The rest of us remained puzzled. We’d never seen Jack so worked up. Was he trying to get himself booted out of the program?
Jack stood up and slapped the paper out of Bill’s hands. “Listen to me!” he said wildly. “We’re going to change things. We’re going to change them starting right here, right now. No more fucking narc rounds. No more starting IVs in the middle of the night.”
His voice was rising. Residents at surrounding tables were starting to listen, wondering what was going on.
“I’ve had it!” he roared. “This is all going to change. And the first thing that’s going to change is call. I’m not taking any more call!” He was shouting now and the entire cafeteria was listening. Medical students in line gaped in amazement. Nurses with plates of food stopped and stared.
“Starting today,” Jack said, “ortho call will be taken only by attendings. IVs will be started only by Clinic administrators. Narc rounds will be performed by emeritus staff and must be done between three and four in the morning.”
People started laughing. We ortho residents breathed a sigh of relief. Jack was on a roll. He stood up on his chair and started appealing to the faces around him. “Your Attention Please. This is the revolt of the ortho dogs! We wish to inform you that the Mayo Clinic Orthopedic Junior Residency will now take place in the south of France. The assigned hours will be Tuesday through Thursday from ten A.M. until four P.M. Noontime clinical conferences will take place over bottles of chilled champagne and imported oysters.”
We were all clapping and laughing. Frank let out a cowboy, “Eeeh-hah!”
Jack was shouting now to be heard over the laughter. “All nurses,” he said, “will be named Babette or Cherie and will be required to have extremely large breasts which they will cover with only the flimsiest of material. They will also be highly skilled in the arts of massage and yoga.”
“Yeah! And what about getting rid of our beepers?” someone shouted.
“Don’t be an idiot,” Jack sneered at him. “We will need the beepers so the chef can let us know when the Roast Duckling Montmorency with flaming cherry sauce is ready.”
The crowd roared its approval with each new declaration. From behind the polished serving counters, women in hairnets, serving spoons in their hands, looked on in amusement. Janitors in faded blue overalls leaned on their mops, and smiled as the tirade continued.
“At the completion of their training program all residents will undergo extensive testing. Those with insufficiently high liver enzymes or inappropriately low levels of prostatic hypertrophy will be forced to remain for further training.”
He raised his hands and silenced the crowd. “Gentlemen,” he said, looking down at the table of ortho residents at his feet, “this offer is good for a limited time only. Please have your applications on my desk in the morning.” Then he raised his eyes and looked at the internists around us. “Fleas need not apply.”
A chorus of boos and a hail of napkins and pieces of toast greeted him from the surrounding tables. He covered his head and quickly sat down. Within a few seconds everyone had turned away. The line started moving again. The janitors resumed their mopping. Two medical students who had been with us for the last week came over and timidly asked if they could sit with us. Jack reached over and removed a cup of coffee from one of their trays. He leaned back and sighed. “It’s a dog’s life, boys,” he said. “It’s a dog’s life.”
Chapter Eighteen
September
I moonlighted about two weekends a month at St. Joe’s. On the other weekends I was usually on call at Mayo. This meant I would sometimes work fourteen to twenty-one days in a row before I had a day off. Whenever I had a little free time I tried to spend it with Patti and the kids.
I made rounds early one Saturday morning, then we drove up to St. Paul to see my brother Pete who was a student at St. Thomas College. We had a picnic, watched a Disney movie, and finished the day with dinner at a nice Italian restaurant that had singing waiters. Finally, around 9:00 P.M. we piled the kids into the backseat and headed home.
An oldies station was playing softly as we headed south on Highway 52 to Rochester. It was dark in the car. The kids were asleep in their car seats, their heads lolling forward, teddy bears clutched in their hands and blankets tucked around them.
We drove for a while and then Patti asked, “What Mass should we go to tomorrow?”
Oh, God, I thought, I must have forgotten to tell her. “Patti,” I said as gently as I could, “I’m moonlighting tomorrow.”
