Saving Jane Doe

by Carolyn Purcell

  That Saturday, three days after the initial surgery, we realized Jane would need the respirator for an extended time, and because prolonged use of an endotracheal tube can damage the vocal cords, we placed a tracheostomy tube through her neck to connect the airway to the ventilator. There had been signs that Jane was about to wake up before this second surgery. She was clearly more responsive to pain; however, she had to be put back to sleep so as to prevent struggling against the respirator. For days we had to increase the pressure that forced oxygen into her rigid, fluid-filled lungs. Then, as her lungs healed slowly, we began to decrease the pressure.

  Twelve days after the second operation, the abdominal incision fell apart and her bowel spilled out onto the bed. Her nurse covered this evisceration with saline-soaked towels. In Jane’s third trip to the operating room we resutured her wound. This time we placed a row of large mother-of-pearl buttons on each side of the incision. A very heavy rope-like suture material connected the buttons of one row to the corresponding button on the opposite side. These retention sutures, as they were called, ran beneath the strong fascia layer that held her together and made her belly look like a double-breasted suit. If the incision did not heal this time, these sutures would prevent the disaster of a repeated evisceration. Dr. Gray criticized Dr. Armstrong for not using retention sutures during the original surgery.

  With each new disaster I wondered if she really was one of the “lucky ones.” Fortunately, she was spared kidney failure and she was alive, barely.

  “It sure is quiet in here,” I said as I sat down to write my notes in the ICU. It was Sunday of Labor Day weekend, my first holiday weekend on call, the first of years of holidays on call, and the start of my last week on the gynecology service. In one week I moved on to Psychiatry. The third year of medical school was divided into ten-week rotations. Large services, like Internal Medicine, Pediatrics, and Surgery, spanned ten weeks, but smaller services were five weeks. Obstetrics and Gynecology shared the ten weeks with Psychiatry. I don’t think this was meant to imply that women needed Psychiatry more than men, but sometime in the Dark Ages someone did name hysteria from the Greek word for uterus.

  “I volunteer to work holidays for this quiet,” a nurse said as she emptied the catheter at Jane Doe’s bedside. “I would go crazy if I had to be conscious in one of these beds for a month.”

  As I thought about what she said, I pictured myself in one of those beds. Bright lights burned twenty-four hours a day. There were no windows. A clock on the wall read seven, but was it morning or night? Only a thin curtain separated your bed from one on either side. With few exceptions you were in constant view of the nurses’ station. People talked, laughed, cursed, cried, and died in hearing distance. Metal instruments and pans crashed onto the metal carts and tile floors. Water was turned on and off. Carts rolled in and out with medicines and equipment. There was nothing in the way of food for patients, but the aroma of popcorn was always present as workers grabbed a snack during their five-minute breaks. If the Occupational Safety and Health Administration had objections, they kept quiet about it back then.

  Unconsciousness has its benefits if you have to be on a ventilator in a place like that, but my patient was about to wake up. We were giving Jane smaller doses of sedation since we were trying to wean her off the respirator and she had to assist with that process. For several days she had squeezed my hand on command. As I wrote my notes I became aware of her watching me. Because she still had her tracheostomy tube, I took a notepad and pencil to the bedside so we could communicate.

  “Where am I?” she wrote.

  “University Hospital, Intensive Care.”

  “Are you one of my doctors?”

  “Yes, I’m Dr. Cara Land. I am the medical student assigned to your case.”

  “Who am I?”

  “What? You don’t know?”

  “No, I can’t remember anything.”

  “I don’t know who you are. You had no identification when you came in.”

  “When was that?”

  “August 5.”

  “What day is today?”

  “September 5.”

  “I’ve been here a month?”

  “Yes.”

  “What’s wrong with me?

  “You hemorrhaged and got an infection from an abortion that went wrong.”

  “I wouldn’t do that,” she printed with big bold strokes.

  Having no idea what to say, finally I squeaked out, “You should rest now.”

  I went to the house staff lounge searching for Dr. Armstrong, taking the notepad with me. “Jane Doe is awake. I let her write some questions.”

  “Good. What did she say?”

  “Look.” I gave him the notes.

  “She doesn’t know who she is! What did you say?”

  “I told her I didn’t know who she was either. I didn’t comment after her emphatic response as to why she was here.”

  “We’ll need to get a psychiatry consult as soon as we get the trach tube out and she can talk.”

  By the end of the week Jane had been weaned from the respirator. Her tube was out and she could speak. We moved her from Intensive Care to a semiprivate room on the floor. The gynecology team got a psychiatric consultation as her amnesia continued along with her absolute denial that she would have had an abortion.

  As it happened I was on the psychiatry team that came to Jane’s room for the consultation. She told us the same thing she had said before. The opinion of Dr. John Whyte, the chief of Psychiatry, was that she was in a fugue state due to the physical stress of the abortion, infection, and blood loss and the emotional stress that could produce such absolute denial of the abortion. He agreed to transfer her to Psychiatry as soon as she was physically able, which was a matter of days.

