Alyssa sighs really loudly. “You can give him one amp of D50.”
I report this back to Jill, who probably knew what to do all along, then we hang up. I try to smile at Alyssa, who isn’t having any of it. She gets out an index card and prepares to take notes.
“What are you waiting for?” she asks me.
“Sorry,” I say. I clear my throat. “Mr. Petrovich is a 67-year-old man who…”
My pager goes off again.
Alyssa looks so unbelievably angry. Seriously, this is not my fault! I’m getting paged. How can I help it? This is part of my freaking job. I pick up the phone, swearing to myself that I’m at least going to sound like a real doctor this time. No scare quotes.
“Hello, this is ‘Doctor’ McGill.”
Damn it!
“Hello, ‘Doctor.’ This is Marielle on 4-North. Mrs. Richardson was started on an ADA diet but no calories were specified.”
I stare at the phone. “A… what? ADA?”
“A diabetic diet, ‘Doctor,’” Marielle clarifies.
“Oh.” Crap. I look up at Alyssa. I can see a vein starting to pulse in her large forehead. I’m probably going to give her stroke tonight. And I won’t even know what to do, because I’m apparently completely incompetent. I brace myself. “Alyssa, this patient was put on an ADA diet, but they need to know how many calories.”
“Is the patient overweight?” Alyssa asks. She sees my hesitation and shakes her head. “Never mind. Just tell her 1800 calories.”
I report back to Marielle and then hang up the phone. Holy crap, this is hard. How am I going to get through the night without having Alyssa chained to my hip? I can’t answer any of these stupid questions. And nobody’s actually even sick yet.
For a minute, the two of us just sit there, staring at my pager, certain it’s going to go off again. When it doesn’t, I take a deep breath, look down at my notes, and start my presentation once again: “Mr. Petrovich is a 67-year-old man with a history of diabetes and hypertension who presented with substernal chest pain—”
Before I can get any further, I feel the notes being tugged from my hand. I look up and see Alyssa’s angry face.
“Stop reading,” she instructs me.
“Huh?” I say.
“Stop reading your notes,” she repeats. “You should be able to present the patient to me in your own words, without mumbling and looking down at the paper.”
“Sorry,” I mumble, looking down at the paper. I start over: “Mr. Petrovich is a 67-year-old man—”
“Show some enthusiasm,” she says, pulling the paper clear out of my grip. “Have some inflection in your voice. It’s very hard to listen to you like this.”
Apparently, Alyssa expects me to do a dramatic presentation of Mr. Petrovich’s chest pain.
I try my best to present the patient with a reasonable degree of theatrical enthusiasm. By some miracle, I manage to get through the rest of the patient presentation without getting paged again. Alyssa grills me as we go, but at least I have a ready excuse: my patient doesn’t speak English and even the translator couldn’t understand him. Short of him performing an interpretative dance, there was no way to get a more thorough history.
“All right,” Alyssa finally says. “Why don’t you go see if any of his labs are back yet?”
I go over to the computer in the room and log in as Alyssa continues to glare at me. I’m sure she’s thinking that Connie would never dare present a patient to her that spoke no language dialect known to the human race.
The computer is taking forever to log me in. This is truly the slowest, oldest computer in the history of the world. Before our modern-day computers, people used calculators, and before that they used slide rules, and before that they used the abacus, and before that, they probably used this computer right here. The screen is about the size of my hand, and it has frozen up at least half of the times I’ve tried to log in to it. Fortunately, this time it allows me to successfully gain access. It must feel sorry for me.
I’m copying down the patient’s labs when another intern I know vaguely from orientation enters the room. I glance at his badge and see his name is Rohit. He has huge dark circles under his eyes.
“Hey, Jane,” he says. “How’s it going?”
“All right,” I say cautiously, glancing over at Alyssa. “Were you on call last night?”
Rohit nods. “Yeah. Unfortunately.”
“How was it?”
