HIPAA-Proof Grey Wishing Well
Karishma Soni, MD
It isn’t like I didn’t know. It isn’t like it has never happened before. But I guess I never imagined it long-term. Never imagined the build-up. The lipofuscin coating me as the days wear on, the patients switch over, the rotations change—lipofuscin being the pigmented lipid-filled granules that build up in cells, often considered a hallmark of aging, of “wear-and-tear.”
But now I see.
I notice this lipofuscin when I return home at the end of the day as this wear and tear slowly slips off my shoulders, around my arms, and eventually just dangles at my fingertips, though never to be shed completely.
It begins as I walk in. I share the weights at the forefront of my mind, the patients whose plans I feel uncertain about, with the feline HIPAA-proof grey wishing well that is my roommate. Hanging up my jacket, wondering aloud if the treatment was aggressive enough, slow enough, or whether it will have the response we hope for.
Her eyes, dilated with the glow of nighttime, follow me as the badge goes back to its proper place.
As the rest of the accoutrements of work assume their resting place by the door, I talk about labs and tests pending and resulted. The diagnostic gymnastics play out again as I scoop her up for that close reunion of familiar comfort.
As I set out her food in front of her, the residential thoughts—the daily residue at the back of my mind— also lay out before me. The patients whose futures are uncertain. Their recovery, their course shrouded by the mystery of the nebulous players of fate in medicine. The hidden genes, the looming environmental factors, the pieces on the board we only guess at.
She eats in between check-ins around my feet. She drinks in between absent-minded strokes of her soft grey companionship. She listens attentively to my quiet musings…. What could I have done better? How can I make tomorrow free from the mistakes of today? How could I improve how I handled the situation? Catch it earlier, try it sooner, see it faster, do it better, hear it before, order it in the beginning, discuss it at the start.
When the day has finally reached its end and the night calls, we settle into bed where the final vestiges of the shift can no longer stay hidden behind distraction. I wish aloud with her snuggled in close…. I hope they get better, I hope the treatment works, I hope they find solace in the answers we painstakingly found where before there were just questions, I hope they can get back on the path they want, I hope I…. I hope I never see them again. That they move on from these worst days and that if I do see them, their eyes don’t catch on my badge but on the grey fur of my friend who knows their story.
Karishma Soni, MD
VTC Psychiatry Resident PGY-1, Class of 2026