Glossary:
Toradol: a non-narcotic pain medication.
Syncopal episode: medical-speak for fainting spell.
A-fib: atrial fibrillation, an abnormal heart rhythm.
Hospitalist: a doctor who works with patients admitted to the hospital.

I am no stranger to pain. The worst three days of my life were spent huddled among rotting potatoes, scared, confused, and trying not to scream too loudly as the venom worked its cold, fiery way through me. But I'm glad for the experience, because it's given me empathy for others' pain, something my profession sorely lacks. Patients in pain were often met with scorn and annoyance. After all, pain rarely brings out people's good manners, and it was sometimes impossible for us to tell legitimate pain patients from drug seekers, leading to a lot of frustration and tough decisions. But I know how it feels to be in pain, to be alone, to be afraid and confused and helpless, and I swore early on that I would never dismiss anyone else who faced the same situation.

It was something I bore in mind as I regarded the patient in room eight, a young woman in a Western Washington University sweatshirt who lay on her side, hugging her knees to her chest and fighting back tears. Twenty-one-year-old female, chief complaint of abdominal pain times two years, the chart said.

"I'm Dr. Cullen," I said, holding out my pre-warmed hand for her. She reached up and shook it weakly.

"I'm Annie."

"Can you tell me a bit about what brought you here today?" I was deliberately vague; I didn't want my questions to lead her answers, and I certainly didn't want to sound like I was judging her for coming to the ER at two in the morning for something that had been going on for two years.

"I know how this looks," she said, her voice rough with pain, "but my stomach is killing me. It's been killing me off and on since I was nineteen. These days, mostly on. And yes, I've seen my primary about it. And he said it was just period cramps, and I should take ibuprofen. So I saw a gynecologist, and she said that I was stressing too much and needed to relax. Third guy I went to thought I was a drug seeker, and that's when I gave up. I tried to ignore it, and relax, and take ibuprofen. And it's gotten worse. And I know it's probably not going to kill me right now, so it's not technically an emergency, but I have midterms in three days, and I can't take another second of this. I'm done."

I inhaled subtly. She smelled like sweat and instant noodles and rented textbooks and frustration and the acrid tang of menstrual blood. Also I was pretty sure I knew what she had. She was in for a long haul.

"I believe you," I said. "I don't think this is just cramps, or stress, and you were right to come in. I'm going to need to go over your history one more time, and do a few tests, and then we'll go from there. But first, I'm going to put in an order for some pain medication."

Annie looked at me with mild surprise. "Seriously?"

"Of course. You'll need a clear head to go over your medical history. Do you have any allergies?"

"Bactrim."

I made a note. "Taking any medication, including over-the-counter?"

"Ibuprofen."

I made another note, and went to put in the order for toradol. If that didn't work, I'd prescribe a low dose of Mobic or tramadol. Annie had been in pain long enough.

An hour later, Annie was sitting more or less comfortably on the toradol, describing the pain as "down to a dull roar." She seemed more relieved that I was taking her seriously than anything else.

And it was a good thing I had. As I suspected, the pelvic ultrasound showed multiple endometriomas adhering to her ovaries, fallopian tubes, and uterus. The pelvic exam I'd done had also been suspicious for uterine scarring, and although I'd done it as gently as possible, Annie had still gritted her teeth from start to finish. Her history was more or less what I'd suspected: heavy, painful cycles starting at age nineteen and getting steadily worse, until the pain was constant and then worsened during menstruation.

"It's highly suspicious for a condition called endometriosis," I explained to her. "It's caused by the uterine lining growing outside the uterus, which can cause all the symptoms you've been having. It takes surgery to diagnose it officially, though."

"Endometriosis," Annie whispered, turning the word over in her mouth. "En-do-me-tri-o-sis. So, how do we fix it? Do I have to have surgery or do I take meds, or what's the plan here?"

I sighed. This was the hard part. "There's no cure. Surgery and birth control can help some people, but a lot of it is just pain management. I'm afraid I'm a bit out of my depth, but I'm going to refer you to a specialist. I've known her for years; you'll be in good hands."

"No cure," Annie repeated. "Am I going to be in pain for the rest of my life?"

I shook my head. "I don't know. But I do know that you're not going to be in pain for the next few weeks. I'm writing you a prescription for two weeks' worth of toradol, and five doses of a narcotic called Mobic for the very bad days." I gave her a serious look. "Use them carefully, only when you really need them. And this is just a short-term prescription; you'll need to come up with a long-term plan with the Dr. Muir. Understand?"

Annie nodded. "Wow. This … this'll get me through midterms no problem. Wow. Endometriosis. Is it rare?"

"Not especially. It can be hard to get good numbers, but most common figure is ten per cent of women of childbearing age."

Her face darkened. "One in ten? If it's so common, then how come everyone else missed it? I went to three doctors, and two were gynecologists. How come it took a random ER doctor in the middle of the night to diagnose me?"

"I'm sorry," I said, on behalf of my profession. "I don't have those answers for you."

Annie signed her discharge paperwork, looked over the prescriptions and instructions and referral information, and walked out the front door, shuffling a bit but otherwise showing no signs of discomfort. I watched her leave, wondering if her pain would ever end, as mine had.

After she was gone, I stood for a moment, letting my mind go blank and simply absorbing the sensory information around me. The smell of floor cleaner and cavicide disinfectant and blood and pus and oxygen tubing and vomit. The sound of the lights overhead, the cars outside, the clacking of a keyboard, the hum of Dr. Snow on the phone with the hospitalist trying to get a patient admitted.

"Sixty-seven-year-old female, came in for a syncopal episode, in and out of a-fib for the past hour and a half," he murmured into the receiver.

"What do you expect me to do about it?" asked the hospitalist, the time-honored refrain of doctors to whom care is being transferred. The first time I'd heard that was in 1855.

Once I'd cleared my head, I logged into a computer and brought up some charts I had been meaning to catch up on. No other patients came in for the rest of the shift. Some paramedics called in to clear a refusal with us, and I happily took the call and gave them my name and license number for their report. Then Dr. Caldwell arrived, seven o'clock on the spot as usual, and I was free to leave.

Esme was waiting for me when I got home. The rare morning sunlight shone through the windows and made her skin glitter. She saw my taut expression and touched a pale hand to my face.

"Hard day?" she asked, pulling me down onto the couch next to her.

"Not really. I just had one of those patients that comes to me after the healthcare system fails them."

"You set it right, though, didn't you?"

Her faith in me was touching. "I did what I could," I said, lacing my fingers with hers, our old I-love-you from back in the day. "It was a quiet night, overall. And how are you?"

"Well, I made a few cabinets, just small ones. Oh, and it's going to be sunny off and on for the next week, so the kids are planning a hunting trip. I've written them a school excuse."

I kissed her forehead. "That will be good for them. What are you going to do with the cabinets?"

"You know, I'm not sure." She rubbed my shoulders. "Maybe give them to a thrift store. I didn't really have a use in mind when I made them; I just wanted to do something with wood and screws and it's been a while since I've worked on a house. I haven't really been doing much lately."

"Do you want to go hiking today, or maybe hunt?" I suggested.

She shook her head. "I don't really feel up for it."

That was strange. It would be a completely innocent thing for a human to say, but Esme was supposed to be immune to the ravages of fatigue and malaise. She'd never not felt up to something in the time I'd known her. I tried to put it out of my mind as she pulled me into her lap and ran her fingers through my hair. If she didn't feel like going out, we'd have a nice day on the couch, just the two of us.

With some effort, I shut off the medical part of my brain and concentrated on the here, the now, the seconds of the eternity that I had to spend with the woman I loved.

You review me; I review you.