July 28, 1996

   The ICU is located on the ninth floor of UCSF hospital on Sutro Hill. Through the northern window one can look out over Golden Gate Park, the mouth of San Francisco Bay, the Golden Gate Bridge and hills of the Marin Headlands. It is a truly magnificent vista. As an intern I would often sit at the desk in front of that window and gaze out for hours, all the while writing interminable progress notes on terminal patients. While recounting the days events and labs results and adding my reasoned interpretation of the collected data, my mind would drift to far off places. I would leave behind the edematous, septic, intubated , pressor-dependent slabs of flesh and bone. I would day-dream of sunny days, of walking across the bridge, of standing on the hilltops gazing down on the sea. But the reality of the ICU would soon kick in - usually in the form of an odor - and I would hurry to finish my notes and escape.

   A few days ago I was sent to pre-op a vascular surgery patient in the ICU. I entered the unit and headed straight for the north window. A dense summer fog had enveloped the city and I could see only the ambulatory care center across the street. I turned and headed to bed 9 - a 70-year old man status-post repair of a ruptured abdominal aortic aneurysm who now required abdominal wound closure.

   As I entered the room I recognized an old familiar smell. You see, my Persian genes have blessed me with a rather generously proportioned proboscis. I can detect odors at distances that blood hounds would marvel at. I can tell you the hematocrit of melena by its pungency. I can identify the composition of organisms in a polymicrobial abscess by the aromatic undertones. I can correctly identify - to within 18 hours - the number of days that a sock has been worn by a homeless alcoholic by the complexity of it's mustiness. I was destined for a career as a designer of fine perfumes were it not for the cruel affliction of allergies to anything fragrant or floral. Alas, the only scents that do not cause me to degranulate are horribly offensive ones. In fact, the more repugnant the odor, the more my nasal mucosa shrinks to allow the inflow of rancid air.

   Anyway, bed 9 didn't smell good at all. There were three or four distinctly foul odors emanating from the abdominal wound dressings alone. The feet were harder to define - perhaps a combination of weeping edema fluid and hospital-issue hand lotion. I walked northward to the head of the bed. Bed 9's response to my first question revealed a cacophony of mouth fumes so disturbing as to cause me physical pain.

   I cursed my Middle Eastern heritage and wondered why I was not born with a small nose. I took a few steps back - slowly so as not to incur suspicion. I posed my second question - the vapors again rose to greet my snout.

   I was Ali on the ropes, Frazier was beating me senseless. I prepared myself for what was to follow - the dreaded airway examination.

   "Open wide and say aaahh." I had to lean close enough to gauge the anatomical details, tongue size, posterior pharyngeal wall anatomy, dental anomalies, bits of pork rinds caught between dentures and hard palate.

   I refrained from breathing. Somehow, my nose still managed to entrain a hot-air balloon-sized portion of Bed 9's purulent pulmonary output. I became vagal and excused myself from the room, reassuring Bed 9 that he needn't worry about the anesthetic as I darted for the door, my heart rate in the low 40's.

   A few minutes later, I was paged by the attending who informed me that he had assigned the case to another resident.

   "May I ask to whom," I queried.

   "Erik."

   "Good, he's got a cold."

   "What."

   "Never mind. And thanks."

   I went to the cafeteria for some chow mein.

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