It was right around 1800 and I was in the middle of spiking new bags of TPN and lipids. I had forgotten the PICC IV adapter and was halfway out the door to grab one when her visitor peeked around the corner.

Before me stood a woman about the same age as Mary, my patient. She held her purse with both hands and peered at me questioningly. I paused and smiled at her, told her she was welcome in the room - Mary was awake for a change and watching TV.

She hesitated and looked at me again, eyes darting briefly between me and the room behind me.

Eyes wide, she asked it:

So... how's she doing?

Whoa, loaded question.

My mind lurched briefly and then started racing. Who are you? What do you get to know? How much do you already know? What do I know? Where's the line supposed to be, and how do I draw it?

Mary was not doing particularly well. She was currently weak but stable. The severe ischemic colitis was a major complication; if it turned gangrenous, the mortality rate could be as high as 50-75%. At this point it was a wait and see game, to determine whether she'd recover some bowel function and be able to live a normal life, or perhaps her bowel might perforate and she would have to be treated for life-threatening peritonitis. Surgery could entail resecting the bowel, or even removing it entirely, and creating an ileostomy. Mary was also experiencing some mental status changes, had pitting edema to one leg, and was becoming increasingly gaunt.

So *I* knew all of this. But I was also acutely aware that this visitor would hang on every word I said, and I would have to be as diplomatic as possible, but there was no time to really think about what I would say because every moment I hesitated she grew ever more concerned. There were also concerns of who was she, and what was she entitled to know. What was I entitled to share? How could I put it?

So, with my heart pounding in my chest, I asked the visitor who she was. Mary's best friend since we were in high school, she told me. We go way back.

'Okay,' my mind raced, 'a friend. Good friends, by the sounds of it.'

I took a deep breath.

"Mary's surgery is healing well, but she has developed a complication with her GI system." Her eyebrows raised and I cringed internally. GI? Who the hell says that?

"Her, uh, bowels are having some problems, and we are, uh, keeping an eye on her." I winced inside. It was extremely hard for me to find the right words that would simultaneously protect Mary's privacy, avoid false reassurance, and also respect the friendship of these two women; made harder still as she watched me, nodding carefully and hanging on every word I said. "She is doing well today and you are welcome to go and visit her."

"So, when will she be able to leave the hospital?"

Good question, I thought, I have no idea either. "When the doctors feel she is strong enough."

"So we are just waiting for her to get strong enough, and then she can leave?"

Yes, if she doesn't perforate and go septic... or lose her bowel function entirely and need major abdominal surgery to create an ileostomy... and if that surgery doesn't develop complications too--
"Pretty much. She should be discharged then."

"Okay, thank you." She smiled at me, and I smiled weakly back at her as she walked into the room and gave Mary a big hug.

I let out a huge exhale. My heart was pounding. They never taught us how to deal with that in school...