The Elevator Crisis
Ellen Solomon - 4th-year Medical Student, Sidney Kimmel Medical College
On my first day of third year clerkships, I spent two hours in an elevator. That elevator in June 2020 in the middle of a global pandemic provided the most profound learning experience of my third year of medical school.
I walked into clinic that morning with my white coat draped over my arm, a symbol of my much-anticipated admittance to the world of hands-on learning. I carried with me, too, the excitement, anxiety, and uncertainty that comes with translating knowledge into practice. I was rotating in a clinic that focused on caring for patients with Intellectual and Developmental Disabilities (IDD). That morning I watched with amazement as my attending cared for her patients and their caregivers in a way that so clearly communicated empathy and understanding of their specific challenges. These challenges were exacerbated by the pandemic; routines were disrupted, day centers were closed down, and caregiver exhaustion was at its peak.
Around 1pm, my attending and I were called out of a patient room mid-visit with a request for help. We learned that one of the morning patients was refusing to leave the clinic. It caught us by surprise, as this 19-year-old gentleman with autism was remarkably calm, cooperative, and interactive during our visit. Now, in the discharge area, he was hunched over in a chair, hands clenched around a clinic toy, eyes fixed on the floor. It was clear that he had been in this position for nearly an hour. Finally, after thirty minutes of coaxing and help from various team members, his rigid posture relaxed, his furrowed brow softened, and he hesitantly stood from the chair. As we took careful steps towards the elevator, I saw relief bloom on his mother’s face.
This relief was short-lived. As the patient crossed the threshold of the elevator, his demeanor shifted. In a moment, he was curled in a ball on the floor of the elevator, head in hands, and unwilling to move. We tried everything: toys, snacks, a call from his father, fewer people, more people, a water bottle, his favorite song. He wouldn’t budge. He was frozen in time, scared, beyond our reach.
An hour later, my patience started wearing thin. The constant, irritating buzz of the elevator, angry that we’d been holding the doors open longer than its programmed time, was a nagging reminder that this moment of crisis defied the limits of any plan, schedule, or timetable. The whispers and glances of curiosity from onlookers frustrated me. The patient’s meltdown was on display while we seemed to be making no progress, adding to my feelings of helplessness. As my mind wandered, I looked to the mother and saw patience, love, and resilience—strength I couldn’t comprehend.
Ninety minutes later and out of options, we decided to physically remove the patient from the elevator. We knew that the use of force would only escalate his fear and resistance, but there was no alternative. It was physically difficult, as he was a well-built, strong 19-year-old, but even more, it was emotionally jarring. As his mother and a security guard carefully carried him over the elevator threshold, his body tensed and his agitation grew. As he lay on the lobby floor, he grabbed his mother’s shirt, all his fear channeled into his desperate grip, pulling her closer in panic.
After nearly two hours of patience with no visible frustration, his mother broke down. Bent over his body, her tears flowed onto the son whom she loved but could not rescue from this moment of fear. My face shield began to fog as my eyes teared. I saw the exhaustion on my attending’s face. One of the medical assistants who had been helping for the past hour began to cry, thinking of her own son with autism. The patient’s father soon arrived, having left work to help physically get his son into the car. We could hear the fits of screaming and agitation even from the 2nd-floor clinic.
I walked into clinic that morning excited to learn, to feel like a doctor, to move towards certainty in diagnosing and treating diseases. In the span a few hours, I felt farther from certainty than ever. I felt like I bore witness to a collision of the pain, uncertainty, and fear of this moment in history with the lives of this patient and his mother.
The disruption of routines, which everyone felt in the height of COVID-19, is more visceral for those with autism who rely heavily on routines to calm anxiety anxiety. COVID-19 has also exacerbated caretaker burnout as daycares, family members, and other sources of support can’t operate in the ways they normally would. Particularly poignant, in light of George Floyd’s death just a few weeks prior, this moment of crisis could have ended tragically for the patient and his mother, who are Black. George Floyd’s death has brought to front of mind the history of police violence towards Black Americans and the deadly consequences of racist presumptions of danger associated with Black men. It was all too easy to imagine how this patient, agitated and unyielding, could become a victim of police violence. If this same crisis happened in a different location, without the support of the clinic staff and understanding of the context, it could have ended very differently.
In healthcare, we can’t avoid the messiness of humanity––family stress, broken systems, physical suffering, collective grief, historically-rooted racism, one young man’s meltdown, a mother’s exhaustion. And for all these problems, we don’t have easy answers. The elevator crisis continues to remind me that there are so many problems that a prescription or vaccine can’t fix, no matter how many years of clinical training and experience I complete.
The elevator crisis also reminds me that as a doctor and as a human being, there is more I can offer when answers and solutions run out. When I think back to the elevator crisis, I remember not the absence of certainty, but the presence of my attending’s compassion that extended far beyond the walls of the exam room, the presence of an interdisciplinary team that dropped everything to respond, and the presence of a mother’s resilience and love for her son.