By Crystal Wallin, NREMT-P, CCEMT-P, Tri State Ambulance

It’s her birthday, and she’s only got two years on me. But her eyes are world-weary, and in the slump of her shoulders lies a thousand different disappointments. Pancreatitis, she tells me. Acting up again.

We talk about the outward manifestations of her functional health, as I run down the assessment steps. We stand in the confidential location of a woman’s shelter. The curved bannisters arch gracefully up and out of sight somewhere above. Stained glass windows filter the light falling in through them, dim on this gloomy day yet warmed by the colors of the old glass. Pocket doors slid behind us as we entered, preserving some semblance of privacy here in this gentle embrace of a genteel old home. Women and children pass through here in a never ending stream, and we meet some of them. I wonder now, as always, where they go, what happens to them, did this house of kind strangers afford them a new start, a fresh beginning? Or did the familiar pull to old unhealthy relationships win out? Did they return to the abusive partners from whom they sought shelter here? And the children - do they fall victim to the cycle or do they emerge strong down the line and find fierce ways to ensure they do not allow such treatment in their adult lives? How many fall one way - or the other? The awful sadness is the never knowing.

Her hands are kind, and soft. Her mouth seems to have a hard time remembering how to curve upwards. I work at it, establishing rapport and extending gently honest respect to this woman who is before me. Something in her tugs at me. Maybe it’s the way she is in pain, maybe it’s the way she seems surprised when I realize her date of birth makes today her birthday and I exclaim, “Happy birthday to you!” It almost seems as if no one has been that exuberant about her birthday in quite a while. Maybe they haven’t. Maybe she just didn’t realize what the date was today.

Her boy will ride with us, and the stranger who is the helper at the house today disappears in search of him. Soon they reappear, the child just under ten. His speech leaps and bounces from topic to topic as we make our way outside and towards the truck waiting at the curb. His eyes never linger long, scanning up the street and then down again. He surveys the ambulance and announces his desire to ride up front. My partner looks at me with a shake of his head and I guide the boy towards the back with promises to ride by mom. He shrugs. Climbs inside. Resists the seatbelt but caves when I stick firm to following the law. Mom is silent, docile, amidst the verbal stream coming from the boy. He asks about computer privileges at the hospital, will they have something to eat, what will he be able to play with? My patient speaks up then, quietly, asks him isn’t he worried about her, she’s sick. Again, he shrugs.

Her eyes drop. The shoulders round even more somehow, as her chin nearly touches her chest. The shirt is worn. The boy’s shirt isn’t new but it’s in much better shape than hers. He rambles on in complete disconnect or disconcern for mom and her pain, mom and her fears about her health. She seems unsurprised yet saddened.

I wonder as I give report to the receiving facility via radio regarding the outward, measurable data - who last made this kind, quiet woman a birthday cake? What man or men taught the boy that a woman’s fears and illness are so easily dismissed? Who models for him that his needs take such utter precedent? Or is this simply age appropriate egocentricity? Is he scared too and thus the chatter is a nervous avoidance of his fears about mom’s health? Who has he lost? The same person who left mom such a saddened husk of a lady?

I walk them in and I give report to the receiving facility staff. I shake my patient’s hand, and looking in her eyes I let my heart shine visibly outward as I softly wish her a happy outcome ot this ER visit, and many happier birthdays to come - that I believe they will come. Her eyes flicker with surprise and a smile finally - finally! - lifts that mouth. Her eyes drop to her lap. I shake the boy’s hand too, and tell him to be a good man and take care of that sweet mama of his. That it’s ok to be scared, that kids can’t fix everything but my friends here in the ER will help with that. He just needs to love mama while she gets feeling better. His head cocks up at me and he nods vigorously.

The entirety of my body is not yet through the doorway when I hear his querulous voice asking the patient care tech for a computer to play on. I look back at mom, framed by the doorway and placidly lifting her arms into a gown - and wonder what happens to the light in people when they don’t get loved enough. Do you suppose it goes out for good eventually, or does it lie dormant, waiting for the warmth of the right person to bring it to light again?

Happy birthday, dear lady. I hope next year finds you happy and laughing - and loved.