Seven Patients

by Atul Kumar

  “What you need that for?”

  “Uh, Dr. Sun asked me to get one for him.”

  “Ah, you met the eye doc? He’s a good guy. You could stand to learn a lot from him. He’s one of the few that loves what he does and teaches anyone who shows interest, not just fellow physicians. He even lets students help out with procedures and examinations. You working on the maggot lady?”

  I nodded and she led me to the storage room, raving about the eye doc and handing me several pieces of plastic equipment.

  “Good luck, let me know if S needs anything else. And don’t mind that I won’t be stepping into the room.”

  I headed back to Beatrice, learning that despite his foul tongue and overly casual style, Dr. Sun was one of the most published residents in the university and loved by nearly all.

  Beatrice’s room had been converted to a mini operating theatre with drapes all over Beatrice, a bright overhead light, and numerous tools and containers. Dr. Sun stood at arms, all gowned and gloved, waiting for me.

  “Great, good work, you got all the right stuff. Most students get anything but what is needed. Here, let me show you how to plug it all in.”

  He went on to show me how to setup a Yankauer. Apparently it was a suction device used for aspirating fluids by anesthesiologists and surgeons. Turns out I’d used them before during major surgeries, but it was just always referred to as ‘suction.’ The maggots wouldn’t slurp through the Yankauer tip I’d brought, so we modified the apparatus by cutting the tubing to create a large bore suction hose, akin to a hand held vacuum.

  All gowned, gloved, and masked up we set to work slurping up maggots from Beatrice’s right orbit. The suckers were smart and sensing something was happening, tried to burrow deeper into her tissues. But Dr. Sun outsmarted them by having me pour sterile normal saline into her orbit to flush the maggots out. Apparently they couldn’t breathe underwater. They slowly surfaced and we slurped away for a good 20 minutes. They passed through the tubing just like tapioca boba balls with a little “plop” as they splashed into the collection container where they writhed in the blood-tinged saline, like little fishes out of water, until one by one they just floated.

  When we were down to the last few maggots, we stopped with the suction and switched to forceps to procure a few specimens for the pathology and microbiology departments. The famed Dr. Debakey (inventor of the forceps we were currently using) must never have envisioned his tissue forceps being used like this.

  After getting a couple specimens, Dr. Sun asked me to come closer and handed me the forceps.

  “Ok Rajen, your turn. Gently grab the little suckers and place them in the formalin vial. Don’t squeeze too hard; they tend to squish and squirt some white spooge-like shit.” He pointed to his gown as some of the whitish discharge had splattered across his chest.

  I grasped the forceps and realized this was the first time I was going to do a procedure, even if it was to collect a maggot from a person’s half eaten face. I also realized that I had a tremor. Well, either that, or acute onset Parkinson’s. I prayed it was the former and just due to nerves, else I’d have no potential career as a surgeon.

  Guiding my hand, he assisted me in grasping and collecting a maggot. I placed it in the formalin and labeled it. There were only two left and I grabbed the next one on my own. I reached and grasped the last one. But before I could put the specimen in the container I felt another hand squeeze around mine. Then I felt a “pop” and something splattered my forehead and hair.

  “Sorry dude, I couldn’t be the only one with some splash damage!”

  “Ewww!” I reflexively dropped the forceps and ran for some towels to wipe away the maggot innards.

  The charge nurse and Dr. Sun were by the door laughing themselves silly. I guess it could have been worse, at least the mask and eye shield protected me. I finally felt like I was part of the team instead of just hoping to be noticed.

  “Here, babe, let me help you.” The charge nurse wiped the goo off of me and collected the specimens.

  “Thanks, Lorraine, appreciate you taking those to Pathology for me,” said Dr. Sun as the nurse disappeared down the hallway.

  “I owe you S, for not making me assist in that mess. Do me a favor and take the student out for dinner; he deserves it after that.”

  We disrobed and threw away all our personal protective apparel and finished up our paperwork.

  “So you know her?” I asked Dr. Sun.

