The situation remained troublesome. “Oh, shit!” yelled Steve. “The wedge pressure is only two! This guy is dry! Totally volume depleted, let’s get a move on those fluids! Squeeze another liter of LR through the cordis! And someone get x-ray up here for a stat chest x-ray.”
“I’m very impressed, Dr. Carmichael. How many of those
have you done?” asked a very curious Agusta.
Steve looked Agusta straight in the eye and said, “I have placed three central lines and helped float two Swan’s before-”
Just then, Dr. Rosberg burst through the ICU doors. “What the hell is happening, Carmichael? Where the hell is Douglas?
That shithead is in deep shit!”
Steve hurried to fill Dr. Rosberg in with all the details. Right as he was finishing, a nurse shouted, “Vfib! Vfib!” Steve looked at Dr. Rosberg for anything: some reassurance, some ideas, anything to help Steve out. But instead, Steve saw Rosberg step back.
Steve cursed in his mind but continued, “Okay, let’s get the paddles out and charge to 200. Agusta, start compressions.
And let’s push a 100 of Lido. CLEAR!”
The machine jolted energy through the patient’s body.
“Nothing!” shouted a nurse.
“Alright, charge at 360. CLEAR!”
“Still nothing,” reported the same nurse.
“Maybe the Dopamine is over stimulating the heart,” Steve considered out loud. “Let’s stop that for a minute. Charge at 360
again!”
Steve was freaking out, but he quickly shot a glance at Rosberg. He saw him raise his eyebrows and nod his head up
and down toward Agusta as if to say I am very impressed
with this intern. Steve smiled and kept going.
Within a few seconds, the patient’s pulse came back, and his blood pressure bounced back to 125 over 88.
“Good job, Carmichael! Nice save.”
However, just as Rosberg was giving credit to Steve, the monitor alarms went off.
Steve quickly looked at the monitors to see a flat line. “Asystole! Shit. Go ahead and give one amp of Epi and one of Atropine. Charge the paddles to 360 again!” Steve was getting ready to shock the patient when he felt a warm secure hand
reach across his back.
“You did a great job, Carmichael,” said Dr. Rosberg. “But this guy came in behind the eight ball. After having his entire blood volume bleed out and be replenished a few days ago, I think he is trying to tell us something. I am going to call it. Time of death: ten thirty.”
Steve just stared at him.
Dr. Rosberg continued, “Steve, you did a superb job. You have nothing to be ashamed of, young man. Let me go talk to the family, and I’ll be right back. Good job! Agusta was right.”
Steve was very proud of himself. He conquered the most frightening aspect of his internship: running a code. Just as he sat down to dictate the death summary, he heard a familiar shout.
“What the HELL is going on here, Carmichael?” shrieked Jake.
Steve wanted to crawl under a rock and hide, but there was nothing big enough to hide from Jake. Steve knew that Dr. Rosberg was impressed, but that wasn’t going to make life with Jake Douglas any easier. One would think that after doing a good job at something you would get some kind of reward or positive acknowledgement, but not in surgery residency.
Jake stomped over to Steve demanding an explanation, “What the HELL! What the hell happened here, Carmichael?”
Steve paused for a thoughtful moment. He wondered if he should explain that after a person loses five liters of blood from a liver injury and then doesn’t go on antibiotics, then he just might get septic and die. But Steve felt that would not be the proper explanation at this particular moment.
“I think he got septic and became hypotensive from that, and then he started swirling from a low blood pressure. Then he coded.”
“Well, what stupid moron would-” Just as Jake was about to drill Steve, Dr. Rosberg returned.
“Jake, I want to see you in my office after rounds tonight, and don’t make it late. My wife has plans for dinner. And Douglas, you should feel lucky that you have one of the best interns on your service. He did an outstanding job resuscitating Mr. Gordon.”
Steve knew Rosberg was impressed, but Jake was not so happy about the entire episode. Jake made evening rounds difficult for everyone, especially for Steve. Every chance he could, Jake grilled Steve with questions, demeaning remarks, and generally speaking to him with a very condescending attitude. Jake made rude comments throughout rounds and tried to make Steve look stupid in front of patients and nurses by asking questions that had no answers. Fortunately, Jake had to meet with Dr. Rosberg, and so rounds were painful for only a short while. Before he left, Jake delegated the work that needed to be done for the night, which usually fell into the hands of the
person on call. Tonight that was Steve.
After the work was listed for Steve, everybody else left, and Jake went to talk with Dr. Rosberg. Steve finally had a moment to himself to collect his thoughts and organize the work that he needed to do. Just then, his beeper went off. When he returned
the call, Erica was on the other end of the phone.
“Hey, big surgery intern, the one who has mastered codes, would you like to grab a bite to eat?”
Steve glanced at the clock over the nurses’ station and
could not believe his eyes. “Seven thirty! Shit that went quick. Hey, how did you hear about the code?”
