by Atul Kumar
I saw her in the gurney on her way out of the hospital escorted by both Bernard and Josephine. No other members of her family were present despite it being Saturday.
I called out after them, “Hey, Bernard, we never did get to finish our discussion on who Abigail is?”
“Ha ha, you do have a good memory don’t you? Even her family doesn’t know who she is. She’s the darling little girl next door who comes by every day and does her homework by Matilda’s bedside.”
“So she’s not related?”
“Not by blood. Her parents are very high powered professionals and her siblings are grown up. She was a bit of an accident,” he winked, “if you catch my drift. She used to always come by just to say hi and play with the pets. Over the years Josephine and I have adopted her as part of the family. We help her with her homework, and she usually has a snack with Matilda. She came by the hospital once, but I think you were busy attending to the gentleman next door. May I inquire about his status?”
“Let’s just say nice guys finish last, shall we?”
“Dear, dear, he was quite handsome from what I recall before he was transferred away. I had figured he went home to his lovely wife.”
“I can’t divulge too much due to hospital security protocols, but I can say he’s not going home for quite some time. Ms. Maude is the lucky one here.”
“Well, you keep up the good work, and we thank you again for your kind care. I’ll notify the board of directors, through an anonymous benefactor, about the wonderful care that you and the team have provided. Your name will be mentioned with high praise.”
I watched as they loaded her into her chariot for the plush ride home where she would continue to drool and moan in the lap of luxury until she needed another part repaired or another infection fought off. We’d be ready and waiting.
The same was hardly true for Duane.
His stay in the burn unit was estimated to be at least two or three months, only to be followed by a two or more month stint in a skilled rehabilitation unit, after which he would likely require skilled nursing at home for at least a couple hours a day for potentially several years … and that was all if everything went according to plan. And we know how well things went according to plan for Duane Little.
For Duane’s first three weeks in the burn unit all was well. He would have daily visits by his wife and daughter who were always encouraging him and taking great pride in the baby steps he was making towards recovery.
His burns and multiple skin grafts were healing nicely. He was able to slightly move the left side of his body, if you consider twitching real movement. The vision in his right eye was slightly improved; he could see fingers at about two feet in front of his face, though bilateral corneal transplants were definitely going to be required in the future.
The downward spiral for Duane started at about week four after discharge from the ICU. Daily visits from his wife had severely decreased to only a couple times per week. Thus, his progress stopped and the goal now became “maintenance” of what he had—which was not much, essentially a vegetable with a sharp mind, poor eyesight, a barely understandable voice, and very limited writing.
I had completed two months of other rotations and was meandering the hallways with nothing to do when I remembered Duane and looked him up in the computer database. He was still in the hospital, so I decided to pay him a visit.
I went to say hello and found his wife at the bedside. As I approached she turned and looked in my direction, there was a possible hint of recognition, but that was all. She didn’t stop; instead she walked right past me. The lady who had opened her soul to me now no longer remembered who I was. Perhaps because I was dressed in formal shirt and tie instead of the scrubs I used to wear on that rotation. Easy come, easy go; wounds of the psyche, too, heal with time.
She no longer possessed that loving demeanor she once had. She was now cold and distant. I suppose such occurs as one realizes the person they once knew no longer exists. Even though the body is alive the person is forever changed.
I thought about saying hi to Duane, but I realized he might not want to hear me, and I doubt he saw me from the dozen feet away where I stood due to his limited vision. I slowly backed away, but his eye was locked onto me, unblinking.
Curiosity overtook me and I approached and introduced myself. He remembered and we communicated for a while both through nods and written words. His ability to write had significantly improved. Unfortunately this stroke had also progressed and his verbal ability was almost nil despite speech therapy.
He was quite mad at me for not upholding my promise. I sat at his bedside for almost three hours, and what I learned sent shivers down my spine.
His wife had met somebody else and just last week requested a divorce. She apparently didn’t want to take care of a vegetable and thought that Jenny needed a real father figure in her life if she was to grow up normally. That would explain Duane’s recent decline and unwillingness to participate in physical therapy. He had no motivation.
Against my better judgment I asked if his previous request of me still stood. He said it did and that he holds me to my promise. The only difference was now he had changed his will with his lawyer such that his estate would be going to his daughter on her 18th birthday. Apparently he didn’t approve of his wife’s moving on while he was still alive.
I’m sure she’d be quite surprised to learn of this. She was not savvy to this change as of yet.
I wasn’t sure what I’d do as I left Duane’s room.
Months later I made my decision.
Chapter Three: Pancreatic Scare
The first time in your life when an alarm clock rings at 3:40 a.m. to signal the beginning of your day is seldom met with delight; today was no different. It was the first day of my surgery rotation at the university hospital.
Coming off a recent rotation on the medical wards, I’d been exposed to a ton of sub-acute cases, not all with happy endings.
A surgical rotation promised to be much different. And this was not just a surgical rotation; this was the “Robor” service. Burt Robor wore many hats, including MD, FACS, Professor of Medicine, Chairman of Surgery, and Vice Chancellor of the university, to be exact.
