One of the nurses, a heavyset, fiftyish woman with frizzy brown hair, asked, “Are you Dr. Connolly?”
“No, Collins,” I said.
“Dr. Collins?” She looked puzzled. “Dr. Leone said Dr. Connolly would be taking over.”
“Where is Dr. Leone?”
“He just left. He said to tell you everything was fine. The place is empty except for the guy in four who sliced off the end of his tongue on a can of peaches.”
I laid my shaving kit on the desk. “The end of his what?”
“Yeah, his tongue. Dr. Leone said it was a perfect case for your first day moonlighting.”
I didn’t like the look in her eyes.
“Hey!” came a voice behind one of the curtains in the corner of the room. “Izh shomebody gonna fish my fuckin’ tongue or what?”
The nurse (Connie her name tag said) handed me a chart. “Mr. Berghof awaits you.” She led me to the cart upon which a bearded man in a bloodstained Jerry Garcia T-shirt was sitting.
“Sit back down there, Al,” she said, placing a hand on his chest and pushing him down. She turned to me. “Mr. Berghof got home from the tavern an hour ago. He opened a can of peaches with his pocketknife, pried back the lid, and was slurping down a peach when he cut his tongue on the edge of the lid.”
“Fuckin’ shing,” Al muttered.
“Could I see your tongue, Mr. Berghof?” I asked.
“’Ere uh izh,” he said, sticking out his bloody tongue.
The tip wasn’t completely severed. It was still dangling by a few strands of tissue. This would be interesting. I had never sewn a tongue back on.
I told Connie what instruments I would need. As she went to gather them, I considered how I would anesthetize the tongue. There was a nerve to the tongue—was it the glossopharyngeal or the hypoglossal? And which cranial nerve was that?
There are twelve cranial nerves: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, accessory, and hypoglossal. Medical students and nursing students always struggle to remember these nerves. Patti, in nursing school, had learned a pleasant little pneumonic that began: “On old Olympus’s towering top” or something. We had learned a cruder version in medical school: “Ooh, ooh, ooh! To touch and feel a girl’s vagina—ah, heaven.”
All right, so what nerve was it—girl or heaven? I finally gave up and decided to do a local block.
“Mr. Berghof,” I said, “I’m going to give you a shot near the base of the tongue to numb it up, okay?”
“Uh-huh,” he said.
Connie, gloved, was pulling on Al’s tongue, holding it between two gauze pads.
“All right,” I said, holding up the syringe and squirting out the air, “now you hold real still while I give you the shot, okay?”
“Ahgle, ahgle,” he said.
I nodded to Connie, indicating she should hold the tongue. Then I stuck the needle in the base of his tongue.
Al screamed and jerked his head away. He glared at me and said something that sounded very much like “You cogshugger.”
“Mr. Berghof,” I said, “you have to hold still.”
Connie, who seemed to have little patience with drunks, grabbed his tongue again. “Did you hear what the doctor said, Al?” she asked, pulling on his tongue for emphasis. “He said to hold still.”
Al’s eyes bulged. “Aghaharble,” he said and nodded his acquiescence.
I gave him three or four injections around the base of the tongue. Then I said we would wait a couple minutes for the anesthetic to take effect. It took me an hour, but I finally got the tip of his tongue sewn back on. I would have finished sooner but the smell of garlic chips and beer on his breath made me stop every couple minutes to turn my head and breathe.
“I think it’s going to be okay, Mr. Berghof,” I told him.
I snapped off my gloves and tossed them on the stand next to his cart. “You should stay away from solid foods for a few days. Stick with milk shakes, maybe a little custard, that sort of thing, okay?”
“Ah-kye.”
As I turned to go he said, “Kedda habba kubba beerzh?”
I looked at Connie. “What did he say?”
Connie turned to him. “No, Al,” she said, slapping him on the head with a towel. “You’ve had enough beers. Now go home and go to bed. And stay away from that can of peaches, too.”
