by SA Magnusson
“Are you trying to figure out which one tastes better?”
I turned to see Dr. Roberts leaning against the wall, looking over my shoulder at the screen. “I can tell you they all taste like piss.”
I smiled. He hadn’t been back at work for long. He was still moving slowly from his surgery, but with each day, he had more energy to him. We overstaffed to support him, not wanting Brad to need to take on too much, and since I was a new attending, they were able to pair him with me often enough to ease me in as attending, and also ease him back into work.
“Why am I not surprised you would know what that tastes like?”
Brad took a chair, straddling it as he sat, resting his elbows on the backrest. He winced slightly as he did, something I knew he tried to hide, and I suspected that few people here would even realize he did it. “What do you have here?”
“A case my intern wanted to chalk up to costochondritis.”
“How old?”
“Thirty.”
Brad shrugged, and he winced again. I knew what pain he was in, and that he was avoiding using any pain medication. Not only did he not want to, but he couldn’t if he was trying to work. From what Brad said, most of the time the sternotomy incision didn’t hurt too much.
“Thirty’s pretty young to have real heart problems,” he said.
“I know, but you know how you get those cases where something doesn’t feel right.”
“All too well.”
“This guy had a history that just made me suspicious. I figured it couldn’t hurt to work him up all the way, and besides, from the way it sounds, he drinks a significant amount of caffeine every day.”
“How significant?”
I glanced at the average caffeine per energy drink, multiplying it times ten. “About three thousand grams.”
Brad started to laugh, but he cut off, clenching his jaw. “Yeah. That is quite a bit. And it wouldn’t be the youngest person I’ve seen with heart problems. There was a guy I took care of in medical school who had advanced lupus, and came in with chest pain and an abnormal troponin. He had a clean cath but it’s the kind of thing which at least raises suspicions, you know?”
“I know.”
Brad rested for a moment. “What are you doing after work, Stone?”
“I thought I was making sure you were eating the way your doctors advised you needed to.”
“Oh, come on. You’ve got to stop siding with them. I’m not nearly as helpless as everyone wants me to seem.”
“If you’d rather I not cook for you…”
“I’d rather we go somewhere else.”
I met Brad’s eyes. He had deep blue eyes, a square jaw, and his dark hair was a bit longer than he usually kept it. I liked it like that. I also liked seeing him a little more helpless, needing—and accepting—someone else to assist him.
“I’m supposed to have tomorrow off, so I guess I could go out.”
“We have to get you beyond this.”
“Beyond what?”
“Beyond you thinking you can only go out if you don’t have to work the next day. Where did the Jen Stone that I knew from medical school go?”
“She’s now an attending at Hennepin General Medical Center.”
Brad met my eyes, flashing a smile. “You’re damn right she is.”
I shook my head. He might comment on how I had changed since medical school—and there was no arguing with that, as I had changed—but he had changed, too. It wasn’t just that he’d changed since the attack, though there was something to it. Ever since his near-death experience—and actually a lot before then, too—he had been a whole lot more decent than he’d ever been before. Even before he had nearly died, Brad and I had shared a moment, and that moment had left me questioning whether or not I could consider him in a way which took me by surprise.
“Are you doing okay?” I asked, lowering my voice to keep the other nurses from overhearing. I knew Brad didn’t want them to know he still struggled, and it wasn’t that he even struggled much, not like he would have even a couple of weeks ago.
“I’m doing fine, Stone. Besides, I’m supposed to be orienting you to your new position, or don’t you remember?”
I shook my head. “I remember. I also remember you don’t love working with the interns.”
He shook his head. “The interns aren’t the issue. It’s the damn students who drive me nuts. I’d rather take an intern—even those straight out of school—than any of the students. Especially the gunners.”
“You were one of those gunners.”
“Exactly, and I have no interest in teaching somebody who was as much of a jackass as I was.”
“Was?”
I smiled, but felt it fall away when the code blue alert went off. I sprang to my feet, and Brad made to get up, but I shook my head and waved him off. “I’ve got this.”
As I ran toward the alert, I frowned. It was coming from the direction of where I had been—the room with Mr. Johnson. Swearing under my breath, I raced toward it, and when I went in, the nurses were surrounding him, already beginning CPR. Dr. Edwards was there, and I glanced over at him for a moment, checking to see if he was taking charge or not, and realized he wasn’t doing what he needed.
“What happened?” I asked.
“I’m not sure. He just started to code.”
“And?”
“And what?”
“And do you know why?”
“No.”
“Have any of his labs come back in?”
He pulled out his phone, starting to look it up, but I grabbed his arm, shaking my head. “Just ask the nurses. That’s going to be your best bet now.”
And really, the best bet now was to continue resuscitation efforts. He was young, which meant we should be able to save him.
Maybe it was going to be a far busier day than I had anticipated.
