Cold Sandwiches

Megha Dogra, MD

t is just another fall morning. I am greeted by a gush of cold air as I step out of my centrally heated apartment for work. I have been waiting for fall. The orange, yellow, hints of red and rust in the trees are a welcome change. The leaves make a crunching sound as I make my way to my car. I drive to the hospital.

My new patient today is Riley Lane. Riley was found in a van, covered in her urine and soot. She lay there for hours until Danny found her and called grandpa to help. Danny is 8, by years of birth. He was forced to grow far beyond his age. He would cook, clean, get himself ready for school and walk himself to the school bus stop every day. In the evening he would come home, scavenge the fridge for leftovers, and make dinner. My first question to him was what does he cook? What can an 8-year-old cook? Can an 8-year-old be trusted near a burning stove? He answered “cold sandwiches” which reassured me. Danny was blue-eyed, pale-haired, maybe a little overweight, much unlike his mother. His mother had also grown far beyond her years. On first glimpse I assumed nothing short of 60. The chart said 45. I was 35 when I stood in front of her. I imagined if I would look like her in 10 years. What if my daughter had the life of Danny in 10 years? Can she be trusted near a burning stove?

Riley had black teeth, not the tattooed kind, but the kind that aren’t taken care of, the kind that belong to someone who has to choose between paying bills or paying for dental insurance. Her skin was freckled and told stories of the countless hours she must have spent out in the sun. Skin so thin that you could see through the bends and hills in her bones. The hospital gown could fit two of her kind, or maybe three. A picture of the scene where she was found flashed in front of my eyes. In the back of a school van. I see Danny peeking in, calling for her in a calm voice. He is not screaming, he is not scared, he has seen worse. He has the stoic demeanor of a soldier. He stands still and calls her name. He doesn’t dare to go in. This is not the mother he knows. This one smells of sickness. But does he know how sickness smells? How much is an 8-year-old supposed to know?

Danny and his grandpa are here. Grandpa is well dressed and has a back brace for an accessory. Danny’s crocs are a bright shade of green, the ninja turtle green and have crevices which make them look like jaws. The crocs and his pajamas contrast with the situation Riley might be in. We still don’t know what happened to her. If only she could talk. She mumbles and screams when touched. I hope Danny would know and understand his mother’s mumbling. Alas, it is a mumble for him too. Riley can’t move. Not even when pushed or prodded. Danny must give me answers today. There’s no one else who knows Riley better. I hesitate before framing my words. He’s just an 8-year-old kid. What if I slip and say a word he shouldn’t know. How much is an 8-year-old supposed to know? Danny makes cold sandwiches. I feel reassured. I assume he is safe standing in the kitchen every day, morning and evening, looking inside the refrigerator, figuring out what to cook. What to cook remains a struggle in my kitchen even now. What is an 8-year-old supposed to know about cooking? He wants to be a chef, he says. He loves to cook. He has said that many times now. So much so that I am forced to ponder if he has something to hide.

How do you ask an 8-year-old if there’s a chance his mother could be pregnant? I start with any sight of needles at home. Danny elaborates that the hallway smells of weed. He holds his breath every time he walks by, fearing that he might inhale some of the “bad air”. I believe him when he says he hasn’t seen needles at home. There’s no mention of a father. There’s no mention of friends. I struggle to find words.

It is day one in the hospital. The pregnancy test prohibits me from giving her radiation. We start with an MRI of the brain and the pelvis. All the organs inside the impoverished frame look normal. The blood and the urine say everything is “within normal limits”, mocking the body I see. Riley doesn’t move, doesn’t flinch, doesn’t talk. She has mastered staring at the known and unknown alike. Danny takes out from his bag a strawberry yogurt and a whoopie pie, her favorite foods. She swishes the yogurt inside her mouth, as if she has forgotten to swallow.

In the 19th century a strange disease emerged among the sailors. Ships full of men would turn into ghosts. The ghosts would be skin and bones, lifeless, they laid still, they couldn’t talk, couldn’t move until death would free them. The disease would affect just the lower ranks, the ones who took to sailing to survive the lowlife, the ones who survived on rice and potatoes. The rich on the ground rarely became a part of it. A doctor then staged an experiment. The low lives on a ship were given fruits and vegetables and they seemed to escape the infestation. That’s how thiamine was discovered.

Riley could talk after the magic vitamin infusion. She remembered how to swallow. Unaware who I was, how long she had been there, how she ended up there, but she remembered Danny. I jokingly inquired if Danny was a good cook. She chuckled, “he tries”.

On the days that ensued, she underwent an EMG, a muscle biopsy, scans of the spine and many other tests. The vitamin infusions brought back her chuckles, her independence to walk to the bathroom, a smile on Danny’s face, and her life as a single, struggling mother. Riley stays in my mind as the face of a humbling vitamin. If only malnourishment was as revered as any other disease, we would prevent childhoods like Danny’s.

Megha Dogra, MDInternal Medicine HospitalistSt. Vincent Hospital, Worcester, MAdrmeghadogra@gmail.com