The Robor service was the mother of surgery rotations. Dr. Robor is one of the most respected and sought after surgeons in the country. His clientele is comprised almost exclusively of VIPs. His outcomes are phenomenal. And the workload is inhuman. Well for us, not so much him. See, he gets all the glory, but his “team” (i.e.—us) does most of the work.
Promptly at 3:40 a.m. a good med student would immediately bolt out of bed fully awake and rush to the shower to get dressed in the appropriate medical student attire of shiny shoes, starched shirt, tie, slacks, and unforgettable short white coat with pockets full of everything from note cards to penlights to reflex hammers. I proceeded to immediately hit the snooze button … repeatedly. Bad idea, though it seemed brilliant at the time.
Breakfast was a luxury that I couldn’t afford in an effort to run to the hospital to be on time my first day. I never really thought of 4:10 a.m. as being morning; in my previous life as a normal human being it represented the end of a great night out.
Reaching the hospital eight minutes later and fully out of breath, I realized I didn’t know where I was supposed to be or what exactly I was supposed to do. The hospital wasn’t exactly welcoming either, with its 1950s brick and the longest hallways of any building in the U.S. except possibly the pentagon. Only every third light was on, most of which flickered, providing that welcoming environment found only in 1970s horror films.
It was surreal to be standing in one of the most famous and respected institutes of healing with hardly a soul stirring, but still knowing that miracles were being performed within these crusty old walls.
The lobby was so vacuous and deserted I could have fallen from a heart attack and nobody would have found me for ten minutes. Strange, since the bustling ER must have had a wait of ove
r four hours. Snapping out of my reverie I promptly found the seventh floor which was where Robor admitted his patients and where pre-rounds were to begin.
Pre-rounding is the miserable process in which medical students and interns, the lowest rungs of the proverbial medical ladder (somewhere in between three day old non-refrigerated leftovers and unwanted fungus) collect all the vital signs, “ins and outs,” and overnight events for all the patients on the service. Given that nobody had even provided me with the names of our patients, this task proved somewhat difficult.
I innocently walked up to the nearest nursing station and politely introduced myself.
“Hey gals, we got a new batch coming in. It’s gonna be a looooong day!” barked the charge nurse to her colleagues without actually making eye contact or any other sort of gesture to indicate that my presence was acknowledged. I later learned this was the routine way of treating med students in the harsh world of general surgery.
“They just get younger every year,” announced a voice from somewhere near the chart rack.
I coughed, but being in a hospital, that was a very ineffective strategy for getting noticed.
“So, does that mean my team is not here yet?” I innocently inquired of no one in particular.
That’s exactly who responded to my question—no one.
Getting frustrated, I finally planted myself in front of the charge nurse and didn’t move. “Oh, you’re still here.”
FINALLY the charge nurse looked up from her bench and saw me for the first time. “I think you’re late. I saw one of the interns looking for their student. He was somewhere on the East wing, 703 or something.” I barely caught the last part, as she had already returned to her charting while she was talking to me.
I hurriedly looked for East and darted down the hall searching for somebody in a long white coat that could perhaps guide me. Suddenly, I heard a shout from the West hallway. “HEY, are you RA-GERM?”
I quickly turned and replied, “Uhh, yeah, I’m Rajen.”
I rushed over towards the tired looking intern in a long white coat. Scrap that, it wasn’t white at all. The combination of over wear, hospital debris, and lack of washing had turned his coat into a very unappealing shade of light brown.
“Am I your medical student?”
“Yes, and you’re late on your first day. Didn’t anybody inform you that a medical student should be here before any real MD?” Apparently not. “Well, we can still teach you that students are the last to leave. Anyhow, I’ll call you Ra, it’s quicker. Here, take these four patients and get their notes written. We’ll meet in 15 minutes at 5 a.m. in the conference room to come up with plans before rounds at 5:45 a.m.”
Unfortunately I couldn’t make out his name as his badge was backwards.
I took the well worn and coffee-stained index cards, or sign out cards as they were known, that were thrust towards me, as the intern quickly rushed into a patient room leaving me behind without another thought.
He looked slightly emaciated, a little too tall for his coat, and walked with a slightly forward stoop as though he was constantly about to trip. Not knowing his name, I quickly dubbed him Dr. Lanky.
Now to get started on my notes for the day.
I rushed back to the nursing station and was about to ask where my patients were located, but … I thought better of wasting my time only to receive some snide comment and ambiguous advice. Thus, I looked up on the board and saw that all four were on the West hall, conveniently in adjacent rooms. Apparently Robor’s patients occupied most of this entire floor of 40 beds.
Locating the charts was next on the agenda, and with only 13 minutes left, I started to panic. Naturally, only one chart was on the actual rack where charts were supposed to be located. Another two were on the break room table; and the final one was conveniently located resting atop the giant paper recycle bin. Only nine minutes left to fully meet, examine, and document four patients who had all recently undergone major surgery.