  Jane’s room on the psych ward was a small dormitory-type room with two single beds and two chests. Flowered curtains hung at the windows, and carpet covered the floor. With the walls painted a bright yellow color, it looked less like a hospital room. As the census was down, Jane did not have a roommate.

  “I’m your student doctor again,” I said when I visited her on the day after her transfer. “We’ll be spending a lot of time together. At least now I don’t have to draw blood and keep an IV going.”

  “That’s good.” Jane was wearing a pair of gray slacks at least two sizes too large and a blue turtleneck shirt that fit. White tennis shoes with no socks completed her outfit. “How do you like my outfit?” She smiled. “I got these out of the used clothing closet. I guess I’m not the first to arrive with no clothes.”

  “Those pants could fit better,” I said. “You’ve lost a lot of weight since you arrived, but I doubt they would ever have fit. How are you feeling?”

  “I guess I’m better. I don’t hurt. I feel a little stronger, but I’m so tired.”

  “That will gradually improve. It will probably take a year though before you are as strong as before.”

  “What is going to happen to me here?”

  “Dr. Whyte says he wants to try treating you with hypnosis. The idea is that under hypnosis, you may remember who you are. Contrary to what a lot of people think, you remember what happens under hypnosis unless you are given a specific suggestion not to remember.”

  “That sounds reasonable. When is he going to start?”

  “This afternoon.”

  That afternoon, Jane came to a small treatment room where Dr. Whyte performed the hypnosis. Besides Jane, only Dr. Whyte, the resident, and I were present. Dr. Whyte explained his plans for hypnosis before he began, and Jane nodded agreement. She sat in a gray overstuffed recliner. The rest of us had straight chairs. The resident and I sat on either side of the recliner, out of her direct view.

  Dr. Whyte cleared his throat, leaned forward in his chair and said, “You can be hypnotized. Contrary to common perception, hypnosis is not about being weak and suggestible; it is about being able to focus, to concentrate on exactly what I say.” Jane nodded and he continued
in a low, even tone. “Now sit back and relax. Close your eyes. Feel the chair as it supports your head, your shoulders, your upper back, your lower back, your legs, and your feet.” I could actually see Jane’s muscles relax. She sank down into the chair, and her head rolled slightly to the left.

  “Now relax your face, your eyebrows, your nose, your cheeks, and your chin.” The lines in her face disappeared as the muscles relaxed.

  “Take a deep breath and slowly let it out.” She did. “Now relax your shoulders, your upper arms, your lower arms, your hands, and your fingers. Take a deep breath and blow it all the way out. With each breath you will feel more and more relaxed, deeper and deeper asleep.” Jane swallowed. He continued in this way down her whole body. Then he said, “Picture yourself in an elevator going down. Watch the numbers as it goes down, down. With each floor you are going to be deeper and deeper asleep, more and more relaxed. You may hear a noise outside—just let it float in and out of your mind; concentrate on my voice. You have no place to go, nothing to do but be here and relaxed.” A look of absolute peace came over her face.

  Dr. Whyte waited a few moments. “Picture your childhood. You are four years old. Your mother is calling you to come to dinner. What do you hear?”

  After a long pause, in a childlike voice Jane said, “Jessie, come wash your hands, supper’s ready.” I could hardly keep quiet. Her name was Jessie.

  “Is there anything else?”

  She paused longer this time. “No.”

  “Picture yourself a little older. A friend has come to visit. What does she call your mother?”

  After an even longer pause Jessie said, “I can’t see anything.” In spite of several attempts Dr. Whyte made to indirectly approach her last name, at least her maiden name, she could remember nothing else.

  “Okay, Jessie,” he said in the same even tone, realizing that he would likely not learn anything else today. “Slowly, I am going to count to ten. As I do you are going to wake up. When I get to ten you will open your eyes and remember everything we said. You will also feel rested and relaxed.” As Dr. Whyte said ten, Jessie opened her eyes. “It’s nice to meet you, Jessie,” he said.

  “Thank you.”

  “That is enough for today. We will try again tomorrow.”

  “I feel wonderful,” she said.

  “Yes, Jessie, hypnosis has that effect.”

  The next afternoon Dr. Whyte proceeded in the same way. After Jessie appeared completely relaxed, he asked her name. Her only response was Jessie.

  “Let’s go back to your childhood, Jessie. Can you see any picture from when you were little?”

  “I remember my father helping me pick green beans. My mother helped me break them and showed me how to cook them. We put them in a pot, covered them with water, and cooked them for a couple of hours. After a while, we added some bacon fat and salt. When they were finished, we ate them with chopped onions.”

  She obviously grew up somewhere in the South, I thought to myself.

  “How old were you then?”

  “Six.”

  “Can you remember being older.”

  “I remember going to church one Sunday.” Jessie started to tremble. Tears dripped onto her blouse. “The preacher said when you sin, you go to hell. He said that when you are in hell, you can look up and see your loved ones in heaven.”

  Dr. Whyte clenched his fist and got red in the face. “How old were you then, Jessie?” His kind voice belied his expression.

  “I think I was eight.”

