Her zinnia flower

Her zinnia flower, robustly pink in color and potted alone, stood proud in the window sill. It remained the one constant variable in Carrie’s room, a room full of ever-changing atmospheres.

When Carrie first arrived, jaundiced, distended, and delirious, she was welcomed onto the floors with marked hesitancy. Accompanied by a history littered with substance abuse and unemployment, it was not altogether surprising that she had not followed-through with AA meetings nor kept in contact with either her sponsor or her family. Nonetheless, she was known to everyone. Her endorsements of pain were a constant hum to nursing and visitors’ ears alike.

Our first day together started with me peering meekly into her room, spotting the motionless body curled in the fetal position in bed and making note of her flower pot sitting silently in the corner of the room. No sooner did the creak of the door announce my presence, did her icteric eyes open and she began to wail. I remember trying to introduce myself as a member of her medical team, as the shouts of back pain, abdominal pain, and profound nausea erupted. Very much overwhelmed, I stool there motionless. She was clearly intrigued by the new face. As the new intern on her primary team, I felt very much at the will of her every desire, and she knew it.

“Are you a doctor?” She asked. “Yes.” I replied immediately trying to sound assured but at ease. “But are you a Doctor?” she repeated, and when I began to reply yes again, immediately retorted, “So, call yourself a doctor. You earned it, didn’t you?” I replied with a grin.

As we sized each other up, I was not one to be too coy. I had taken it upon myself to prove that I could be a fastidious intern. I starred at her directly in the eyes and began my own barrage of questions—attempting to fill the room with what I believed was constructive interviewing. She was less than amused. My open-ended questions soon became more closed as the responses I received became less informative. She started and ended our first conversation all the same—“what are you giving me for my pain?” With no clear answers in sight, our arduous journey began.

I returned from our first encounter discouraged but not depleted; however, I did come to face another predicament. In an already growing census of patients, Carrie stood as a formidable obstacle for our team. She was one to consistently ask for the very medications that we were taught not to give and was nonnegotiable in her requests. And as our care plan came into view, it became obvious that I would be its honorable spokesperson.

The following morning, I came mentally equipped with various negotiation skills googled online and a slew of meditative thoughts. I had braced myself to be the bearer of bad news. However, to my surprise, our second encounter brought a set of new faces. The smell of tobacco wafted off his worn sweater as he paced about Carrie’s bed, slightly stooped in posture, eyes wrinkled at the edges. He occasionally stretched out an arm to rub Carrie’s back or playfully tousle her thinning hair. A woman stood to the back of the room, a grimace stuck to her face. “These are my parents” Carrie groaned. They both turned their heads toward me as I approached. With no mention of them before, I was taken aback when they warmly introduced themselves and started off with, “She’s a real treat, isn’t she?”

My carefully crafted rhetoric for the morning had evaporated into thin air. Although reassured by the social supports present in the room, I became keenly aware of my larger audience. I stumbled between communicating medical concern, keeping a casual but professional rapport, and making eye contact with three pairs of eyes. It made for a diaphoretic, tremulous intern, a smile plastered to her face and a medical record twisted into a roll in her hands. No sooner had I taken a pause did Carrie begin to wail and the tables turned. Negotiations were set forth regarding what pain medications would be appropriate for her. Each witness stepped forward, one of a doting father, another of a mother, herself a former alcoholic, and lastly one from the patient, tears strewn across her face. No doubt, there was a complex family dynamic at play.

Inundated with opinions, I found myself stepping backward, overwhelmed. Sliding into a chair—I attempted to exude confidence. As the minutes passed, I found myself saying less and less, questions left hanging in the air. When a moment of silence arrived, we found ourselves dazed. I hadn’t left the room nor had I changed my position on Carrie’s care. In a moment of grace and perhaps a bit of spontaneity, I decided to change the subject and comment on the only other character in the room—her flower—“who gave you that?”

No more than a few minutes later, I had come to learn about her zinnia flower—its ability to grow in low sunlight, its ability to be potted in a group or as a single flower, that Carrie’s favorite color was pink, and she desired to one day hold a bouquet of them on her wedding day. Her parents always brought this flower to her room when she was hospitalized. This time was no different—other than that I had noticed it in the corner of the room. Although I left this visit feeling very much lucky to have had an alternate subject for conversation, I was keenly aware that there was only one flower in that room and I had figuratively plucked it.

Nevertheless, that day did leave an impression. Carrie would now offer a smile as my visits became regular even though her pain was never touched by any of our medications. It became easier for me to be stalwart about what I thought was best for her even though she never agreed. As long as our bickering started and ended with a smile, I considered it a successful day. It appeared that we could have played this tit for tat for weeks; however, she wasn’t clinically improving.