Grabbing progress note papers from the charts I hurriedly scribbled down the vital signs from overnight, including the “ins and outs,” a patient’s total fluid intake compared to their total fluid output, inclusive of all orifices as well as a description of each fluid’s consistency. There are the chalky green nasogastric collections, the coffee ground emesis, the bilious and turbid abdominal liquid, and the ever popular colostomy output (lots more on this later).
I literally ran to my patients’ rooms. Luckily two of them were gone for CT scans. That left me with seven minutes and two patients to examine.
The first was Bertha (if you think Big Bertha you’re way off, think HUMONGOUS Bertha). She’s a morbidly obese female who underwent bariatric surgery a few days ago, commonly advertised on billboards as “stomach stapling” or “lap band.” Her case went well and she was scheduled to go home today. I lifted up her gown and checked her wounds. They all looked good … at least good to me. Her lungs were clear, and the fact that she was sleeping indicated to me she was not in pain. She didn’t even wake up from my exam. Perfect, no questions to slow me down.
Last up was Johnny, a homeless gentleman who had been in the hospital for the past two months due to lack of ‘placement.’
All hospitals have strict rules; namely, a patient can only be discharged from the hospital to a residence (read: not the street). Also, a patient must be discharged to somebody. Of course Johnny had neither a residence nor a somebody.
Two problems all too common in medicine.
Sure, he could go to a homeless shelter, but he has an open wound in his abdomen due to the exploratory laparotomy (ex lap). Johnny had undergone surgery in which the entire abdomen is opened up and the intestines ‘explored’ for injuries which are repaired at the time of surgery. Most people who undergo ex laps get staples to close the foot long incision. But Johnny’s abdomen was infected and would not allow for staples or stiches—the tissues were too macerated and friable. The reason for that was because he waited three days before coming to the hospital after being stabbed in the abdomen with a shard of dirty glass.
The only reason he came in at that time was because he astutely noticed that his food wasn’t getting digested. Instead it was dribbling out of his small intestine onto his shirt from his puncture wound. That realization only took him two days; another day was spent attempting to get drunk.
That’s when the gravity of his problem hit home. Too much of the alcohol leaked out through his new fistula, preventing intoxication. This is what prompted him to seek medical attention.
The reason for his stabbing? He lost a bet and was dared to stab himself.
Johnny isn’t the sharpest tool in the shed.
As a result of his lost bet he punctured his duodenum about three inches from where it connects to his stomach. The wound was repaired, but due to the infection, the tissues have to heal themselves from the inside out. Translation: Johnny has about another month left in the hospital before he is stable enough to be discharged to a homeless shelter without any medications. Since Johnny doesn’t have any insurance, it’s only costing tax payers about $2,000 a day.
Fortunately Johnny didn’t bother to wake up for his examination this morning, either, leaving me a full minute to spare before I had to meet up with the team.
I power-walked to the conference room at the end of the hallway, if the converted closet could be called such. It was a small square room with a single round table surrounded by plastic chairs; to one side was a kitchenette and the other contained a row of three computers. The entire room was littered with used coffee cups and old newspapers.
I scanned the room and did a double take. The three long coats in the room were the most tired looking souls I’d ever seen. All had massive bags under their eyes. Two were yawning and the third dozing off in his chair while writing his notes.
“You made it,” announced Lanky, and he went on to introduce me to the rest of the team, “this is Dr. Parker and Dr. Reed, they’re the interns. I’m Dr. Coope
r, the senior resident on the service. Team, meet Ra, our medical student for the next month.” I’m not sure that they noticed me because they were too busy writing notes for the day.
I already didn’t like surgery; it was too formal. Not only did I have to call the interns “Doctor” even though they were a whopping two years older than me, but I was expected to be in shirt and tie at 4:30 a.m.
“Ra, you can join me in the OR today and take call overnight tonight with Dr. Parker. You’ll be in charge of all post-operative patients for which you scrub in on. We have three cases today, a couple Whipples and a splenectomy in OR number 18. Generally I expect you to see the patients the night before their surgery and complete the pre-operative H&P, but you’re exempt from doing that today.
“We meet here at 5 a.m. on all weekdays and 6 a.m. on weekends to go over all the patients before formal rounds start at 45 minutes after the hour with the chief resident, Dr. Blake.”
Shit, talk about information overload. I didn’t even know where the OR was located. But given the lightning pace of the debriefing I felt it was the wrong time to ask.
Lanky continued, “Our attending is Dr. Robor; he’s the chairman of the entire department of surgery and very well respected. I’m sure you’ve heard of him, as he’s quite renowned. He expects formal attire at all times when not in the OR. Do not speak to him unless addressed if you want to pass this rotation.”
I hazarded asking a question, “I thought Dr. Robor had a very VIP clientele, but the patients I saw this morning were …”
Lanky cut me off, “Bertha is the daughter of a Congressman. Johnny, well, he’s special; even Robor is on ER call and has to operate on whatever comes in on those days. Now let’s get started before Blake gets here.”