On the Other Side of the Glass

By Rachel Ewing

Sabrina Layne has spent enough time on clerkships to imagine what the people in scrubs are saying outside the sliding glass door: “This is Mallory Smith. She's a 25-year-old female with a history of cystic fibrosis complicated by B. cepacia infection. We are now post-op day five from a double lung transplant complicated by possible vocal cord paralysis.” But today Layne is on the other side of the glass, on the other side of the state, in a surgical ICU in Pittsburgh. She is the best friend holding hands at the bedside, watching the pain in each of Smith’s movements, helping the nurses move her, helping to toilet her, giving her tiny swabs of moisture on a toothbrush because she isn’t allowed to drink.

Eight years earlier, when Layne and Smith were matched by the housing office as freshmen at Stanford, Smith seemed as outwardly healthy as a person could be. Six-foot-tall blonde, beachy, athletic, Californian Smith towered over the ultra-petite, curly-dark-haired, talkative New Yorker Layne. Though they appeared to be opposites, they instantly bonded. Layne quickly came to realize how much Smith’s vibrant exterior belied the seriousness of her chronic illness. Smith spent hours every day in their dorm room doing inhalation treatments and wearing a percussive vest that pounded on her chest to prevent mucus buildup—often while she studied. During their sophomore year, Smith’s illness began to worsen, and Layne often sat at Smith’s bedside as she was in and out of the hospital for their remaining college years. Layne was sometimes a sounding board to Smith’s frustrations with the medical system when nurses wouldn’t allow her to administer her own medicines or when her parents and doctors disagreed over treatment plans. But, mostly, they were just regular best friends—studying together, gossiping about boys, and laughing at inside jokes and goofy nicknames that Smith coined for Layne, like Sa-bra-bra, Sabrizz, and Sabrizznatch.

Even when Layne departs for med school on the opposite coast, she visits Smith as often as she can. During one trip early in Layne’s second year, Smith explains for the first time the implications of her B. cepacia infection, a serious complication that typically makes patients ineligible for lung transplants. On the flight back to Philadelphia, Layne cries, but not because of B. cepacia. It’s because Smith’s illness had progressed so much since her last visit. They hadn’t explored San Francisco. Their big outing was a short walk down the block to get manicures and pedicures; they got an Uber ride back to Smith’s apartment because the slight incline of the street was too challenging. Layne trailed behind Smith, carrying her oxygen tank up the stairs.

The visits slowly shape Layne’s perception of illness and health. One visit to the doctor’s office, or one hospitalization, never shows the medical provider this long view—the lowering of a day’s expectations from surfing to mani-pedis, the chronic challenges with both a weakening body and with the medical system.

Over the next year, Layne visits Smith three times at the University of Pittsburgh Medical Center.

Once while she is listed for transplant, against the odds.

Once just after the surgery, when she sits at her bedside in the SICU.

And once at the end.

Smith is intubated, partially sedated, and her organs are beginning to fail. Layne is one of a crowd of close friends who circle the bedside then—joking, laughing, and trying to convey hope despite the grim prognosis. Smith’s father, Mark, has begun rallying researchers across the world in a last-ditch effort to develop phage viruses that may destroy the newly virulent, antibiotic-resistant B. cepacia. By the time they inject Mallory with the experimental phages, her infection has advanced too far. Three days after Layne has returned to medical school, knowing that she has held her best friend’s hand for the last time, she learns that Smith has died.

More than a year later, Layne still thinks about Smith almost every day on the wards. When patients are struggling, when families have conflicts with clinicians, she sees echoes of some of her friend’s experiences. “Even in moments where people on the team are starting to get frustrated with a certain patient, I find myself thinking, ‘What would that have looked like from the other side?’” She is resolved to carry that perspective forward as a physician, whether that means giving a family a few extra moments to process their feelings, or pausing to try to communicate in a different way.

On March 14, 2019, the evening before Match Day, Layne stands before an assembled crowd of classmates and professors to talk about these lessons she’s learned from Smith alongside others who knew her intimately—a number that is poised to grow. Diane Shader Smith has carried out her daughter’s wish to publish her journals. The newly released posthumous memoir is entitled Salt In My Soul: An Unfinished Life. Profits from its sale will benefit research into phage therapy.

Layne keeps her poise as she introduces Diane and Mark for their talk about Mallory and her memoir, but the emotion cracks in her voice. “I can still hear Mallory laughing as she called me by those nicknames,” Layne says. “I will never forget them. I will forever treasure our special friendship. I’m grateful now that Mallory left us her words, her gift.”

Read more about Layne’s journey through medical school, along with six of her classmates, in the full story, The Path Through Penn Medicine.