And I scream.
Julia is standing about two feet from the door. It is literally the creepiest thing I can imagine. Well, that’s not true. It would be creepier if she were standing there and had dyed and cut her hair to look just like mine. But why would she do that? She hates me.
“You can’t bring men into your room,” she says accusingly.
I stare at her, then look to my left and right. I am quite definitely (and sadly) all alone. “Do you see any men?”
“You were with that surgery resident,” Julia points out.
Okay, this is super creepy. “Were you spying on me?”
Julia doesn’t say anything but just reiterates her point: “No men allowed in the room.”
“That’s not even true,” I say.
Julia recites, as if memorized: “Tenants of the dormitories shall not invite unauthorized guests into the suites without explicit verbal or written approval of all other tenants occupying the suite.”
“So I don’t have your approval then?” I ask. I’m not sure why I’m provoking her. I must be meaner than I thought. Maybe Ryan is right about me.
“No, you do not,” Julia says, answering as if it was a legitimate question.
Well, I don’t think Julia’s got much to worry about. Right now, I’m going to eat, sleep, and breathe internship. It doesn’t look like there will be any “unauthorized guests” entering the suite any time soon.
Chapter 11
Call #2
Today will be different. Today I will not make any mistakes. I have my sticky notes. I will not give Alyssa any cause to yell at me. I will be the best intern who ever was.
Ha.
I have five patients going into my call and we’re meeting Alyssa in the resident lounge at 8a.m. Even though I’m technically not supposed to arrive at the hospital until 7:30 for call to avoid breaking work hour rules, I come in at 7:15 because I am supposed to pre-round prior to our meeting, and I want to make sure I have all the information ready. I am just that dedicated.
I arrive at the lounge at 7:55 a.m., but Alyssa and Connie are both already there and acting like they’ve been waiting for hours. Alyssa looks at her watch and sighs loudly. I’m early, you know!
I plop down on the couch next to Connie. For some reason, Connie only has one patient going into call, while I have five. How did this happen? I have no clue.
Connie is blessed, I think. She’s the sort of person to whom good things always happen, and it’s not clear whether she engineers it that way or she’s just lucky. She has a very innocent look, with her layered black hair always pulled back in a thin pink headband and dimples I could stick my whole pinky inside. It’s hard to imagine any treachery coming from Connie. Then again, she’s a dermatology resident. (More on them later.)
Alyssa crosses her legs and glares at us. Well, she glares at me. She gives Connie a knowing smile.
“I was reviewing the history and physicals you wrote from the last call,” Alyssa says. “And I wanted to give you both some feedback.”
Alyssa whips out of her pocket photocopies of the notes that we’d written during our last call. I see my handwriting scribbled over with red pen, angry lines crossing through my sentences, often with only the commentary, “No!”
In the first paragraph, Alyssa has left only one word untouched. The word is “diabetes.”
I look over at Connie’s note. She received only a handful of red marks. A few times in the margin, Alyssa has written, “Good!” And once, “Great!”
This is not boding well for my call tonight.
“This needs a lot of work, Jane,” Alyssa says to me, shaking her head in utter disappointment.
“Sorry,” I say. I’m only five minutes into my call and I’ve already been forced to say that word.
“Did you pre-round on all your patients?” she asks me.
I nod. “Yep.”
She squints at me. “When did you get here this morning?”
“At 7:15,” I admit.
“You know,” Alyssa says, “considering you’re still learning your patients, you should be spending thirty minutes pre-rounding on every patient.”
I do the math in my head. I have five patients and we were supposed to meet at 8 a.m.. So that means I’d have to arrive at the hospital at… 5:30 a.m.? But I’m not supposed to show up until 7:30 for call!
I turn this paradox over in my head, knowing that whatever answer Alyssa gives me probably isn’t going to be satisfactory. Before I can say anything, Alyssa says, “Well, what’s going on with your patients?”
Not a whole lot. Mrs. Coughlin’s biopsy is still pending. Everyone is sick enough to be in the hospital, but not that sick. But I’ve got a handful of updates. “Mr. Chang’s magnesium is low,” I begin. “Should I give him some magnesium?”
Alyssa frowns. “Why wouldn’t you give him magnesium? What would be the downside?”
“Nothing, I guess,” I say.
She huffs at me. “Jane, you should know this by now. Replacing electrolytes is your responsibility, not mine.”
“I understand,” I say.
It would be great if she was going to let this go and let me continue talking about my patients, but I can see she isn’t.
“Yesterday, I had to replete Mrs. Coughlin’s calcium for you because you didn’t do it,” she says. “That is not my job.”
“I understand.”
“There’s no harm in giving a patient a little extra calcium,” she says. “Just, as you know, don’t give it at the same time as phosphorus.”
My eyes fly open. And… what do you do if you’ve already done that? Before I can figure out a way to delicately word that question, Alyssa’s pager goes off.
It’s the ER. We’ve got our first admission.
“You’re up first, Jane,” Alyssa says.
That means I need to keep track of what she’s writing, so I don’t waste a precious second of time. Except Alyssa has her index card at a weird angle and it’s hard to read her handwriting upside down. Finally, I stand up to get a better look and I’m practically doubled over Alyssa, balanced on the toes of my clogs.
She cups the phone receiver and glares at me. “Jane, could you give me a little breathing room?”
“I can’t see,” I explain lamely.
Alyssa sighs and tilts her index card another five degrees toward me so I could read it.
My admission is Alexander Chandler, a 63-year-old man who is HIV positive and being admitted for shingles with severe pain. He’s currently sitting in the ER, screaming in pain.
