Guardian Angel

A doctor is always looking for signs—some externalized order in the happenstance referencing a deeper meaning. Some of these associations seem preternatural to the uninitiated. I stroke the sole of an old woman and see the toe majestically rise. “Babinski’s sign,” I say, putting her peripheral nervous system aside, and waiting for other secrets in her central nervous system to declare themselves. Through a series of signs handed down to me I localize the lesion like a remote viewer visualizing a spy lost behind enemy lines. At our best “we see into the life of things,” as Wordsworth wrote. Sometimes, this means “mak[ing] the negligible considerable,” as Dr. Jonathan Miller put it, as happens on belabored rounds when we discuss how high the jugular venous pressure really is.

In residency we often refer to colleagues as “Black Clouds” or “White Clouds”. The former seem to admit twice as many patients as the average resident in a night, while the latter seem to sleep soundly without so much as a page for Senna by the nurse. In these cases, it is the person who becomes a sign for the night ahead.  

There’s a lot of anxious augury in residency. We seek out signs to make sense of the unknown. I’d think about how my previous nights were—was I due for twelve admissions, or because it’s my first night, would the Universe mercifully give me a break? Arriving for the nightshift, I searched the face of the day resident for any hint of the day’s rhythm. Was the tide of work in ebb or flow? Were all the patients settled or were they disturbed and needing tending? I considered external questions outside the bounds of the hospital, too. Was it snowing or raining so that people might stay home, or were they more prone to slipping or crashing cars? Was it cold enough for some folks to stay in their homes, or was it too cold for the homeless in our world to survive on the street? 

I remember the vision. No fire except a bright red hospital fleece, no wings except her frizzy hair brushing way out past her shoulders. No halo except the radiance of her smile at 2 AM. It had already been a terrible night with too many admissions at once, and I was wondering if this would be the night I break down on call (so far that had only occurred at home in anticipation of the next shift). I was coming out of the emergency room on my way back to the wards when I saw her—this Latina woman about my mother’s age standing alone and serene at the top of the stairs. And I recognized a serenity in myself, and I thought, this must be a sign.

And so I did not take the elevator as I had intended, but ascended the stairs towards this woman, and when I got to the top of the stairs I found she was just about to push a line of wheelchairs down the hallway. She saw me crest the stairs and said, “Doctor! Thank you. You having a good night?” Thank me for what? I wondered. Her joy at this hour of the night surprised me, no more surprising than the joy she made me feel in myself. 

I said, “Better now that I’ve met you.” She smiled even more widely and shook her head knowingly. For all the pages and troubleshooting and codes of every color, it was the first time I had been addressed as a doctor all night and the first time that night I’d been asked how I was. Prior to her question, I was tense, tired, and troubled. But her question shook me awake, as to me it expressed, “I care that you care, doctor, being-to-being, I am glad for you that you are here to care.” 

“God bless you, doctor. Bless you!” she responded as she waved and pushed her wheelchairs away.

When the dawn came and the morning team arrived for pass-off, they asked me, “Was it a good night?” As I looked back over it, the night was a good night for me, yet with more reflection it wasn’t for fewer admissions, pages, or codes.  There was no change in the quantity of the work, only the quality of my appreciation of that work, and it was that appreciation which made the difference between a good night and a bad night. A sign doesn’t change what you’re seeing, a sign illuminates so that you can see all the better the truth of the world before you. In this case, I felt that hard nightshift work—sometimes rued by the patients themselves and perceived by peers in written overnight notes—had gone unseen. I had developed a tunneled vision towards seeing that nightshift work was as meaningless as it was mean. 

Instead of searching for black clouds and white clouds, I should have been looking for a different messenger—one I found that night in this woman. Her placid and gracious outlook radiated. Even from afar she drew me into a brief exchange that changed my outlook. That’s what signs do. What cannot be said is felt and drawn closer until what cannot be said becomes understood. When I left the workroom in the morning to return home, I saw her again, this time pushing an empty bed.

“Did you have a good night, doctor?” she asked me.

“I did. Because of you,” I said. She just smiled and shook her head again.

“You doctors are like angels..” She said with both certainty and joy. 

Now I blushed and felt a bit put on. I shook my head no, but she said, “Yes, yes. Every night I pray for me, for my family, and for you doctors. Especially during this,” referencing COVID. “You’re like angel,” she said again.

I protested, “No no, you are my guardian angel.” And that was that. I recognized her as such, and she understood herself in my eyes as a sign of something blessed and comforting. I had my head in the black and white clouds, when I should have been keeping an eye out for angels—messengers—and here was mine in the flesh. The next night, instead of waiting for the shift to end, I kept a watchful eye out for when I would see her, like a star or a lighthouse—a guide of sorts—though more for navigating my inner turmoil than negotiating the outward difficulties. 

I don’t know my guardian angel’s name. I think of her as being a Grace, because that’s what she brings whenever I still see her on my night shifts. I probably overlooked Grace many times before that night. I remind her that she’s my guardian angel, and she always says, “I bless you, Doctor. I bless you and pray for you,” and it charges me with something numinous, and I’d like to think I bring that to my work when it’s needed most. It’s not that work was not meaningful until she changed it, but she recognized—and helped me recognize when I needed it most—the inherent wonder in weary moments 

For me, Signs in the profession of medicine have changed. I still scan the body for whispers of disease, but I also search the person and their world to be recognized and addressed—to be signified. Perhaps, instead of ‘making the negligible considerable,’ as Dr. Miller put it, it’s about making the unrecognized significant.

Painting: Guardian Angel by Bartolomeo Cavarozzi, 17th century