We were busy all day: lacerations, sprains, babies with ear pain, women with belly pain, men with chest pain. After my stint on the ERSS I was ready for just about anything. About 3:00 A.M. I finished treating a guy with a whiplash injury from a car crash. I sent him home with a cervical collar, a prescription for some pain meds, and instructions to follow up with his family doctor on Monday. The ER was empty so I went back to the call room and dropped into bed. I had been asleep for two hours when the nurses called. They had a young woman with back pain.
I staggered out of bed, pulled on my shoes, and slung my lab coat over my shoulder. I introduced myself to Mary Goff, an anxious young woman who was sitting on the edge of a cart.
“This is my husband, Jim,” she said.
“Hi, Mr. Goff,” I said, shaking hands with him.
Mrs. Goff then went on to describe her pain. It had started earlier that night. It didn’t seem too bad at first but had slowly increased to the point to where she could hardly stand upright now.
I examined her, then ordered a blood test and a urine test. I returned a half hour later to give them the results.
“How long have you two been married?” I asked her.
“One month—today!” she answered with a little smile.
“Well,” I said, “you have a bladder infection. In fact, this is a fairly common problem in newlyweds. It’s called honeymoon cystitis. It’s usually not serious. We’ll start some antibiotics tonight. You’ll need to get another urine test in a few days to be sure you’re responding to treatment.”
“Why is it common in newlyweds?” she asked.
“Well,” I said, “when a woman isn’t used to having sexual relations, sometimes a little infection can get into her bladder.”
“Oh.”
Mary and her husband glanced at each other and then quickly looked away. It was obvious they were uncomfortable with this discussion. It was almost as if they were embarrassed to have everyone know they had been having sex.
“Is this permanent?” she asked. “I mean, will it keep happening?”
God, the poor thing. Did she think she was going to have to give up sex or have excruciating back pain for the rest of her life?
The medical term for painful sex is dyspareunia. It seemed like an oxymoron to me. In medical school we had two weeks of sex education during our psychiatry rotation (where else would a Catholic medical school put it?). There were only two things I could remember from the entire two weeks. One was that nymphomania was not as common as my classmates and I had hoped. The other was my locker partner Joe Coyne’s comment on dyspareunia. “Dyspareunia,” he observed, “is better than no pareunia at all.”
I turned back to Mrs. Goff. I didn’t want her to think she was going to be stuck with this forever. “Usually these infections are a onetime thing,” I said. “But it’s important to discuss it with your gynecologist if it keeps happening.”
“I don’t have a…gynecologist.” She was embarrassed to say the word.
“Well then your family doctor. Or,” I said, “maybe your mother could give you some advice.”
She gave me a look that said I was crazy if I thought she was going to talk to her mother about that.
I wrote out a couple prescriptions. “Drink lots of water,” I told her. “Cranberry juice can help, too. And if you aren’t getting better, come back here. Sometimes we have to use IV antibiotics if the pills don’t clear up the infection.”
I could see the look of horror on her face. The thought of coming back here was too much for her. I had a feeling that she was going to be drinking cranberry ju
ice by the gallon in the next few days.
It was after six by then. I chatted with the night nurses for a while, then took a shower and shaved. Steve Tucker, who was taking over for me, came in about ten to seven.
“You survived, huh?” he said.
“Yeah. It went okay.”
“Well, go home and get some sleep. It’s a beautiful day.”
As I walked out to the parking lot, my shaving kit under my arm, I couldn’t help but feel guilty. At twenty bucks an hour, I had made almost as much money in the last twenty-four hours as I made in two weeks at Mayo. It was so much money, in so short a time. I felt like I had ripped someone off.
I grew impatient with myself. Jesus Christ, I thought, do I have to analyze everything? Who knows why moonlighters are paid more than residents. The fact is they are. I don’t make the rules. I just live by them. I wish everyone could have free health care. I wish everyone could win the lottery. I wish the White Sox could win the World Series. Oh, and don’t forget world peace and an end to hunger. Fine, okay, that’s great. Now can we skip the infantile dreams and get back to reality? I moonlight so I can pay my mortgage and buy food. There is no reason to feel guilty about getting twenty dollars an hour to moonlight.