“Oh, Mike,” she said. Her words were a groan of weariness and disappointment, frustration and irritation, betrayal and oppression. “I was hoping for once we could…”
She raised her hands weakly and let them fall in her lap. I could see the light from the oncoming headlights reflecting off her tears. I couldn’t bear the note of hopelessness in her voice.
I was starting to hate myself and the things I did to the woman I loved. I reached for her hand. She started to pull away, then relented. The motion made the front seat rock back and forth.
“It’s not my fault,” I said. It sure as hell was my fault, and I knew it. “It’s just that, well, I don’t know what we would do if I didn’t moonlight.”
“Oh, I know,” she said in a choked little voice.
She knew. She didn’t like it any more than I did, but she knew I had no more control over my life than she had over hers. We did what we had to do. She unbuckled her seat belt, slid over, took my arm in hers, and laid her head against my shoulder.
An hour later when I pulled into our driveway in Rochester they were all asleep.
By 6:30 the next morning I had finished rounds and was halfway to Mankato. Mine was the only car on the road, a green tank rumbling westward through the rolling farms and woods of southeastern Minnesota; my only company, the ragged strands of geese winging low over the fields, heading south. I had the window down, loving the smell of the farms and the coolness of the early morning. I crested a long hill and saw tall fields of corn, punctuated by thick stands of oak and elm, stretching as far as I could see. The sun was just coming up in my rearview mirror, and patches of gray mist were lingering over the low, wet fields where the pheasant rose.
Periodically the speed limit would drop to thirty as I passed through small towns—Waseca, Janesville, Smith’s Mill. I would take my foot off the accelerator and coast down the three-block-long stretch of Main Street. In each town the only thing open was the small diner with three or four old Ford pickups parked in front. Inside, men in faded, blue overalls and green John Deere caps sat hunched at the counter over coffee and eggs.
I envied them. I envied their easy familiarity, their taken-for-granted intimacy. I was nothing but a hired gun caring for a succession of strangers whose lives would briefly touch mine and then swing away forever. I wasn’t Mike Collins to them. I was “the guy in the ER who casted my ankle,” or “that ER doc, the one from Mayo, who stitched up my leg.” If I ran into one of them on the street it is doubtful they would even recognize me.
But I longed to connect with the people I treated. I wanted to be more than just the dispensing machine that gave them their pills when they put in their quarter. I wanted to walk into one of those diners and be recognized and welcomed.
The bell over the door would tinkle as I came in. The guys at the counter would turn around and greet me as I hung my coat on the hook in the corner.
“Hey, Doc.”
“Mornin’, Doc.”
Steve, behind the counter, would smile and pour me some coffee as I swung my leg over the stool. Arnie, sitting next to me, would push back his hat and ask if I could believe the North Stars hadn’t pulled their goalie last night with a minute left and the face-off in the Maple Leafs zone.
We’d all shake our heads in disbelief.
“Cold this morning,” I would say as I wrapped my hands around my mug of coffee.
Steve, returning to the grill where he was tossing a pile of hash browns,
would nod and say, “Yup. I hear they had frost up on the Range last night.”
When I reached the end of town I jabbed at the accelerator. What was the point of this daydreaming? I wasn’t getting up at 4:30 in the morning and driving halfway across the state just so I could be someone’s pal. I wasn’t Albert Schweitzer or Francis of Assisi. I was just a broke resident who needed money. I was a businessman engaged in a commercial transaction. And the people I treated, they weren’t looking for a new friend. They just wanted someone to make their earache go away or to sew up the cut on their forehead. I should just do my work, take my paycheck, and go home. I was a businessman. Period.
Maybe. But I kept thinking there was another name for what I was doing, another name for someone who sold himself.
At nine o’clock that morning a thirty-eight-year-old man with a scraggly mustache and a three-day growth of beard came in. He was leaning on a friend. “Walt’s been sick,” the friend said. “He’s been throwing up and I think he’s getting dehydrated.”
