When I was a medical student, the chief of the intensive care unit told me once 'Neurologists are useless. They can sit at the bedside and examine the patient. They can intellectually masturbate for ten hours as to what's going on in the brain and where. In any case, one picture is worth a thousand words. And one CAT scan of the brain is worth a room full of neurologists.' I sat in front of Mr. Sullstein's room and called the neurologist on duty. Dr. Thalamus didn't answer his pager. So I called him at home and woke him up.
"Thalamus, here. Who's calling?" he asked in a half conscious voice.
"Doctor Baldi. I'm the intern on the vascular service. Doctor Harshberg asked me to ring you to consult on a patient."
"It's one in the morning. Can the consultation wait for 8 a.m.?" he sounded annoyed.
"No, sir. I need to talk to you about Mr. Sullstein. He's post-operative day number two. He has been heavily drugged for pain control. We slowed down his sedation this morning to wake him up. He lightened up a little bit. His whole left side is paralyzed. He's currently at another facility getting his head scanned. The question..."
"Yes, it seems like a stroke. Why are you calling me now?" Dr. Thalamus interrupted me.
"Because his brain is in question. Dr. Harshberg is a blood vessel surgeon and not a brain specialist. He wants a neurologist involved. The question is..."
"He stroked. There isn't much I can offer him tonight. We'll sit on him and wait. I'll see him in the morning," he interjected again. I started to get pissed off at him.
"Sir, the question is thrombolytics. If it's a blood clot and not a bleed that caused his stroke, should we thin his blood and dissolve the clot? We can get a neurointerventional radiologist to open up the clogged blood vessel with a balloon catheter. I know that at Stanford University they're doing that routinely with good success and good neurological recovery," I said. "That's Stanford. The boys out on the west coast are crazy and aggressive. I'm not comfortable with that. I'm afraid to thin his blood. He may then bleed into his head or his leg where the operation was performed. His leg may suffer. How does Doctor Harshberg feel regarding his leg?"
"He feels that if we can help his brain then we should do it. Between recovering his brain or bleeding into his leg, he says to fuck the leg! We can always fix the leg a second time. But his brain has only one chance," I hurried to comment.
"I see. So what do you want to do, Doctor Baldi?" He was ready to fall asleep again.
"You're the neurologist. You're the brain specialist. What would you recommend?" I asked. I tried to make him decide.
"If there's no evidence of bleeding into his brain on the C.A.T. scan, you can do whatever you want. If you want to thin his blood, go ahead. No one can fault you. But be aware that he may get worse. You may kill him. In any case, he's your patient. You decide. I'll see him in the morning. I'll write any future recommendations in his chart," he hung up the telephone. Irresponsible asshole, I thought to myself. I'm not a neurologist to decide. What do I know about brains as the intern. My job was to take care of the patients' surgical needs. The brain is such a precious organ. One mistake on my part, and Mr. Sullstein could bear the consequences of my decision for the rest of his life. I stood in the intensive unit. I was scared. I had no help. Both Drs. Harshberg and Thalamus had dumped the patient on me. I had to choose for Mr. Sullstein's brain. He was my patient and I wanted to help him. If there was any chance of recovering some of his brain function then I should do it. To live with half of a paralyzed body is a cruel existence. But what if he got worse or died in the process?
"Doctor Baldi, Mrs. Sullstein is in the waiting area," the nurse interrupted my thoughts. "Would you like to talk to her?"
I dragged my body to the waiting area. I wished I didn't have to see her. What should I tell her? Should I confess to her that Dr. Harshberg thought that her husband was an unfortunate bastard? Or should I tell her that Dr. Thalamus wanted his sleep tonight so he was letting a stressed intern handle the brain of her husband? Before I had gathered my thoughts I was standing next to her leaning against the wall.
"Hello, Mrs. Sullstein. It's good to see you. I'm sorry you had to come here this late. Your husband's condition has deteriorated over the last few hours. We believe that he has suffered a stroke. I have sent him to a different facility to image his brain."
"Is it serious, Doctor Baldi?" asked the terrified wife.
"We're quite concerned about him. We'll do our best to help him out. It's really quite unfortunate. We were afraid it was going to happen. Do you remember us discussing this in the clinic?"
"Yes, I do. But his leg was hurting him so much. Has Doctor Harshberg seen him?"
"Yes, ma'am. He has personally seen and examined him. He's following the course of events quite closely," I lied to her. Dr. Harshberg cared the least.
"Do you think you may need a brain specialist to see him?" she inquired.
"I have involved one of the best specialists in the clinic, Doctor Thalamus. He has seen and examined your husband already. He's following him closely as well. Depending on the results of the head scan, he'll decide what happens next," I lied a second time.
She started to cry. I felt awful. I was tired. I needed to flee.
"Let's hope that he'll get better. Don't worry, Mrs. Sullstein. I'll take great care of your husband. I promise. If you'll excuse me now, I have to return to the operating room. Good-bye," I took off without giving her a chance to ask another question. I didn't look back, but I could hear her crying.
The operating rooms were just around the corner. I covered my mouth with a mask. I stood at the scrub sink in front of operating room number seven. Through the window I could see Drs. Harshberg and Ungaman. They looked busy. With their necks bent forward, their arms were reaching back and forth for surgical instruments. I scrubbed my hands. I felt awful. I couldn't stop my tears. I cried. I remembered what my father had told me about honesty. I had let him down by lying to Mrs. Sullstein. But that was the reality I had to accept. I suppose that was what internship was all about. To get in the mud and get dirty. To be responsible for sick people and to try to pull them through with whatever resources were available at whatever time. I remembered what my father had taught me about faith. To have faith in myself. So I started repeating in my head: 'Fear knocked on my door, faith answered, no one was there.' And as I walked into the operating room, I pledged to myself that I was going to pull Mr. Sullstein through his crisis. I walked to the scrub nurse with my arms raised and elbows bent with water draining on my pants. She handed me a sterile towel. I dried my hands. As she dressed me with the sterile gown, I looked back. Mr. Jacobs was still on the table. The two surgeons were focused on his belly. I was thinking about his soul. His only hope was me. I wasn't going to let him down this time. I was determined to see him suffer no longer...
|Chapter Four||Chapter Six|
Copyright © 1996 Maher Abbas, M.D. All rights reserved