Red Patient One

Octavia Ruelas

Mrs. Red was my very first patient. She was assigned to me as an eager MS3, chomping at the bit and more than elated to finally be out of the lecture hall.


Aesthetically, it was the color of her wig that always greeted me with a vibrant shine. Clinically, it was the color of the blood she was missing. She came to us (the inpatient medicine team) with a hemoglobin drop that was significant and unexplained. Her workup included an abdominal CT that showed spots peppering her liver.

“Severe anemia” became “occult malignancy.”

Suddenly, the red theme of anemia, hemoglobin, and her wig became the cold, ugly word we whispered around her when she was out of earshot: cancer.

Her vibrant wig was always the first thing I noticed when I walked into the room. Sometimes she had it on, smoothing out her edges nervously. Other times it was off, set down unceremoniously next to an empty food tray. The wig reminded me that this woman had a personality, a personhood outside of the hospital. The object was my only glimpse into who she was out there in the “real world.”

Mrs. Red was always warm to my touch. She never appeared pale to me, her dark skin hiding the occult blood loss from peering eyes. The pallor sometimes snuck out, though, in her downcast eyes and her too soft voice that was always sad and cautious.

Her husband often stood in the corner. A preacher and her guardian. He had this warrior angel vibe about him, like he was battling on his weary wife’s behalf. He was trying to be strong, tension held across his shoulders and chest. I think he thought that if he uncrossed his arms, he would fall apart, faith and all.


That’s all the medicine team had to offer her. A cold unit of blood, a cold room, a cold diagnosis, and a medical student with cold hands.

I tried to make up for it later. I wished her a “happy birthday” on pre-rounds one morning after I noted she would be spending it with us. For a brief monumental flash, she smiled. It was a quick and shy thing that I knew I would never see from her again. It was beautiful, but it was too fast to share.

I hang on to that moment when I think of her, wishing that the smile had reached her eyes and that I could have seen it last a little longer. I can barely remember it now.

(Sometimes I wonder if I just imagined it).

As I continue through my third year of medical school, I often wonder how I have changed as a healthcare professional since meeting Mrs. Red. I wonder what patients see when they see me.

During one conversation, I remember Mrs. Red telling me she was not sure I was old enough to be in her room asking her questions. She was a little suspicious of the five-foot even, braces-wearing medical student asking very personal questions and coming in for a physical exam at 7am. She asked me how old I was in that direct, inoffensive way women of a certain age can ask you your age. I told her and she shook her head unbelievingly. We chuckled about it.

Sometimes I worry that my somewhat young appearance and title of “Student” will make patients nervous. After thinking about my interactions with Mrs. Red, however, I realized that my petite build was not a barrier, but a segue. A point of human connection. I am small, yes, but I could sit down with her and listen to how the heating pad had shut off in the middle of the night, allowing her chronic flank pain to worsen. I might have been younger than she was expecting, but her husband remembered me when I ran into him on the wards a week later and caught up about why she had to be readmitted after my team’s discharge.

I have realized that there is no formula. No combination of brains or physical attributes that can make a perfect medical student (or any other kind of healthcare professional for that matter).

I can only be me. I am petite, I wear braces, and while those things in isolation could be reason to make me self-conscious, I realize that it’s minimal in the grand scheme of what patients — people — are looking for.

Someone to see them, someone to talk to. Someone who will listen.

Mrs. Red taught me that more can be said with silence than words. To take each hard-lined smile with gratitude. I realize now, that though I only saw her smile once, her bright red wig had always been there, shining with unapologetic, iridescent, curly waves, voluminous in nature and speaking volumes for her.


Becoming a Doctor at the University of Minnesota Copyright © 2021 by Octavia Ruelas. All Rights Reserved.