“I don’t want to talk about it,” he mumbles, collapsing onto the filthy sofa next to me. “So are you taking sign-out? Someone told me you were.”
“Yeah, sure,” I say. “Just give me one minute to finish copying down these labs before the computer logs me out and I’ll be right with you.”
“No problem,” Rohit says as he shuts his eyes and probably falls instantly asleep.
“No,” Alyssa says, so sharply she jars Rohit awake. “Jane, he is post-call. Drop everything you’re doing and let him sign out to you immediately.”
“It’s really okay,” Rohit tries to say, but Alyssa has already crossed her arms and says, “Now, Jane.”
Now, it is.
I sit down next to Rohit and he fumbles around in the pockets of his white coat to pull out his sign-out sheets. This is a list of all his patients, their major diagnoses, and what needs to be done overnight. The pages are littered with yellow sticky notes, explaining things that need to be done: follow-up results of CT scan, check recommendations from the renal service, etc.
“I don’t think I’ve ever seen so many sticky notes in all my life,” I say to Rohit, who laughs.
Alyssa, who is listening in, widens her eyes. “You have sticky notes, don’t you, Jane?”
I do? No, I don’t.
“No…” I say.
“You need to get some,” Alyssa informs me. “It’s very helpful to attach them to the sign-out sheet to help the person on call remember what they need to do.”
“Got it,” I say. Apparently, I’m going to be making a little post-call trip to the drug store to get some sticky notes.
When Rohit finishes going over the sign-out with me, I stuff the notes in my pocket, which I can tell Alyssa doesn’t like. What does she want me to do—frame them?
“You need to learn to be more organized,” Alyssa informs me.
This is going to be a really long night.
_____
The patients trickle in after that. I’m conflicted in that I want to avoid being near Alyssa at all costs, but also terrified of being too far away from her because I don’t know how to answer any of the nurses’ questions. Well, I know how to answer some of the nurses’ questions. Like when they ask me, “‘Doctor,’ have you written the admission orders yet on your patient?” The answer to that is no. I have not.
One thing County Hospital is teaching me is that I led a very sheltered life. I had absolutely no idea that meth was such a popular drug. Apparently, meth is the new… well, I don’t even know what was popular before meth. I am just that uncool. But trust me, meth is really popular. At least among people who seek medical care at County Hospital.
Here’s another thing I never heard of in my sheltered life: skin popping. That means injecting drugs directly under your skin. Sounds fun, right? Apparently, it gets you a better high than ingesting or snorting the drugs, and I guess it’s easier than trying to find a vein. The only problem is that it’s a great way to get an abscess. (An abscess is a big ball of pus. That’s the official definition.)
At about 10 p.m., I meet Mr. Swanson, a 56-year-old man who has engaged in skin popping and now has a high fever and a huge abscess dangerously close to his groin. He also has a heart murmur that scares me a little bit, considering there’s probably all sorts of bacteria floating around his bloodstream.
When Alyssa comes in to see Mr. Swanson with me in the admitting unit, I can tell she’s impressed by the size of the abscess. It’s the size of a tennis ball and deep red in color, located inches away from the line
of his briefs, and he practically jumps off the bed when Alyssa puts her gloved fingers on it.
“This is too deep under the skin,” she says. “I think we’re going to need Surgery to drain this thing.”
Translation: Jane, stop daydreaming and call Surgery right now!
Alyssa pulls her stethoscope from around her neck. She listens to Mr. Swanson’s heart for a moment then looks at me accusingly.
“He has a huge heart murmur,” she says.
“Right,” I say. “I mentioned that.”
“You didn’t tell me how loud it was.”
“Yeah, it’s pretty loud,” I admit.
“You can practically hear it across the room.” Alyssa sighs and shakes her head at me. “You better order an echocardiogram too. Make sure the heart valve isn’t infected.”
“Okay,” I say.
Alyssa looks me up and down. “Did you get those sticky notes yet?”
I stare at her. Did she see me leave the hospital and take a trip to the stationery store to buy a pack of stickys? “No,” I have to tell her.