  “Beatrice? Yeah, met her about eight months ago in eye clinic. I helped with her biopsy. Squamous cell carcinoma of the right orbit. It was pretty large, and we told her we needed to exenterate her right eye. That’s taking out the eye, skin, and superficial bone. And doing so would have saved her life. With some plastic work and an ocular prosthesis she’d have looked almost the same as before surgery. Of course she declined; instead she decided to treat herself with topical milk therapy.”

  “She can do that?”

  “Well, I thought she was nuts, so we admitted her to the hospital and got a psychiatric evaluation … twice. Both times the attending faculty said she was capable of making her own decisions, and we couldn’t force her. Well, now you see the results. She was in a nursing facility for palliative care as the cancer had spread to her brain and who knows where else. She refused testing and routine evaluations.”

  “So what’s next?” I asked.

  “I’m guessing you called a psych consult?”

  “Yeah.”

  “Cancel it, no need to waste their time. She’s DNR. And on palliative care, doubt she’ll be around more than a month or so anyhow. Now you’ll get to see me be a bully; we’ll call in the ENT guys and have them take her to the OR to clean up the wound and dress it properly. They’re gonna be thrilled. But I figure there is nothing for us to do. Hell, the eyeball is missing, can’t fix what ain’t there.”

  Psych was happy to have the consult called off. ENT was pissed at having to come in and fought Dr. Sun against the consult, refusing to see the patient, claiming it was not their area of expertise.

  “Dude, you don’t have to tell me you’re not coming in. Tell Peters, she’s on today. Let me get her for you.” Dr. Sun spoke politely to the ENT resident knowing that he was going to win this little battle by enlisting the name of the supervising physician.

  “Wait, Peters wants the consult?” inquired the ENT resident with sudden renewed interest, knowing that an attending was involved and he was now no longer just being beckoned by another resident.

  “Yep, hold up, she’s coming over to talk to you.”

  “No, no, it’s cool. Tell her we’re happy to help and I’ll be there in a few minutes. I’ll book the OR, too, so she doesn’t have to bother.” Amazing how quickly things were accomplished when the appropriate authority’s name was dropped.

  “Wow, I thought he wasn’t going to come in the way he was talking to you earlier,” I sputtered as soon as Dr. Sun hung up the phone.

  “Rajen, medicine is a huge fucking pecking order about who has the biggest penis … or ovaries … whatever your reproductive organ of choice. While on the surface we have to make it seem like we’re all here to help each other out, it’s really just about who wields the power—at least in academics or at university hospitals. In the private world everybody’s willing to help out because they all get paid.”

  We left Beatrice alone with her dementia, to whichever happy corner of her subconscious that it takes her, and found Dr. Peters to sign out. We also informed her that ENT was on the way. Dr. Sun was very precise in his wording about how they were happy to see the patient at her behest. She simply nodded and continued to proceed with the lumbar puncture she was performing to evaluate a patient for possible meningitis.

  Dr. Sun peeled off and hurried down the hall. He turned when he realized that I wasn’t following and hollered, “Hey Rajen, you did great today. If you keep up that attitude, you’re gonna be a great physician.” And with that confidence boosting remark, he was off.r />
  I stood there, strangely content that I’d helped make a difference in somebody’s life even as a lowly medical student. Maybe this whole medical thing wasn’t such a bad idea after all.

  My afterglow was short lived as I felt something slimy in between my fingers when I placed them in my right side coat pocket. I knew without having to look down that Dr. Sun had left me a little present from our recent patient. Holding my hand out in front of me, there was the last little maggot from Beatrice, squished and sliding down space between my middle and ring finger. The trail of slime on my fingers glistened in the fluorescent light of the hallway.

