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I will never forget the elderly lady in room 9. At 90 years-old Mrs. S had been living 2 months from hell. She had come to the Emergency Department because she had fallen at home, and was unable to walk-her “hip was killing her.” The month prior she had lost her husband of 70 years-count them… 70 years. One week after that she was walking outside, had fallen, and landed on her face, rupturing her eye ball, losing her teeth, and breaking her nose. On the fourth of July an errant bottle rocket deployed on the roof of her house catching it on fire. Two days ago, her dog “Mr. Fluffs” had been stolen out of her car at the mall. And now this.

When I walked into the examination room I was surprised to find a spry, witty, energetic woman sitting on the bed reading a “People Magazine.” She had explained to me in great detail, the events of her life over the past 2 months, interjected with a magical spark of energy, and candor which could only be generated by a woman her age. She described the events of how she fell-quite simple compared to the last 5 tragedies- “You see, I was walking from the living room to the kitchen, and I tripped over one of Mr. Fluffs toys." Oh, the irony-my heart sank.

After examining her, I realized how serious her injury was: her hip was very deformed, her leg cocked outward, and rotated, which made me suspect immediately that she had fractured it. At the time I told her that we were going to get an X-Ray, the Emergency Room became tremendously busy-as can happen in a Trauma Center. There had been a car wreck and 4 critical patients were coming to Stanford. This can grind the busy pace of the Emergency Room to a halt-suddenly the name of the game becomes “triage”: helping those in need who might die…first.

Our help was summoned to the trauma bay. At this point as an Emergency Room Resident your job becomes something of a juggling act-you need to help the sickest of the sick first, but be mindful of the other 6 patients you are treating as well. After an hour of trying to stabilize the trauma patients, and running back and forth from my other patient’s rooms-looking up lab results, x-rays, and seeing if the treatments we had given them were working, some (with the exception of Mrs. S) had become understandably restless, hungry, tired, and irritable. Although most understood that we were very busy and that I was trying to treat them as quickly as possible, the 25 year-old College Student, who had an ear ache in the room next to Mrs. S, had started yelling and bemoaning that he “had to wait 30 minutes!!!” I had explained to him that this was an Emergency Room, and unfortunately when very sick patients need our help, we need to tend to them first-this was of no consolation, and only fanned the flames.

I left the room to get him his prescription for Motrin, and realized that Mrs. S’s X-Ray was back: she had a badly fractured left hip and was going to need surgery-if she wanted it. I walked in the room, she was reading her People, she looked up at me and I told her the news…. “Isn’t this the *@%&!!!” she replied, with a huge grin, missing one eye, 5 teeth, and let out a loud infectious cackle. I laughed with her. I could not believe her infallible spirit-after everything she had been through-after all of the loss.

Meanwhile, the 25 year-old next door continued to yell, this time threatening “to sue us all.” I was struck by the contrast of the situation-the impatience, the lack of putting others ahead of your own needs... for just 30 minutes, a woman with a possible life-ending injury laughing in the face of adversity. How did Mrs. S. display such grace under fire? How do people like her maintain that attitude and spark for life-the notion that “nothing is going to bring me down”, even when things are at there worst?

I asked her, the response was elegant: “You cannot change the past, so there ain’t no use complaining, and there ain’t nothing a smile or a good laugh won’t fix-call the surgeons, I have more life to live.”
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The Stanford Emergency Room is the center of emergency care at Stanford University.

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