Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Starry, Starry Night

"The Starry Night," Vincent Van Gogh, 1889, Museum of Modern Art.


There are times that as clinicians we become patients ourselves, needing compassionate care for injuries entirely unrelated to our chief complaint.

With a hoarse voice, I called my brother pleading with him to tell me that Thomas was still alive. A defining pause followed, “No, our brother is no longer with us, he did not survive.” The sudden silence was transient, followed by an acute gasp for air and difficulty in breathing. I think I tried to yell out multiple times but I was disoriented and ill. One of my younger brothers had just took his own life. He was 39 years old. For the past few years, he struggled with severe depression, chronic pain further complicated by substance use disorder—but I’m not writing this to share his life story.


My subsequent calls thereafter were to my sisters who were not yet aware of Thomas’ death. I could barely speak from the loss of voice and onset of emotional trauma, but somehow the quasi-audible sounds emanating from my raspy throat conveyed the isolating sadness of my message. Our younger brother had just died. My sister kept repeating in a solemn tone, “do not do this to yourself, you did what you could to help him, please do not do this to yourself.” I could not speak any longer with my eyeglasses blurred from the constant cadence of my tears. The calls ended and I was alone. I gathered my reserve after bawling through prayers of repose, finding a chair while playing poetic music in my intense search for peace, albeit only peripheral. Relentless episodes of melancholy that I had never experienced equated to the sense of dredging through mud on a long hike in the aftermath of a heavy spring rainfall.


Within a matter of a couple of hours, I was too weak to move and my fever spiked to 104.5 when my husband arrived home. I could feel the tympanic pulsations of my tachy heartbeat. Feeling my senses decline, I laid in the bed insisting that no one enter for fear of contagiousness.


My husband called 911. Firefighters arrived first followed by the paramedics. With assistance, I was moved from the bed onto the gurney, lifting my neck to see my family’s worried expressions as they waved at the door during this cold and empty period in time. A breath of crisp, frozen air was calming as I was rolled towards the ambulance. Lying supine, there was an eerie swiftness posed with viewing the night sky as I stared upward while the gurney rolled over gravel. I could see the mix of scattered glitter stars positioned in the backdrop of a blackened canvas of sky reminiscent of Van Gogh’s depiction of his own “Starry Night.”


Upon arrival to the hospital after the long drive in the ambulance on ice-covered country roads, I was rapidly triaged by the team with my temp trending down to 102.8. It was a Friday night and the emergency room was overwhelmed. Holding my blood pressure with a pulse rate of 125, I was promptly masked and immediately sent to the waiting area. Hours lapsed while I was periodically brought back for blood work, then a chest x-ray.


The first person to show genuine interest in my symptoms was the medical student, who curiously posited my history of present illness by asking what brought me to the ER. “My husband called 911 because of my high fever and weakness,” followed by an even more subtle and somber tone of, “I just lost my brother today.” The student’s response revealed a type of compassion that was ineffable—what I describe as the initial act of mercy in this encounter with the healthcare system.


His approach with conveying his condolences demonstrated sincerity, “I am truly sorry for your loss,” as he naturally paused in silence out of respect before slowly venturing into my social history. “May I ask what your occupation is?” he quietly asked. “I’m a general internist,” I responded groggily with a muffled and barely audible voice. “Oh, you are a physician,” he stated cautiously, pausing again. The medical student asked additional questions, then listened earnestly until he finally excused himself to review my history with his attending. As more time lapsed, I was later admitted to the hospital with influenza A.


Despite interactions with dozens of clinical staff during my intake, I was met with a second act of mercy on a busy medical ward by the floor nurse. It was 4:30am and I could not hold my composure. Hours before, I tragically lost on one of my younger brothers to suicide. The nurse came in to comfort me in between overhead announcements and various alarms sounding. The registered nurse, who was required to wear a mask in my room, sat down holding my hand. Before being asked to tend to another patient, she agreed that I would benefit from a visit with the chaplain but it would be hours before the chaplain arrived.


Placed in respiratory isolation without any family or the comfort found in close friends during my time of immense sorrow, I decided to use social media as my outlet to the world. I felt an intense need to share what happened knowing that some of my colleagues and others may empathize with the indescribable pain experienced with the sudden death of a loved one—from cancer, Alzheimer’s, a sudden accident or suicide—no matter the etiology, death is death.


It was also through social media that the outpouring of support, encouragement and prayers surrounded me with a loving grace. It provided a seed of hope that this pain would not last forever especially during an era when the stigmatization of mental illness is still so prevalent in our society. There was tremendous guilt that followed as the funeral arrangements became a bold reality that as a physician sister, I could not save my own brother’s life. Through social media, I was at least able to do something in the wake of my personal illness—I was able to grieve during a mournfully piercing starry starry night.