“Are you kidding?” asked Erica. “The entire hospital is talking about it. The brilliant surgery intern who can code anyone and do no wrong! I even heard two ward clerks talking about you.”
“Shut up!” replied Steve.
“Why don’t I meet you in the cafeteria?” asked Erica.
“That would be a great idea, if the cafeteria was still open.”
“Yeah, I know, that’s why I stopped and got some sandwiches for you. You see, your mother asked me to keep an eye out for you and make sure you don’t wilt away to nothing.”
Steve started to laugh. “Alright, thanks. I’ll see you down there in two minutes.”
When he got down to the cafeteria, it was empty except for Erica, who was putting some utensils on a table. “This is pretty nice of you.”
Erica blushed. “Yeah, yeah, yeah. I just feel sorry for you surgery interns. You people work so hard.”
“Oh, so then you do this for all the surgery interns?”
“That is not what I meant at all! I mean-”
“I know what you meant,” interrupted Steve, “I just really appreciate your generosity.”
They settled down to have dinner, but after only a few seconds, his pager went off. Steve and Erica looked at each other and smiled.
“That is how my entire day has gone,” Steve said. “I get all of my scut and tasks done and finally sit down, and shit, the damn thing goes off again. Sorry, I will be right back.” He walked over to a wall phone and spent a few minutes talking before returning to the table. “Well, that was easy. The nurses’ station just wanted to clarify an order. I’m sure it will get worse as the night progresses.”
“I’m sure,” agreed Erica.
When Steve had a big mouthful of a turkey sandwich, Erica took the liberty to ask a few questions. “So how is it working with Dr. Jake ‘the shit head’ Douglas? I mean, is he as much of an asshole as the rumors predict him to be?”
Steve, trying to finish his sandwich before his next page, nodded yes with his mouth full. “He certainly has not impressed me with his four years of surgical experience. Besides being a jerk, he really is not a very good surgeon. The way I see it, Sally is really the one who keeps the patients alive. If she’s late for rounds, the patients really suffer. Jake does not make very wise decisions.”
Erica’s curiosity got the best of her, “Do you think that is because of stupidity, or do you think he is moonlighting on the side, maybe doing something else?”
&
nbsp; Steve looked at her with confusion. “What do you mean?”
“Well, I thought maybe if he is really tired or involved with doing other things, then he might not be as efficient. I mean, he has been a resident for four years, so you would think he would be able to take care of his patients a little better. I don’t know, I was just thinking.”
Steve was attempting to understand her direction of questioning and where it was leading when that all too familiar sound came from his waist. “Shit, there it goes again. Well, at least I got to eat something. Thanks a lot for the sandwich! I owe you.”
Erica smiled and said, “I’ll take you up on that and look forward to it.”
Steve looked down at his pager, “Oh, shit, another trauma
code! I have to go. Thanks again for the dinner!”
“I hope your call shift goes well.”
“It doesn’t look like it. I have this feeling this is just the beginning of a busy night.”
“Well,” Erica replied, “Maybe you’ll get to do an appendectomy later.”
Steve laughed. “I doubt it. Jake is pretty pissed about the code this afternoon. I will have to put that wish on hold for a while. Hey, thanks again. I’ll see you soon.” He grabbed his white coat and disappeared through the cafeteria door.
Chapter 12
Steve dragged himself to the cafeteria where he could grab one more cup of coffee before he hit the road. After nearly forty hours in the hospital, he was ecstatic to get home. He certainly learned many things while on call, but he could no longer comprehend what his residents were telling him. Jake finally insisted he go home after he began falling asleep while they were discussing a patient on evening rounds.
He filled a cup with hot java, grabbed a bagel, and then made the long journey back to his car. He looked at the clock on the way out and saw that it read 10:10. He started to laugh when he realized that he had arrived at the hospital almost two days ago. The worst part was that he barely slept during the night. First it was the ICU patients, and then it was the ER consults. Steve would never forget Mr. Gordon. Every time he tried to go to his call room, his pager would go off. He finally did make it to his call room some time after four in the morning, but he only laid in bed with his shoes and socks on, waiting for the next trauma call or a code in the ICU.
He finally fell asleep around five o’clock, only to be awakened by the hospital operator at 5:30. He had requested a call at this time in order to make pre-rounds before the rest of the team returned. The day started off great, but by about 2:00 PM, Steve was having difficulty staying awake. He had one cup of coffee after another, but it didn’t seem to make much difference. He just got more and more tired. If I were an internal medicine resident, he thought, then I probably would go home after a call night until the next day. But he wasn’t. He chose to be a surgery resident.
Steve spotted his car and made a mad dash to get home fast-
er. During the drive, he remembered when as a student he heard about a resident who died in a crash while driving after a night on call. He now understood how that could happen. He felt himself doze on more than one occasion on the way home. His eyes would get heavy and begin to fall shut. Then he would say to himself, “I’ll just rest my eyelids for a minute…” That’s probably what that resident said to himself right before he died in the car accident. So Steve did everything he could think of to stay awake. He rolled the window down and turned the radio on loud. He slapped himself in the face a few times and pinched his arm on occasion. He didn’t care if these tactics were amusing to others: he made it home in one piece.