  “I think this is enough for today,” he said. “As I count to ten you will gradually wake up. When I get to ten, you will open your eyes and remember everything that has happened.”

  After Jessie left the room, Dr. Whyte said in a harsh voice, “That kind of Christianity is why she’s in this shape. She can’t face what she’s done. Whatever happened to love and forgiveness?” I thought that Dr. Whyte must be a nonbeliever, but I learned later that he was a devout Christian.

  Every weekday for the next week, Dr. Whyte hypnotized Jessie. Under hypnosis she remembered elementary school. She not only loved it, she excelled and was almost every teacher’s favorite. She got to be the assistant who collected lunch money from all the classrooms and took it to the principal’s office. In the seventh grade she assisted the photographer who took the school pictures. She remembered a story about her teacher who, when the photographer asked her to drop her chin, said, “Which one?”

  “I love the hypnosis,” Jessie told me one day. “I feel so energized. I feel confident, like I could do anything. Why can’t I remember who I am?”

  “I don’t know.” I realized how pathetic that sounded and wanted to be able to give her an answer.

  “I do remember how to do things, some I haven’t even told Dr. Whyte about. For instance, I know I can sew. If I had a sewing machine I could take some of the clothes in that closet and make them fit me. I’m so tired of wearing these clothes. I wonder what happened to my clothes.” It was the first real complaint I had heard her utter.

  “The ER nurse cut them off. They were soaked with blood.”

  She looked startled by my comment. “I forget that you know more about my life’s history than I do.”

  “Do you think it would be helpful for me to go over all that happened to you here at the hospital? You know, while you were unconscious.”

  “It couldn’t hurt . . . uh . . . could it?”

  Her medical chart, quite thick by this point, was useful to refresh my memory. I told her about where and how the EMTs found her, about her blood transfusions and three surgeries. I showed her the pathology report that proved she had been pregnant and had a perforation in her uterus. I even told her about the red rubber catheter. I told her about the scars that proved she had delivered at least two children and probably three. At that point she stopped me.

  In a hushed voice, she said, “Three.” She looked down at her hands folded in her lap. “I have deserted three children. How can I have done this? How can I live with it?”

  When she said no more, I asked, “Would you like me to go?”

  “Yes, please.”

  That evening I couldn’t get Jessie off my mind. I had no children, but I could imagine that the thought of deserting three children would be a terrible blow. Could a loving mother do what she had done? Maybe I should not have told her. No, she needs to know. She even needs to accept what she has done, if she is ever going to figure out who she is. Maybe knowing, even though it is painful, could trigger some memory of them and of herself. I wondered if we were doing all we could to find out who she was. That was the only way we could get her back to her children. I had an idea.

  As I dressed the next morning, I thought about Jessie wearing the same clothes day after day. I would have been happy to give her some of mine, but we were so different. I was short and stocky and she was tall and thin. I resolved to go shopping over the weekend, and I hate shopping. As soon as the morning staff conference was over, I went to the office of the social worker, Ann Long.

  “Do you have a few minutes?” I asked when she answered the knock on her office door.

  “Sure, come in.”

  “I’m the student doctor for Jessie Doe,” I began. “I had an idea about how we might find out who she is, and I wonder if you could help me?”

  “What do you have in mind?”

  “Can we check with the police to see if any Missing Person reports were filed around the time she came into the hospital? She probably left home on the third or fourth of August.”

  “We did check. We gave a photo to the police, and at least two people failed to identify her. I can ask a friend in the police department to check again since we now know her name is Jessie.”

  “Would you? I hope we can find out something. I told her yesterday that we think she has delivered three children, and she became very upset.”

  Ann echoed my thoughts. “Maybe it will stimulate her memory.”

  “I had hoped so, but it d
idn’t right away. I guess we’ll know this afternoon at her hypnosis session.”

  The hypnosis session started as usual. When Dr. Whyte asked Jessie about any thoughts that came to mind, tears welled around her closed eyelids and she sobbed silently. The next day the session ended the same way. I felt responsible and thought I should confess what I had done.

  “Dr. Whyte,” I called as he was leaving the room. “May I speak with you?”

  “Sure, come to my office.”

  He closed the door and turned to face me. “What is it?”

  “I think you know that I was Jessie’s student doctor on GYN.”

  “Yes.”

  “She asked me to tell her everything I knew about her medical case, said I knew more of her life history than she did. So I told her. When I told her we thought she had delivered three children, she became very upset and said she had deserted them. She asked me to leave her alone and hasn’t wanted to talk about anything of importance since. That was the day before she started crying during hypnosis. I am so sorry.”

  “Don’t blame yourself, Cara. It is important that she know as much as she can about herself. That information could just as well have stimulated a breakthrough. It still might, but I’m doubtful. I believe this sobbing indicates she had a major depression before any of this ever happened. That may be at least part of the reason she had an abortion when she has so clearly stated her belief that it is wrong and she wouldn’t do it.”

  “I asked Ms. Long to check Missing Person reports for the time Jessie came to the hospital. She said they had checked, but it was worth checking again now that we know her first name. I hope that turns up some possibilities.”