She shakes her head at me. “Make sure you get some.”
As Alyssa flounces off to answer a page of her own, I quickly make a checklist of what I need to do:
1. Contact Surgery to drain big ball of pus
2. Order echocardiogram
3. Get sticky notes
No problem.
I locate a phone where I call the operator, figuring reaching Surgery will be the more challenging task.
“Hi, this is ‘Doctor’ McGill,” I tell the operator. “Can you tell me who’s on call for surgical consults tonight?”
“That would be Dr. Reilly,” the operator says. “Do you want me to page him for you?”
“No, just give me his pager number,” I say. I suspect it may take several tries to reach this Dr. Reilly.
I place a page to Dr. Reilly, and meanwhile flag down a nurse. She doesn’t look thrilled to be bothered by yet another clueless “doctor.”
“Hi,” I say, trying to sound as nice and respectful as possible. You gotta be nice to the nurses. Or else. “Do you know what form I’m supposed to fill out to get an echocardiogram?”
The nurse narrows her eyes at me then wordlessly goes to a file cabinet. Since she didn’t actually say anything to me, I’m not entirely sure if she’s looking for the form or if she’s looking for something that she needs and has just decided to ignore me. I stand there like an idiot for a minute until she finally plucks out a white form and hands it over to me, then leaves without another word. Maybe she was mute?
I look down at the form. It’s got tons of checkboxes but none of them say “echocardiogram.”
Also, Dr. Reilly hasn’t called me back yet.
I page Dr. Reilly one more time while I sit and examine the form. How could it be this hard to order a simple echo? I mean, this is a test that gets ordered all the freaking time. It should be on every form! It shouldn’t be some crazy puzzle.
I’m still mulling over the form when by some miracle, the phone next to me rings. My page has been returned!
“Hi!” I say excitedly, forgetting myself for a moment. I clear my throat. “Uh, this is ‘Doctor’ McGill.”
I hear an irritable female voice on the other line. “I’m returning a page for Dr. Reilly.”
“Oh,” I say. “Um, are you Dr. Reilly?”
“No,” she says. Obviously Dr. Reilly is too important to return pages himself. Also, I think I am learning to hear people rolling their eyes. “Dr. Reilly is in surgery right now. He can’t be contacted.”
“Well, I have a consult I need him to see,” I explain.
“Well, he’s in surgery,” she says.
My head is starting to throb. “Can I leave a message for him?”
“No,” she says. “You have to wait until the surgery is finished.”
“Well, when will that be?”
“I’m not sure.”
“But…” I bite my lip. “Isn’t there supposed to be some way to contact him? I mean, what if there were a life or death emergency with a patient?”
“You can page him again after the surgery,” the woman says.
It’s becoming fairly obvious that this is a hopeless situation. Maybe I’ll try again in an hour. It’s not like I’m going to bed any time soon.
I hang up the phone and look back at the form. It hasn’t miraculously filled out itself while I was on the phone.
There’s a woman on the computer near me who doesn’t look horribly busy. I approach her and clear my throat loudly a few times until she looks up. “Hi,” I say. “Can you tell me what box to check to order an echo?”
She looks down at the form then up at me. “Transthoracic or transesophageal?”
“Um,” I say. “Transthoracic?” Or the other one.
“That’s the wrong form,” she says.
Of course.
She goes back to the file cabinet and rifles around until she comes up with a new form, this one pink. She hands it over to me and I breathe a sigh of relief. At least I will have accomplished one thing for Mr. Swanson.
I look down at the form. There’s still no box for echocardiogram.
I might cry.
Hours awake: 17
Chance of quitting: 78%
Chapter 8
You won’t believe it, but eventually I do figure out how to fill out the form to order the echocardiogram. I end up having to recruit Alyssa’s help, which she gives me only after a colossal sigh. And then she asks me if I’ve gotten sticky notes yet. I have not.
