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It's call night again. The day itself was fairly smooth, being a Saturday and all: folks run lightning rounds and do their very best to get the hell out of the hospital so they can go home and relax. There were no scheduled o/r cases. As a result, there wasn't a whole lot going on.
I do get one sorta strange call around eleven a.m. though. I can see on the phone's little LCD display that it's coming from the parking garage. "Hi, are you Vascular Surgery?"
"Sure, why not? What can I do for you?"
"Well, we have this patient who had a cardiac catheterization done a month ago, and they took the introducer sheaths out last night."
"Yeah?"
"Well, there was some bleeding, and it looks like she could have a pseudo-aneurysm that might need a vascular repair."
"I see. Um - where are you calling from?"
"Oh, I'm in the garage. I'm about to leave."
"Uh-huh. And it just now dawned on you to let us know about it? No, nevermind. I'll go see her. Thanks for the call."
So I go to see the lady, who sure enough had a nice big pseudo-aneurysm. I trace its boundaries on her thigh with my patented Sharpie red pen and then go to look through the chart. Therein I discover that not only did she have a cath, but also underwent angioplasty. Nice to know. I also discover that it occurred yesterday rather than last month. This makes a lot more sense, 'cause there ain't no reason to leave the sheaths in that long. As for exactly what had happened when the sheaths were removed however, I am at a loss. One note says she bled a lot, another says she didn't. One says the aneurysm was pulsatile, implying some pretty significant arterial bleeding, the other says it wasn't. I'm starting to get very frustrated indeed when I finally come across a short, neatly written note which explains the entire chain of events in clear concise prose. It's signed something like BethAnn McLaughlin, MT.
"What the fuck is 'MT?'" I ask one of the nurses.
"Oh, that would be the medical tech who took out the sheaths. Why - did she write something wrong?"
"No, she's evidently the only person in the whole goddamned lot of 'em who has a clue, or who cared enough to document anything useful. There are five notes from different MD's which don't tell me a goddamned thing, and then there's her's which is perfect. This is just fucking lovely."
I wonder sometimes what we'd do without the so-called 'ancillary staff' who actually make the hospital function.
The day winds on. A call for pain meds here, a query about how to address an astronomical blood sugar there, a surgery consult someplace else. It's all fairly simple, straightforward stuff, especially after I run it by the junior who's supervising me.
About ten p.m. or so, I'm back on 6C, which is pretty much my home-base this month. I'm flipping through a chart, going over some labs when I hear, "Hey - we need some help in here. Doctor E --"
"It's `Marcus,'" I interrupt.
"Well Marcus, do you think you could drag your ass over here and help us for a minute?"
Her request is redundant, because I'm already there. There are seven or eight nurses at the room's threshold, laughing.
Can't be all that serious if they're laughing, I think to myself. As I round the corner, I'm confronted with the object of their mirth. There before me is a great rotund pair of buttocks straddling the edge of the bed, with a scrotum peeking out between. As we enter, the buttocks loudly and malodorously break wind.
Oh, lovely.
Dennis tells me later that I should have taken my white coat off right then and there, tossed it to the floor and announced, "Alright, dammit - I quit."
I help the assembled nurses get the gentleman properly back into the bed, and then inquire as to just what the hell is going on. They tell me that he's a trauma patient who has a little drinking problem.
"Yeah, sure looks like DT's," I tell them after I talk to the guy for a while, then I page Scheid, who's on call for trauma.
"Dude!" I say when he answers, "I found you an earpiece for your stethoscope."
"Excellent! You da man!"
"Listen - your guy up here in 620 is DT-ing pretty tough. You wanna give me a voice order to increase his lorazepam? What you've got him on ain't doing it."
"Yeah, go ahead. I'll be right there."
Scheid comes up to asses him, arranges for someone to hang with him full time in his room so he doesn't get into trouble, and gets him on a heart monitor. I boogie off to put out fires someplace else.
Later, sometime around two a.m. Scheid pages me. "Listen, I'm sorry to call you, but we need someone down here to help out with traumas. We're getting swamped."
"I'll be right there."
When I get down to the E/D he tells me, "You just need to hang with this guy for now. Paperwork's done, and he already has a room. Get his films and his head CT, then get him upstairs. You can take a look at his hand if you have the time."
"Hey, no sweat, bro'. I've got it covered."
I stop and stare at him for a moment. He looks like hell, which is very, very unusual. "You alright man?"
Scheid looks back at me with dark-rimmed eyes. "That guy died."
"What?"
"He coded at midnight. He died."
"Jesus Christ, what happened?"
"I don't know. He went tachy with respirations in the sixties, then he coded. I missed something."
"Are you kidding? He was agitated, sure, but he didn't have chest pain, he wasn't short of breath, and he was oriented. You did everything right, man - there was even someone in the room with him."
"No. I missed something. He shouldn't have coded."
"Bullshit. You didn't miss anything. He flipped an embolus or maybe infarcted. There's no way you can predict that. C'mon, man - you know it's not your fault."
He looks back at me injured, and shakes his head, denying it. "Thanks for coming down. See you later."
So once again, I'm up at Royal's place on Mount Washington. He's out of town, so it's all mine. It's a glorious Sunday afternoon, and the city is spread out before me in glittering panorama. The sky is clear, no clouds anywhere. I can see to the surrounding hills in all directions, maybe seven or eight miles, or as far away as a jetliner is up when you fly across the country.
As always, I'm trying to put it all together.
I can see the Parkway from here, you know. Cars clocking along at something like seventy miles an hour, going here and there. I'm watching folks on the sidewalk below, even as I sit here typing. They're taking in the view, same as I am. Yeah, perhaps I'm paying more attention to the lovely women in short sheer dresses than to some of the other folks, but what of it?
Scheid was here a while ago. We talked about miscellany for a little bit, then the conversation turned to the guy who coded.
"I could have sent him to the unit, maybe..."
"Aw, c'mon. For what?"
"I dunno, man. But maybe..."
"Yeah. I didn't think so. Let it go. It wasn't your fault!"
"I know. I mean, I think I know. I'm not sure. I'm tired. I gotta get home and play with the dog a bit before I go to bed. See you in the morning, man."
There are folks out here in front of me, happy and healthy, meandering up and down the street. I can see the hospital from here, all clean and white, with the brushed aluminum patient tower behind it. The view is beautiful beyond words.
Somehow it doesn't all quite fit together, you know?
Let me know if any of it makes sense to you, okay?
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[ T o n y | M a r c u
s | J a m e s | J a s o
n | R a v i | D a n i e l |
M o | P e t e r ] |
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