The nurses and I helped him to a cart. “Mr….” I looked at the chart. “Mr. Delfmeier? I’m Dr. Collins.”
“You can call me Walt,” the man said. “Mr. Delfmeier is my dad.”
While the nurses were getting his vitals I examined him. He was an obese man, with diffuse, but mild tenderness in the belly. He was breathing rapidly, almost gasping for breath. At first I thought he was winded from climbing up on the cart, but when the heavy breathing continued I became suspicious.
“Do you have diabetes, Walt?” I asked.
“Nope.”
I ordered some blood gases and labs. Walt, meanwhile, kept falling asleep. I continued to wake him periodically to ask questions. He was friendly and cooperative.
Thirty minutes later I got the results of the blood tests. The normal blood glucose level for a healthy person is around one hundred. Walt’s glucose was “greater than 900,” which was as high as the machine in the lab could measure. The tech later diluted the specimen and called back to say that his glucose level was 1443, which was the highest blood glucose level I had ever seen—or heard of.
His blood gases came back several minutes later. They showed that Walt was in diabetic ketoacidosis. I pushed some fluid, gave him some insulin, and called the internist on call. Walt then started vomiting a dark-colored emesis that tested positive for blood.
I was making the arrangements for Walt to be admitted to the ICU when Dr. Whitson, the internist, called back. He said Walt didn’t need to go to the ICU. “Just send him to a regular bed on the medical floor,” Whitson said.
I told him I was uncomfortable with that decision. Walt was conscious and his vitals were stable, but the guy seemed like a powder keg to me.
Dr. Whitson resented being second-guessed. “How many diabetics have you taken care of?” he asked.
“I’m an orthopod,” I said, “but I still think—”
“Send him to the floor.” He hung up.
That was the last I heard of Walt until 2:30 that morning when the code call came over the loudspeaker: “430! 430! 430!” It was the responsibility of the ER doctor to respond to all in-house emergencies so I sprinted up the stairs to room 430 where two nurses were already doing CPR on a man. It took me a few seconds to realize it was Walt.
I told them to hold CPR for a moment while I checked his pulse. The EKG leads were on so I checked his rhythm, as well. At that point I noticed that some kind of liquid was running from the side of his mouth. I grabbed his shoulder and tilted him to the side. A frightening amount of black fluid gushed out. Great puddles of it ran across the bed and down to the floor, spattering my pants and shoes.
Once I had his airway reasonably clear I inserted an ET tube into his trachea, and then an NG tube into his stomach. The black fluid had to be blood so I ordered up four units of blood from the lab.
Dr. Whitson arrived a few minutes later and took command of the code. We did not speak to each other. Since Whitson was there, I was free to go, but I stayed on, hoping for a miracle.
There were eight of us crammed into that little room, but it remained unusually quiet. The fact that this was a thirty-eight-year-old man weighed heavily on us. We all realized the enormity of the tragedy. The room was a mess. There was black blood all over the floor, red blood all over the bed where Whitson had tried to get in a central line. Tubes and sponges were scattered everywhere.
Twenty minutes later a nurse came up and said the emergency room needed me. I told Whitson I had to leave. He glanced over at me and nodded. His look told me what I already knew: Walt wasn’t going to make it.
As I trudged back to the ER I passed a patient standing in the door of his room. He obviously had been listening to everything that had been going on. He looked at me and said hi.
Of all the things that happened that night, it was that patient’s look and greeting that most sticks in my mind. The look, just the look, said so much more than he or I could ever have articulated. There was admiration in it, a bit of gratitude, and a lot of sympathy. It was as though he knew my weariness, my bewilderment, my dejection, and having sensed those things, he was telling me it was okay. I had done my best, and it was okay.
I wonder if there really was such a message sent to me by that patient in the door, or if I saw in his look what I wanted to see. Did I merely imagine the solace and comfort I so sorely needed? It is hard to tell. When a tragedy like that is unfolding you desperately want to believe you can make a difference. You convince yourself you can alter the course of events around you.