I’m less successful in contacting the elusive Dr. Reilly. I page him again at 2 a.m. from the resident lounge and get told by another irritable-sounding woman that he’s still in surgery.
“Can you please tell him that we have a consult he needs to see?” I say. “The guy’s pretty sick.”
The woman puts down the phone and I sit there, my eyes shut, while I wait for a response.
“Dr. Reilly says to page the surgical consult pager tomorrow,” she finally says.
“But I’m calling the consult tonight!” I cry. “The guy has a huge abscess and he’s septic!”
I press my ear against the phone and I can just barely make out a male voice saying, “Well, that’s her problem.”
I hate Dr. Reilly so much.
The worst part is that I’m not even sure I care anymore about Mr. Swanson. Mostly I just want to secure the consult to keep Alyssa from yelling at me. I’m not a terrible person—I swear. I’m just really tired.
After I hang up the phone, I just stare at it for a minute, trying to summon the strength to move. I still have one more admission to do before I even contemplate trying to get some sleep. I’m not sure I’ve ever been so tired in my whole life. I would pay a thousand dollars if I could go to sleep right now. Well, actually I wouldn’t, since I don’t have a thousand dollars. How about this—I’d give up a kidney if I could go to sleep right now.
Not that anyone is offering to trade.
My eyelids are slowly drifting downward when I hear the door bang open. I lift my head and see Nina stumble inside. She looks as tired as I feel.
“Jane,” she says, managing a small smile. “You’re not done, are you?”
“God no,” I say.
“If you were, I’d have to hate you,” she says. “I don’t think I’m going to get to sleep at all tonight.”
“Ditto.”
“Julia might though,” Nina says, crinkling her upturned nose. She collapses into a chair, cuddling against the armrest. “I would give anything if I could just not have to get out of this chair. I’d even give up, like, my spleen.”
Pssh, just a spleen? Kidneys are way more important than spleens. She’s clearly not as tired as I am. But I say, “I know what you mean.”
She sighs and rubs her eyes. “I miss Valsalva. I hope she’s okay all alone in my room.”
“I’m sure she’s fine,” I say. Not that I’m basing that on anything. “H
ey, Nina?”
She yawns. “Yeah?”
“Do you have any sticky notes?” I’ve got my fingers crossed.
Nina stares at me. “Any… what?”
“Sticky notes.”
“Why on earth would I have sticky notes?”
Great question. “No reason. Never mind.”
Apparently both Dr. Reilly and sticky notes are going to be out of my reach tonight.
_____
At around 4:30 a.m., I’m finally wrapping things up for the night. I feel like 4 a.m. to 5 a.m. is that weird time that stands at the junction between when it’s appropriate to go to sleep and when it’s appropriate to wake up. But I’ve stopped caring about anything like that. If I have a chance to get any sleep tonight, I’m taking it. The adrenaline has officially run out.
“All right,” Alyssa says to me, as she approves my orders on the final admission of the night. “We’re going to meet up again with Dr. Westin to round at 7 a.m. You need to pre-round before that, but you can go to the call room and try to get a little sleep until then.”
I love you, Alyssa. I want to give you a drunken hug.
I haven’t yet seen the call rooms, but it says in my intern orientation booklet that they’re located on the eighth floor. I’m sure I can manage to find them if I stumble around the eighth floor for long enough. I step into the elevator and prepare to press the button for the eighth floor and that’s when I realize it:
There is no eighth floor.
I look at all the buttons. Floors one through seven are there. And that’s it. Seven is the top floor. There’s no eighth floor.
Apparently, I am going to be sleeping on the roof.
I’m still staring at the buttons when the elevator doors slide closed. I am so frustrated right now. I have only maybe two hours to sleep right now and I’m probably going to have to spend an hour of that time searching for the call room. If I find it at all.
Maybe I should just sleep on the couch in the resident lounge. Yes, it’s disgusting. But at this point, I could just about sleep standing up. Maybe I’ll just curl up right here in the elevator.
The Devil Wears Scrubs Page 5