  I scurried to the nearest sink and thoroughly washed my hands … thrice.

  ~~~~

  Having nothing else to do, I decided to check the ER patient ‘board’ (which is really a huge digital flat screen of all the active patients) for something interesting. As I was perusing the chief complaints, Dr. Peters came up to me and handed me an envelope. “Raj, this came in for you a couple days ago. You did good today. Why don’t you take off early and take a nice long shower?” We looked at each other and just laughed. I’d never have guessed that I’d be assisting in maggot removal on the job.

  “Thanks, Dr. Peters.”

  I hurried out of the ER for fear that Dr. Peters might rescind her offer allowing me to leave only halfway through my shift. Once safely outside I took the envelope she’d handed me. It was from Peter West, with a return address from New York.

  Dr. Peter West was a cancer patient I’d helped care for a couple months ago. He’d survived pancreatic cancer thanks to a successful Whipple procedure. I’d almost forgotten the generous gift he’d given me upon his discharge from the hospital. He gave me two first class tickets from Los Angeles to New York with open travel dates good for one year and a gift certificate good for two tickets for center orchestra seating at the Avery Fisher Hall, where his son plays in the Philharmonic.

  It was a very generous gift, likely worth more than my car.

  With renewed excitement I opened up his envelope and found a single color photograph of Dr. West, his wife, and his son all standing around the conductor of the New York Philharmonic with huge smiles on their faces. I guess he made good on visiting New York to attend one of his son’s concerts.

  I flipped the photo over and found a short note, “A wise man once told me that ‘talk is cheap.’ Next up is Europe.”

  I was impressed that he even remembered who I was. Dr. West was clearly a man of his word, making good on his promises to me of enjoying life after surviving cancer.

  Chapter Five: High Five

  “Dr. Mok, that was an excellent presentation. You have come a long way since the beginning of this rotation.”

  I was flabbergasted. A compliment from Dr. Clyde was rare, and now I’d received two in the past month. It certainly added a bounce in my step that entire day. It’s true; all it takes to make a med student’s day is a simple compliment; frequently the lack of criticism or anger also suffices.

  This was supposed to be my last day on the ICU rotation for the year, but I got suckered into trading rotations with Cathy because she begged and really wanted to do another elective rotation. Plus, she paid me $1,000. Thus, I’d be taking her spot and doing another month of ICU.

  I pretended it was a huge ordeal for me, but in reality it worked out in my interest. Now I wouldn’t have to do any ICU time next year and could just pick some sissy rotation where attendance was optional and explore the L.A. happy hour scene. The cash didn’t hurt either.

  The only common factor this month would be that Dr. Clyde would be the attending physician for the next two weeks. Otherwise the faces of the ICU would change tomorrow and it’d be a whole new team.

  “Hi … Raj?” came a hesitant voice from behind me.

  I turned and was treated to a pretty face with a shy smile attached to a petite frame with long, straight black hair. Her name badge identified her as Cindy Lee, and the long white coat indicated she was a fully fledged MD, and not a student. I instantly hoped she’d be my resident on the new rotation starting tomorrow. If so, I really came out the winner. Before answering I also took note that her left hand was ring-free.

  “Yep, the one and only.” I managed to dorkily reply.

  “Oh, great, nice to meet you,” said Cindy, introducing herself and shaking my hand. “I’ve heard you’ve done quite the job impressing people in the ICU and wanted to come by and say hi. We’re going to be on the same team starting tomorrow and I was wondering if you could update me on our patients if you have a second?”

  Finally, a small dream comes true, with the beautiful Cindy to lead me; the next month was surely to be great!

  It wasn’t.

  ~~~~

  The meeting with Cindy went well. She was to be my intern on the new team and was nervous about doing the upcoming month in ICU, as she’d never rotated in the critical care setting before. She managed to skip out of those rotations during her training at NYU School of Medicine. She was also new to California and didn’t have many friends here. At the end of our conversation, I made the magnanimous gesture of taking on the responsibility to show her around L.A. Even better, she accepted.

  That’s how we ended up getting lychee martinis just down the street after work and got to know each other. She even treated, maintaining that interns at least made an income versus the debt incurred by med students.

  I liked her even more.

