands are still trembling. I see heart attacks with unfortunate frequency here in the ER — but this was Rabbi Weiss.

Seeing people I know, sick and vulnerable, is harder than treating them. I have to be extra careful to think with my head and not with my heart. It can be hard not to let emotion take over. It’s almost easier not to know my patients.

But easier isn’t always better. Bringing compassion to my job is necessary. Nora. Rabbi Weiss. They keep my heart beating, keep me feeling. They remind me that all of the people I see are individuals someone knows and loves. Every single patient is “people I know.”

The characters in this series are composites; all the stories are true.

(Originally featured in Family First, Issue 897)