Walking up the stairs to his apartment was miserable, but he did it. Pudge started barking loud enough to wake not only the neighbors but also the entire neighborhood. Steve walked into his apartment, and it seemed like a foreign place to him. It was like he was visiting a friend. Even the smell of the apartment seemed foreign. Pudge’s odor seemed strange too, but Steve did perceive that Pudge needed to go out badly. Steve had told his landlord that he would probably be home around dinnertime on his post-call days, not at 10:45 like this.
The dog was hungry, had a full bladder, and missed his master terribly. Steve let the dog out and put some food in his bowl. Steve seemed to move about his apartment in a non-purposeful manner. He was just too tired to concentrate on anything for more than twenty seconds. He threw a TV dinner into the microwave and sat on the couch. He tried to formulate a plan for the night in order to organize what needed to get done. As always, he wanted to read from his surgery text and to talk to Sweetpea to tell her about his first call night. His laundry and grocery shopping would have to wait for the weekend.
The dog started to bark outside, so Steve pulled himself up
to let him in. As he passed the clock, he became numb. In only five short hours, he would have to wake and begin another day. At least he wasn’t on call, but five hours of sleep doesn’t make up for two sleepless nights. He began roaming the apartment again in an unfocused manner until the microwave timer went off.
He decided that he would have to skip reading tonight. Besides, he probably would not comprehend or remember anything that he would read tonight. With that decision, he took his dinner to the computer and signed online. He figured that he could eat and talk to Sweetpea at the same time. This way he could get both of these necessities out of the way.
It took three tries but Steve was finally able to get into their favorite chatroom. Once they located each other, they moved to their private room.
“You must be totally exhausted!” typed Sweetpea. “They should give you guys a break after your call days. How do they expect you to safely take care of patients after a call day? I mean, what happens if you forget a simple thing that ends up killing a person? Now I know why they made those laws in New York.”
Steve responded, “I think if you talk with the residents in New York and ask what their hours are like, they would tell you the same horrifying stories about long hours and lack of sleep. They just don’t publicize it like most places because the public thinks the problem of long hours for residents is solved because there is a law against it. But like for any other law, it is sometimes broken.” Steve continued, “Actually I didn’t mind the call night. I learned a lot. The real problem was post-call. For the first few hours in the morning, I did fine. The problem started after taking a break after writing some chart notes. A few of us went down for a cup of coffee and that was it. I really
couldn’t get enough energy after sitting down for a while.”
“That’s too bad,” consoled Sweetpea. “Tell me how the rest of your week went. I barely talked to you this week.”
Steve told her about his first seven days in the hospital. There was so much to talk about. He told her about the canceled appy lecture and how most of the interns were disappointed. “We all want to do appys in the worst way, but instead we practiced placing IVs into each other. More than likely, this was because some nimrod never learned how to place them in med school. So here we were, poking ourselves until we got lucky with an IV. My friend Dennis and I were able to get them in right away and saved ourselves the misery of making several attempts on each other.”
“That’s cool,” said Sweetpea. “Why don’t you guy’s practice appendectomies on each other? I mean if you did such an outstanding performance with the IVs, think what you could do with a knife!”
Steve replied, “I’ll bring up that idea to Dennis and see what he thinks. Of course, there will be the operating room expense not to mention the time off from work for recovery, but maybe we can plan to do it on vacation.”
Even as he typed, Steve began to fall asleep at the computer. He thought how nice it was that they were online and that she couldn’t see him dozing. He figured if she did know that his head was nodding from lack of sleep while they were talking, that would definitely be the fuel for a disagreement.
Sweetpea asked, “So how was your first night on call?”
“Where do you want me to begin? The d
ay started off ok but then one of our sick trauma patients coded. Basically, I had to take care of a patient who was terribly mismanaged by the chief resident. The doofus stopped his antibiotics way too soon and the guy went into septic shock. The patient then decided to code while I was on call and everyone else was in the operating room. It really sucked.”
“So how did the guy do?”
Steve answered, “After a bunch of electrical shocks to his body and some pharmaceutical assistance, he pulled out of it for about thirty seconds or so, but then he crashed and died.”
“That’s really too bad. So where was the chief when all this was happening? I mean, isn’t he supposed to help you out in tough situations like those? After all, he is the doctor ultimately responsible for the patient, right?”
Steve hesitated before continuing. It was obvious she had no clue what surgery residency was all about. “Yeah, you would think so, but you have to understand the residency system. It’s set up like a stupid hierarchy. You really shouldn’t bother the general unless… unless there is a major problem. Kind of like today. But when you do bother them with an emergency then they are pissed that there was an emergency, like it was you who created the situation. And in fact, this time the problem really evolved because the general screwed up. Jake did show up, eventually, after the guy was pronounced dead!”
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