And then it is all over. A thirty-eight-year-old man who was living and breathing and talking to you sixteen hours ago is now cooling in a puddle of his own blood; and you, who so desperately tried to convince yourself that you could make a difference, must now ask yourself why you didn’t. Is it because you were up against the inevitable all along and no doctor anywhere could have made a difference? Or is it because you didn’t do this, or you should have done that, or you didn’t consider this, or you neglected to see that?
You are left to conclude that you are either a blind fool who couldn’t recognize the inevitable when he saw it, or you are an incompetent idiot who had a chance to save a life and blew it.
It’s not much of a choice, but there it is. There is your late-night menu for you. Thank God for the mind-numbing weariness that leaves you unable to engage in such introspection. You do your work and when you’re done, you lay your head on a pillow. But, while you wait for sleep to come, the ghosts of all your whirling memories vie for possession of your fading consciousness. They are patient, those ghosts, and if they don’t have their say tonight, they have a way of returning nights or years later.
There is no resolution to these conflicts. The questions are fashioned in a manner that defies answering. It is torment these questions are meant to evoke, not answers. What happened? Why did it happen? Why were you involved in it? Why did you fail? How can you stand it? How can any good man, any feeling man, stand it? Don’t you care? Don’t you have any feelings?
Perhaps that is why I needed to arm myself with memories like the look of that man in the door, the look in which I thought I saw sympathy and admiration.
Back in the ER there were six patients, all of them upset at having to wait so long, all of them certain I had been sleeping or watching Saturday Night Live reruns. Connie Fritz, the charge nurse, tried to hand me a chart, but I brushed past her and went back to the call room. I took off my black-spattered lab coat and dropped it in one of the laundry baskets. Then I went into the bathroom to wash the blood off my hands.
It seemed to take a long time.
Chapter Nineteen
October
On a quiet Saturday afternoon I was in the call room at St. Joe’s studying. My eyes were closed. My breathing was slow and regular. Rockwood and Green’s textbook on fractures was lying on my chest. I was trying to transdermally absorb the chapter on supracondylar fractures. My studying was interrupted by the ringing of the phon
e.
“Hello,” I mumbled.
It was Marcie from the ER. “Dr. Collins,” she said, “we’ve got a patient here who refuses to speak to anyone but the doctor.”
I’d been down that road before. It was usually some guy with gonorrhea. They never wanted to talk to the nurses. As I stood up the book fell to the floor. I sighed and ran a hand through my hair. When I got to the ER, Marcie shrugged her shoulders and handed me a chart: Mark Spahn, twenty-three years old.
I pulled back the curtain and entered his cubicle. “Hi, Mr. Spahn. I’m Dr. Collins.”
He looked at me but said nothing.
“Mr. Spahn, is there something I can help you with?”
He shifted on the cart and glanced around him uncomfortably. He mumbled something unintelligible.
“Mr. Spahn, would you like to go into one of the private rooms?”
He shot me a look of gratitude. “Yeah, Doc, I would.”
We went into Room Four, the gyne room, where we did pelvic exams. I closed the door.
“Now,” I said, “what can I do for you?”
“It’s like this, Doc,” he said, refusing to look at me. “I, uh…well, I…”
“You what?”
He put his hand over his mouth, as if trying to keep the words from coming out. He looked at the floor, and in a barely audible voice, the words tumbled out. “Igotadildoupmyass.”
“You got a what?” It took me a second or two to realize what he had said. “Oh,” I replied calmly, as though this were a common problem. (“How was your day, dear?” “Oh, the usual. Just a few guys with dildos up their asses.”)
“How did this happen, Mr. Spahn?”
“Well”—he sighed and rubbed the back of his neck—“I was just sticking it up there, and it went in too far. I couldn’t get it out. I even gave myself an enema and it still wouldn’t come out.”
(Don’t you hate it when that happens?)
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