The pain began suddenly last night, woke her from sleep. It wasn't the first time, but was worse than before. The ER physician diagnosed a gallbladder attack, and that's where I came in. Surgery is often indicated for recurrent gallstone problems.
"L" was surprised to hear the diagnosis. She had assumed it was yet another pelvic infection caused by an STD, just like last time.
As as we talk, I notice the pasty texture and pallor of her skin. Her eyes are bleary and bloodshot. Innumerable scars and scabs cover her body. Her sparse, greasy hair is pulled into a messy ponytail.
"I need a cigarette."
I've seen the medical chart: opiate overdose, methamphetamine use, anxiety disorder, history of sexual abuse, migraines.
I glimpse broken, discolored teeth through cracked lips as she tells me she's feeling better now and wants to go home. I explain the nature of gallbladder disease, my recommendation for surgery, potential complications and likelihood of recurrence.
"I don't want those scars on my belly. And I'm fine. Just let me go."
It's her choice, her decision. I feel hopeless. Her gallbladder was the only thing I could fix. I take her hand and wish her well. Her father is waiting by the door. He thanks me for my help.
I write the order: Discharge to Home. All I can think of is what "home" is for her.
She's twenty-eight years old. She looks fifty. I doubt she'll make it that far.