  She was a gorgeous girl who wanted to spend a few years training in L.A. before heading back to New York to become a Cardiologist. Her inspiration came from her father who immigrated to the U.S. from Korea and worked double shifts in the cardiology ECHO laboratory. It was there he met Cindy’s mother, an X-ray technician at NYU, the same hospital where Cindy was born and educated. And also the same hospital where both her parents were treated for cardiac arrest and where they both ultimately passed away within two months of each other last year.

  She was actually to do her residency there, but needed a respite from the place due to the recent forlorn memories.

  If only she had remained in New York. Perhaps, then she wouldn’t have contracted HIV and dropped out of medicine altogether.

  ~~~~

  “Dr. Lee, what are you doing here? It’s not even 6 a.m.” I asked of Cindy upon entering the ICU. I was accustomed to being the first to arrive, not being greeted by senior members of the team.

  “Rajen, good to see you. Thanks for your detailed update yesterday; it made rounding so much easier this morning. I hope you don’t mind. In order to get more acquainted with our patients, I wrote the notes for today already.”

  Needless to say, I was impressed. Cindy was not only chipper; she did all my work for me before I even got to the hospital, and thanked me for it to boot.

  “Wow, most residents come in ‘bout six a.m. or later. We don’t start call until seven a.m., and rounds don’t begin until 7:45.”

  “Yeah, I like to come in early and be on top of things. I figure that makes the day run smoother. Besides, medical students shouldn’t have to come in any sooner than us interns. What do you think we get the big bucks for, sleeping in?”

  I never thought such creatures existed in medicine: genuinely nice and with a willingness to help out.

  “So I guess we’re on call today; hopefully we get something interesting. I’d be happy to show you the New York style of patient management. It’s much more rigid than the laid back Cali style I’ve seen these past few months.”

  I nodded and we completed the orders: electrolyte replacements, ventilator modifications, x-ray review, and other errands for our five patients.

  Dr. Clyde arrived at 7:45 a.m. sharp and rounds commenced. After quick introductions, I learned our junior resident was Sheila Khan and our senior resident was Jack Flanders. Both seemed as though they wanted to be anywhere except here. Though rumor had it Jack was quite brilliant, insightful, and a master of short cuts. I’d never met Sheila before.

  R
ounds were uneventful and Dr. Clyde sat us all down in the ICU conference room to review how he liked the ICU to run. Just as he began his discourse, Jack’s pager chirped. It could only be one thing: our first admission.

  “Jack, why don’t you kindly give the information you jotted down to Dr. Mok? He already knows how the ICU runs here. He can get started on the patient in the ER until we’re done.”

  We were all amazed that he knew it was an admission and in the ER. I doubt he heard what had transpired during the phone call. Seems as though omniscience comes with experience. Nobody questions Clyde; he’s simply never wrong. That’s why he’s Director of the ICU.

  I grabbed the bullet-pointed note card. It didn’t give much information, but it wasn’t Jack’s fault; there wasn’t much known about our patient.

  Bed 2

  JD, 30ish ♂

  ↓ W. Hollywood

  104°F

  A & 0 x 1

  AMS

  I headed out the door and was impressed by how succinct, yet organized Jack was. In just a few words he managed to summarize that our patient was located in ER bed 2, he was a John Doe, appearing to be in his thirties, was found down in West Hollywood with a high fever, was alert and oriented only to one of the four common questions (person, place, time, and event) asked to a patient when initially triaging them. The reason for admission of our JD was ‘altered mental status.’

  The typical individual who meets this description is somebody who is heavily inebriated and slept the night in an alley after some heavy partying.

  If the fever is higher, in the 106 degree range, ecstasy is the prime suspect. It can literally melt one’s brain due to high fevers if taken in large enough quantities. A lower fever could be anything from dehydration to an infection by any number of pathogens.

  “Blllluuuggh.” It didn’t take a rocket scientist to figure out the origin of that noise. It was followed immediately by a splashing sound of something viscous yet chunky hitting the floor. If the sound didn’t give it away, the smell did.