The morning she became unresponsive I was visiting patients several floors below hers and did not think much of my senior’s text message, “Can you come to rm ###?” No sooner did I make it to her door did I see her wheeled off to the ICU with a mask over her face. I soon also smelled the familiar waft of tobacco come down the hallway and followed it right to her father. We walked together to the ICU in silence.

“Was she in pain?” he eventually asked. I could not answer for I had only known Carrie to be in pain. And now, unable to speak with a mask over her head, she could not endorse it herself. Another period of silence ensued. And this time, there was no perennial perched on her windowsill. Instead, two bodies perched over the foot of her bed—listening to a new hum of noises, a chorus of synchronized beeps and monitors. The absence of Carrie’s voice could not have been more apparent, and any other voice seemed extraneous.

Now off our service, Carrie’s care was managed from afar. However, she was never far from sight. I made a point to visit and check in with her family—hoping a familiar face would bring some relief. It was within these moments that I learned more about Carrie when she wasn’t sick. My every visit was filled with iPhone pictures and videos of Carrie outside of the hospital. I came to learn about Carrie’s ability to always be the life of the party and the most generous aunt to her nieces. How she took after her father and their special relationship was one that weathered any storm. Sprinkled in were her feelings of resentment toward her mother’s struggle with sobriety and jealously of her sister who always, “had it all.” Each character in Carrie’s life brought a new shade to the already brightly colored personality we knew her to be.

She was transferred back to our service within a few days—the culprit for her ICU stint nebulous but likened to oversedation by a combination of pain medications we had prescribed. I was told of her return hours beforehand but was nonetheless startled when I was greeted with, “Miss me?” as if she hadn’t left at all. The smile on her face was matched by her fathers’—sitting in the corner of the room. A single zinnia flower, again, perched on the windowsill.

Carrie continued to make herself known to the floors but as she became less distended and less jaundiced, her imminent discharge loomed in the distance. Conversations regarding her current state of affairs were inevitably brought to light. She was living with a boyfriend both toxic emotionally and physically. Previously working as a manager at a department store, she was now unemployed. Carrie never spoke about these matters freely. I came to weave together her story through tidbits of information she revealed in the evenings when everyone had left and I would be checking in before night float.

Our last day together started very much like the first. I peered meekly into her room, spotting her motionless body curled in the fetal position in bed, her father dozing off in the corner. No sooner did the creak of the door announce my presence, did she awake. This time, though, we sat in silence. In the weeks following up to today, she had enrolled in a suboxone program, ended her relationship, reconnected with her AA chapter, and decided to move back in with her parents. There were no more words of encouragement or rationale left to offer, just a warm embrace.

Her small bag of belongings was set aside at the door along with the scraps of paper listing her medications and follow-up appointments. I, again, became a bit diaphoretic and tremulous, although having spoken to Carrie and her family nearly on a daily basis, a goodbye was not part of my repertoire and seemed contrived. So again, in a moment of grace and perhaps a bit of spontaneity, I decided to change the subject, commenting on the only other character not in the room—“where’s your flower?” A toothy grin appeared across Carrie’s face as she leaned across the bed to unveil her zinnia from beneath her sheets.

Gripping the pot with both hands, she extended it toward me and declared, “I wanted you to have it!” I stood there motionless, and sensing my alarm, Carrie quickly added, “You know I won’t leave unless you take it, Doctor” I chuckled and took the flowerpot into my arms. Again, I was reminded by Carrie how it hardly needed any light to grow, could be potted alone, and was her favorite color. I grasped the flowerpot to my stomach and thanked her—assuring her I would try my best to keep it alive and healthy although I hadn’t had much luck with plants in the past. I walked with Carrie and her father to the door and out the hallway, this time keenly aware of the waft of tobacco trailing away.

Her zinnia flower has since sat with me in our resident’s office—I’ve learned that it used to be considered an eye sore by the Spanish—“mal de ojo” but is now considered a staple among gardeners, commonly used to attract butterflies and hummingbirds. Coincidentally, in the language of flowers, zinnias represent friendship, specifically thoughts of an absent friend. And indeed, I have often thought back to my time with Carrie. The difficulty of her care did not lie in the medical realm, but rather interpersonally. I was blessed to be able to see a more vulnerable Carrie only by staying in her room even when conversations went awry. When unable to answer questions, I tried to remain present and positive even if that meant being silent. In many ways, I attempted to be very much like her zinnia flower.

Never wilting, its petals always tilted upward—Carrie’s zinnia continues to grow. Her flower has seemed to test the limit of time and endurance—persevering through long weekends and holidays of neglect. It has become a symbol for what she stood for and what I strive for—to grow even in low lights or when singled out. And most importantly, to be ever present, patient, and robustly pink to those in our sight even when the weather is not in our favor.