Out Here on the Asteroid Belt

Exploring space with an out-of-this-world patient

Apr 04, 2023

A previous version of this story was published in the Annals of Emergency Medicine.

In studying medicine we learn that our bodies contain potential spaces—spaces between two adjacent structures that, like empty pockets, remain unfilled and flat most of the time—the pleura surrounding the lungs, the pericardium around the heart, the peritoneal cavity in the abdomen. The key, we learned, is to recognize when these transition from potential spaces, to fully-realized, filled, dynamic ones.

There’s a different sort of potential space I haven’t considered often enough in medicine, and I’ve come to think it’s the most important one of all—the space between us and our patients. If we fill this void, the possibilities are endless—we allow room for warmth and whimsy, for meaning and music, for laughter, for story, for connection. This is where the magic of medicine happens.

A physician ethicist and writer, Dr. Daniel Sulmasy, even goes so far as to write that “the transcendent, healing presence of the divine can be found in…the infinite space that subsists between our hands and the bodies of the patients we touch.”[1]

I’d like to share a story of what should have been an ordinary patient encounter I had a few months back in the ER. It should have been ordinary, but it wasn’t. Because an amazing human patient filled the space between us with a unique magic all her own. The story begins when I asked my patient a simple question…

*****

“What’s your happy place? The beach? The mountains? Where do you like to go on vacation?”

I often ask patients this question before I sedate them for a procedure. It seems to help them relax. Today’s sedative of choice was propofol. It is typically pleasant, dream-inducing, and only rarely hallucinogenic.

“My happy place is in a book— sci-fi and fantasy” answered my patient, a middle-aged brown-haired woman with a large sternotomy scar on her chest.

Well, I’d never gotten that answer before. But I felt a pull to explore further.

“OK…sci-fi and fantasy…are we talkin’ Middle Earth, or Outer Space?”

“Oh, definitely Outer Space. And preferably robots and computers and aliens with no humans involved.”

Well that’s specific, I thought. But boy did she seem ready for takeoff!

“Alright” I said. “Let’s go to outer space then.”

This procedure would be pretty quick. Ever since her valve replacement a few months ago, her heart had been bouncing in and out of atrial fibrillation. Today, I explained to her, we needed to use electricity to kick her heart back into a normal rhythm. “Like restarting a computer?” She asked.

“Sure. Like a reboot,” I replied.

“Alright then. Let’s reboot!” she exclaimed. I couldn’t help but love her enthusiasm.

I pushed the first dose of the milky white drug, and watched as a dreamy smile spread across her face.

“I’m on an asteroid belt, I’m a robot fixing computers…” her words began to slur. “I see colors. Yellowzzz and purplezzz and orange…and chartreuse…” I couldn’t help but giggle a little. “Chartreuse?” “It’s my faaaa-vuh-rite…”

She was getting sleepier but still talking some. I gave her another half dose. Her words tailed off and stopped, leaving behind the irregular beeping of her heartrate monitor.

As I looked around the room, it then dawned on me that maybe, in this moment, she and I really had been transported into our very own scene from a science fiction book.

I mean, here’s this sedated patient lying totally still in a sterile-looking room, like a space explorer in hyper-sleep. She has no fewer than 16 wires attached all over her body. She has tubing pumping oxygen up her nose, a carbon dioxide detector measuring her exhaled air, an automated blood pressure cuff on her left arm, a pulse oximeter on her index finger, 9 wires from an EKG machine stickered all over her chest, 5 sticky button electrical leads attached to a cardiac monitor with high-resolution green and red displays, and 2 oversized sticky pads adhered to the center of her chest and her left flank wired to a powerful defibrillating machine with a surprisingly quaint Radio Shack looking screen, a lower resolution, early sci-fi movie yellow.

I set the defibrillator to sync, pushed the charge button, heard the machine power up with its exciting and suspense-building crescendo, BOOOUUUPPPPP. I did one last check: “Clear? Clear!” and delivered the jolt, smashing down on the button with the lightning bolt icon until I heard the electric: Boom. 200 Joules of re-boot.

Her body jumped off the bed, she drew her arms up to her chest and yelled “eeyowch!” Then she squirmed on the bed briefly and was fully back asleep, her arms still up at her chest. And like that, her heart was back in rhythm, and a fresh 12-lead EKG was transmitted wirelessly to our motherboard. Mission Complete.

I can’t believe I had ever come to think that any of this is ordinary, just another day at the office. My patient’s fantastical imagination had reminded me see that what we do every day truly is out of this world. This is 2021: A Space Odyssey.

When she woke up she said she had had the greatest dream. She had seen colors—purple, orange, pink—but they were different. They were more than colors...they were alive. She had a hard time describing her technicolor dreamscape, but I like to imagine it was like some psychedelic version of the Hubble telescope’s deep space images of the Crab Nebula. It had been amazing! She had been a robot out on an asteroid belt fixing computers for the space station. And so had I.

*****

Lately I’ve been trying to explore this space between my patients and me. I don’t often get to travel to outer space with a patient, but sometimes we can simply connect as we discuss a common interest—a musician, an author, a show, a place. Sometimes patiently indulging in a super long story, or talking about their family or their faith, can help me gain a deeper understanding of what drives them. Sometimes we can listen to an old song on my phone that means a lot to them, and it reminds us both of happier times.

I am so thankful when I get to see in them that magical spark of humanity that’s inside of us all, because that’s what keeps me going in medicine. When I remember that this patient in front of me is nothing short of a cosmic miracle, not only am I practicing better medicine, but I’m finding it’s the reboot I need to stay in the right rhythm.

When has someone else’s perspective brought you back to a place of wonder or gratitude?
What have you found to fill the space between you and another person?

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