2
Throwing myself back into the chair, I sat at the computer, trying to get comfortable but struggling. I was exhausted from the code, but relieved we had managed to save Mr. Johnson, and had bought him enough time to get him to the cath lab where he could get a more thorough evaluation. I didn’t know what we’d uncover by bringing him there, but at the same time, it likely didn’t matter. As long as he was given the opportunity to pull through, I had done my job.
“You look wiped, Stone.”
I turned to see Roberts sitting at one of the computers, slowly typing in a note. He glanced in my direction. “The damn guy arrested,” I said.
“Your energy drink guy?”
I nodded. “I should have picked up on it. I saw the EKG, and I knew there was something about it that made me uncomfortable.”
“Is that how you’re going to be as an attending, too?”
“What’s that supposed to mean?”
Brad just shrugged. “It means you could be a bit of a pain in the ass even when you were a fellow.”
“Hey. That pain in the ass is the reason you’re still here.”
“And it’s the reason I vouched for you.”
“What do you mean you vouched for me?”
“You know, served as a reference. I think they weren’t inclined to hire you otherwise, and they needed someone who’d had a good experience with you during your time here. Apparently, such people were few and far between.” He grinned but didn’t look over at me.
I could only shake my head. “Maybe I should get on the hiring committee.”
“Too late. I think they have it all rounded out. Besides, you don’t want to get involved in that side of things.”
“What side of things is that?”
“The administrative side. God, can you imagine doing that day in and day out?”
“I suspect there is some benefit to it.”
“Maybe some, but mostly scheduling and things like that, nothing more.”
“You can’t think of any other reason you’d want to be in administration?”
“Other than to decide when I get t
o work and when I get off?”
I shook my head. Since becoming an attending, the pace of medicine had changed. It was different to what it had been even when I was a fellow, and also from when I was a resident. In an emergency room like this, the residents tended to run the ward, which left the attendings with less to do. For the most part, that was a good thing. I was able to spend time with the residents and the students, teaching what I could. There were some—like Roberts—who didn’t enjoy the teaching. He liked the higher acuity that we got, but didn’t always love the other stuff which went along with it. For the most part, I understood. There were times when I didn’t love that side of things, either, yet I did enjoy taking time and helping the next generation to learn what they needed. And I enjoyed allowing some of the people I worked with to have a better experience than I’d had when I’d first been training.
“Anything else interesting going on?” Brad asked.
“Not really. Unless you consider any of the mandatory training I have to do interesting.”
“One of the good things we have as attendings is that we can do our training while working. The residents don’t get to say that.”
“I’m not sure that’s a good thing,” I said with a smile, finishing my attending note on the patient, and opening up my training window. Even though I had done most of these trainings before, I was employed differently now as an attending than as either a resident or a fellow. It was no longer a training program; now, I was fully employed with all of the benefits and responsibilities going along with it.
“The worst part of having to do it now is that when January rolls around and we have to do it again, it’s still so fresh in your mind.”
“Why is that the worst part?” I asked Roberts, looking over from the screen. He had twisted so he could watch me, and the way his eyes twinkled suggested he was amused by what he might say next. I could only imagine the kinds of things to pop into his mind. Knowing Brad as well as I did, I could all too easily come up with what he might say to me.
“If you have a year in between your trainings, it’s easier to forget how painful they were the last time. Having only a few months in between makes it stick in your mind far more than it would otherwise.”
I grunted, scrolling through the various training programs I had to go through. There were all sorts of regulatory things required by the health system, things on confidentiality and drug diversion and appropriate relations with staff, including the punishments were those requirements not met. The first time I’d taken that particular set of trainings, I couldn’t have imagined why they would be necessary. Then I had gone through my first year of residency, had seen the types of personalities who were around me, and realized not only were such things necessary, they were often under-enforced. There were far too many times when attendings got away with behavior which should have been nipped in the bud long ago. Most of the time, it was in specialties that the hospital feared losing, and far too often that meant surgical specialties. For a hospital, that was where the dollars were.
“Christ, Stone. It doesn’t look like you’ve taken any of these yet.”
“I’ve taken some, it’s just that I haven’t taken many yet.”
Brad shook his head. “You’re going to be doing this for the next month.”
“Then I can space it out. It makes a little bit less painful.”
“What are you going to start with?”
“I don’t know. I don’t need to do the workplace violence session again. What more are they going to tell me than to run, hide, and fight?”
“Not much more than that. The video hasn’t changed, either.”
Sadly, it was something we had to worry about in the emergency room. We dealt with all sorts of violence on a day-to-day basis. There was the run-of-the-mill violence, of people who had fallen and hurt themselves, or minor scuffles, were more like schoolyard tussles if anything. There was the domestic violence, and while that always got to me more than it should, I made a point of taking as much time as possible with those women, wanting to offer whatever help I could to them. For the most part, there wasn’t a great deal I could do for them other than offer resources on how to get out of their existing situation. It was up to them whether they took those resources.