But I did.
Chapter Fifteen
June
I switched off the light in the Mayo call room, adjusted the pillow, and closed my eyes. Finally! It seemed that every night I wasn’t moonlighting at St. Joe’s, I was on call at Mayo, and it was starting to get to me. I was nearing the end of my first year and had learned to deal with sleep deprivation, but I prayed the beeper would stay quiet for a few hours. I let out a long sigh and tried to settle in, but I couldn’t. Something was wrong. I had forgotten something. What was it?
Narc rounds. I had forgotten the damned narc rounds. I slapped my pillow aside, switched on the light, and tugged on my gym shoes. “Son of a bitch!” I jerked my lab coat off the back of the chair and stomped out the door. It was twelve minutes after 3:00—A.M.
“The order for all narcotic pain medicines must be renewed every forty-eight hours.” That was the Mayo Clinic rule and the responsibility for obeying it fell to the junior resident on call. Every night we were supposed to trudge up to the ortho floor and renew all expiring narcotic orders. If we forgot, the nurses couldn’t give the patients their pain meds.
Although narc rounds were our responsibility, we assigned them a low priority. Other, more important duties often demanded our attention. We may have had to assist in surgery, or go to the ER, or admit a patient. I usually tried to renew narcs before I went to bed, but that night I had been so busy it slipped my mind. Now it was 3:00 A.M. and I just wanted to lie down for an hour or two.
I got off the elevator and nodded to the janitor who was swishing a red scrubber back and forth across the soapy floor. “Careful, Doc,” he said, nodding at the floor. I waved a hand, tiptoed through the suds, and trudged toward the nurses’ station that shone like a beacon at the end of the dark, silent hall. Sure enough, when I got there I found nine charts lined up, waiting to be signed.
I had seen three consults that night, had two admissions, casted a ten-year-old kid with a broken wrist, and stitched up the leg of an old farmer who ripped his calf open on a piece of barbed wire. And now I’d been driven out of bed to perform a job a monkey could have done.
“Sign your name like a good monkey,” I muttered as I began the rite of scribblage.
“Pardon me?” a nurse said. I glanced up. It was Annie Cheevers.
“Oh, nothing. I was just encouraging myself to get these charts signed.”
Annie smiled pleasantly. She was used to bizarre nocturnal ramblings of junior residents—ortho dogs, we called ourselves.
Like a bored priest distributing communion I went down the line mindlessly scribbling on page after page:
Renew narcs
—MJ Collins MD
Renew narcs
—MJ Collins MD
Renew narcs
—MJ Collins MD
I never saw the patient, never looked at the rest of the chart, never even checked the name. I just took it on faith that the nurses had pulled the correct chart and I dutifully scribbled my name.
“Good monkey,” Annie said as I signed the last one.
I glared at her until I realized she was smiling sympathetically. Annie was a pleasure to look at, smart and pretty in her clean, starched nurse’s uniform. Her brown hair was pulled straight back and held with a pink ribbon. She and I had by then worked together several times. With her I had started IVs, run codes, changed dressings, and fortunately only once, had to pronounce someone.
What a strange word, and an equally strange custom: to “pronounce” someone. When a patient dies it isn’t good enough to say, “Yup, he’s dead.” A doctor, an MD, has to formally “pronounce” him dead.
Annie had paged me one night and asked me to go into a room to verify a patient’s death. I entered the room, and respectfully pulled the sheet from his head. Well, I thought, he’s cold, he’s blue, and he’s stiff. This narrows the diagnostic possibilities. To be official I felt for a carotid pulse, and then listened to the chest for a few seconds. For once the patient’s chest was colder than my stethoscope.
I turned to Annie and said, “He’s dead.”
Annie looked at her watch. My pronouncement had to be accompanied, as in a train terminal, by the time of departure.