Then there was the other kind of violence. Even in Minneapolis, we dealt with gun violence and shootings no differently from other large cities. We might not see as much as in places like Chicago, but we saw it often enough that it was almost numbing. We had our share of gangs in this part of the country, like we had our share of drug use.
One of the things we always feared was someone coming to the ER with a weapon. We had security guards, and oftentimes the police would patrol the ER, thinking to prevent anything deadly from occurring before it had an opportunity to do so. As a deterrent, it was generally effective. In my time working at Hennepin General, I hadn’t seen anyone harmed while working. That didn’t mean it couldn’t happen, though.
“I think I had better take these compliance sessions first,” I said.
“Those are the worst ones,” Brad said. “It might be better for you to do those at home while sitting and having that bottle of wine you like to have each night. You could watch your favorite TV show.”
“It sounds like you’re trying to invite yourself over and go through these with me.”
Brad smiled. “I’m not saying I’d mind.”
As I fired up one of the sessions, the lights in the emergency room flickered before going dark. There was a moment of darkness before the emergency generator kicked in and most of the lights came back on with it.
“Great. Now what?” Brad asked.
“I don’t know. I don’t think we were expecting a storm.” Even in the bad storms, the electricity had never gone out. What did it mean that it had now?
I wasn’t going get started on my training sessions if there was a possibility I might lose my progress again, so I got to my feet, and headed out to the ambulance bay. Brad trailed after me, moving slowly.
“You could use a cane.”
“Are you kidding me?”
I shrugged. “I don’t know. I think you might look something like a pimp with a cane.”
“That’s not the look I’m going for. Besides. It’s not my bones that are aching.”
“No? You’re still moving like an old man.”
He shot me an annoyed look, and I hurried off, reaching the ambulance bay. Two of the EMTs were there—Elijah and Thorman—prepping their rig to head back out.
“Any idea what’s going on?” I asked Elijah.
He was a fiftyish-year-old black man, heavyset, and he’d been working here for decades. Most of the staff regarded him highly, and for good reason. Elijah was good at what he did. “Not that I know. Probably nothing more than a blown transformer. With heat like this, it can happen.”
“Has it ever happened here before?”
“I can’t say I remember. Then again, I spend more of my time in the ambulance than I do here.”
A crackle from their radio caught his attention, and he nodded to me before pulling open the door and slipping onto the seat to answer the radio.
I glanced over to Brad. “Who else is on today?”
“Besides the two of us? No one, really. Why?”
“I just thought I would ask.”
“If you’re asking so you can sneak out of here while we’re dealing with this…”
It would have been tempting to skip out on this kind of issue, but I wasn’t going to do that to Brad, not with him in this shape.
“Maybe we need to make sure the administration knows about this.”
“See?” he said.
“See what?”
“If you got into administration, this is the sort of crap you’d have to deal with.”
I shook my head. “Why do you think I want to get into administration?”
“I can see where you’re going,” he said. “Even if you can’t.”
“Oh yeah?
Can you see me doing this?”
I hurried from the room and went into the attendings’ lounge. It was different to what the residents used in the ER, and for that matter, it was a little smaller. Then again, there weren’t as many attendings on at one time. I glanced at the phone, then picked it up to punch in the number for administration. I wanted to alert them to what had taken place but my phone buzzed before I got the number punched in. I glanced down at it and saw the text had actually come from administration.
Power outage. Unknown ETA. The control center is open.
Great. As I stood in the dim lights, I couldn’t help but notice it was already getting warmer here. Peeling off my white coat, I held onto my stethoscope and made my way back out to the nurses’ desk. Roberts was there, and I held out my phone, shaking it slightly. “Did you get the message?”
“I saw it.”
“It doesn’t sound good.”
“No. The fact they sent out a message tells me they don’t know what’s going on and they don’t know how long it will be until it’s back on. And it’s already miserable in here,” I said.
“Great. We lose power, which means only the essentials run, and unfortunately, air conditioning isn’t an essential.”
“It’s probably less essential than the oxygen, or heart monitors, or access for the ventilators…”
“Don’t you start making sense, Dr. Stone.”
I shook my head and was about to sit down when one of the residents came up. Dr. Tilden glanced from Roberts to me, as if debating who to go to.
“It’s okay. You can ask either of us,” I said.
“I just have a straightforward UTI to run past you.”
“Let’s go through it,” I said.
Brad grinned at me, and I wondered how he was going to spend his time with me handling most of the attending duties. I went off with Dr. Tilden to see the patient.
As the day went on, the air conditioning never did kick back on, and the end of my shift couldn’t come fast enough. When it was done, Dr. Allen taking over for me, I got my shoes out of my locker. I was getting ready to go when Brad appeared again. “Well?”