“Dr. Collins,” Annie wrote in the chart, “pronounced the patient at 2:14 A.M.”
Patti and I had both grown up in large Irish Catholic families. I was one of eight kids. She was one of seven. We were used to large weddings and larger wakes. How sad, I thought, for someone to die alone in a dark hospital room, no one holding his hand, no one shedding a tear. No one even knows he is gone until an hour later when a nurse finds him. The only notice taken of his passing is when some lowly resident, grousing and resentful, is dragged out of bed to “pronounce” him.
I leaned against the counter, resting my cheek on my fist. I had been working almost twenty hours in a row, and still had another sixteen to go. I glanced down at my rumpled lab coat, my faded scrubs with that old farmer’s bloodstains on the cuffs. My mouth felt grimy, my eyes were bleary, and I needed a shave. I knew I should go to bed, but there was something refreshing about being there with Annie.
“Did you come on at eleven?” I asked, knowing full well that all nightshift nurses come on at eleven.
“Why, yes, Doctor, I did,” she said, trying not to laugh.
“What’s it like outside?”
“Dark,” she said, nodding her head thoughtfully. “Mostly dark.”
“God, it never changes around here, does it? Every night it’s the same thing.”
Annie smiled and began putting the charts back in the rack.
I slumped down in a chair next to her. I wanted to stay, but I couldn’t think of anything to say.
“Mike,” she said, a chart in her right hand, “you should get some sleep. You look terrible.”
“Flattery will get you nowhere.”
I sat there dumbly, too lethargic to get up.
When she finished filing the charts she said, “Okay, if you don’t want to go to bed then how about seeing Mr. Flannery in twenty-three? He’s got a fecal impaction. Maybe you could take care of it for him.”
That did it. “All right, fine. I’ll leave. But what if I never make it back to the call room? What if I collapse and die of unnatural causes at the end of some deserted hallway? It won’t be so funny then, will it?” I stood up and waved my hands in the air, proclaiming the headlines:
MAYO RESIDENT FOUND DEAD IN STORAGE ROOM. ORTHO NURSE
UNDER INVESTIGATION FOR CRUELTY TO ANIMALS
“Will you get out of here? I have work to do.”
“Sure. Fine. Don’t worry about me,” I said as I began walking down the dark hall. “If I don’t see you again, have a nice life.”
“I should be so lucky.”
> “It’ll be too late for tears when they pluck my cold, lifeless body from a floor in Central Supply.”
She laughed and waved a hand at me. “Go to bed. You’re nuts.”
“That’s what they said about Vincent van Gogh.”
I trudged down the dark hall toward the elevator. My first year in orthopedic surgery was drawing to a close. I had never learned so much, never seen so much, never suffered so much as I had in this last year; and yet the road ahead seemed so long. I was still a lowly junior resident, with one more year of holding retractors, one more year of making narc rounds at three o’clock in the morning. But a spark had been ignited in me, and it enabled me to see past all the scut work and ignominy that lay ahead. In one year I would be a senior resident. In three I would be an orthopedic surgeon.
At the end of the hall, the janitor was still swishing the floor. I nodded to him, stepped gingerly across the soapy floor, and pressed the button for the elevator. I stood there, looking wrinkled, rumpled, and drained. As Frank Wales liked to say, I looked like I’d been “rode hard and put away wet.” I could almost read the janitor’s mind as he looked at me out of the corner of his eye. “This guy is a doctor?”
I had come so far. I had grown so much, but as I prepared to start my second year, I found myself wondering the same thing.
Year Two
Chapter Sixteen
July
Although we were into our second year, we were still junior residents, still ortho dogs mired in scut work. We might open or close a case here and there, maybe remove some screws from an old ankle fracture, but none of us had done a big case.
All the fourth-year guys were gone, including Art Hestry, who had joined a practice in Vail, Colorado, and Jonathan Wilhelm—who was not asked to stay on staff at Mayo. A new crop of residents had arrived—nice guys, but as Bill Chapin said, “Were we really that green when we started?”
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