Joy.
At least this time I have no problem finding the room. I grab his ER chart outside the door, then gown and glove before I walk into my patient’s room because he’s on isolation precautions. The lights are out, and I see a man lying under a thin layer of sheets. He’s taking slow, careful breaths and is covered in a thick sheen of perspiration.
He is also in fantastic condition for a 63 year old. I check the chart—he’s 36. Apparently, I am not very good at reading upside-down.
Mr. Chandler’s appearance is a surprise to me. Aside from being much younger than I thought, he’s very clean-cut looking. His hair is clipped short, he doesn’t have any tattoos or piercings, and he seems well-groomed despite his illness. I feel odd saying this but he’s actually fairly attractive. Internally, I click off some of the reasons why he might have contracted HIV:
1. Sex
2. IV drugs
3. Transfusion
4. Needle stick
Mr. Chandler rolls his head in my direction and offers me the smallest hopeful smile. He says in a hoarse voice, “Are you my doctor?”
“Yes,” I confirm. “I’m ‘Doctor’ McGill.” Damn it, I still can’t get rid of those scare quotes.
“Thank God,” he says.
I have to say, this is the first time I’ve announced to a patient that I was their doctor and did not get met with some sign of disapproval or horror. I’m flattered.
�
�How are you feeling, Mr. Chandler?” I ask him.
“Alex,” he corrects me.
I nod. “Sorry. Alex. Can you tell me how you’re feeling?”
“Not so hot, Dr. McGill,” he says, taking a shaky breath. “This hurts. A lot. I mean, a lot.”
“Can I take a look?”
He nods his consent. I lift up his standard light blue hospital gown and I look for the lesions on the left side of his chest. Shingles, also known as herpes zoster, is a reactivation of the virus that causes chicken pox, and is not uncommon in patients who have impaired immune systems, such as people who are HIV-positive.
I see the red blisters clumped together in a wedge-shaped pattern over the front and back of his chest. They are arranged in a “dermatomal” distribution, meaning they follow the path of a spinal sensory nerve. I gently graze the blisters with my fingertips and he gasps in pain.
“Sorry,” I say.
“It’s okay,” he says. I can almost hear him swallow and there are tears in his eyes. “It’s just… pretty tender. And the Tylenol isn’t really cutting it.”
I look down at Alex Chandler’s chart and now it’s my turn to gasp. He’s right—all they’ve given him for pain is extra-strength Tylenol.
“That’s completely unacceptable,” I say.
He gives me a crooked smile. “Well, you know how it is. They figure I’m HIV-positive so I must be a drug addict.”
“I’ll get you some morphine,” I promise him.
He nods. “Thank you, Dr. McGill. I really appreciate that.”
I have to say, I find that kind of unacceptable. The guy has blisters all over his chest and is clearly in a lot of pain. I get that they’re worried about drug seekers in the ER, but it seems to me that Alex Chandler has a right to something a little stronger than Tylenol. And I’m going to make sure he gets it.
Hours awake: 4
Chance of quitting: 12%
Chapter 12
My second admission comes just before lunch. She’s a 59-year-old black woman named Marquette Jefferson. She’s actually a transfer from the surgery service, having presented with an infection of her left foot that spread to the bone. They took off her leg below the knee, but the infection persisted, so they did a revision of the amputation and now Mrs. Jefferson only has a quarter of her leg left.
It’s not clear to me why we’re getting her. She’s sick, for sure—her diabetes is out of control, she’s got heart failure, she’s morbidly obese, and her kidney function is just short of dialysis. But it’s not clear why she has to be in the hospital. But nobody can take care of her at home, and her insurance won’t cover a nursing home, so somehow we’re stuck with her.
Meaning I’m stuck with her.
Mrs. Jefferson is what’s known as a “rock.” A rock is a patient who will be on your service forever, who will never ever leave. Mrs. Jefferson is the rock to end all rocks.
She’s a rock star.
But she’s nice, at least. When I introduce myself to her, her wide face creases in a big smile. All my patients are happy to meet me today. It’s a miracle. “Well, hello, darlin’,” she says. Her hair is entirely gray, but her face is surprisingly unlined.
“Hello, Mrs. Jefferson,” I say. “I’m Dr. McGill. How are you today?”
“Oh, just fine,” she puffs, because her oxygen levels are not “just fine.” They’re more like “barely adequate.”
I start the process of examining her. I place my stethoscope on her chest and hear the thump of a third heart sound—a sign of a failing heart. Her lungs sound mildly wet, but it’s hard to hear much through all the layers of fat. Mrs. Jefferson smiles up at me and I see one of her top incisors is gold. “You have the prettiest red hair,” she tells me.
“Thank you,” I say. I almost cry at the realization that this may be the first compliment I’ve received since my intern year started.
“And a beautiful smile too,” she says. “I bet the boys just love you.”
“Not really.” And I can’t help but think of Sexy Surgeon. That one fizzled out quick. We haven’t spoken since he snubbed me at my door. I have a feeling he won’t be “saving” me tonight.
Then she adds, “You look just like my granddaughter.”
I pull off my stethoscope and stare at her. Mrs. Jefferson has charcoal-black skin, while I’m as pasty pale as a gallon of milk.
“Well,” she amends. “She’s black, of course. But other than that, you two could be twins.”
Okay then.
After I’m done with Mrs. Jefferson, I discover that my first patient, Alex Chandler, has been moved up to a room on the main floor. I head over to see him, to make sure he’s gotten a dose of acyclovir and is feeling more comfortable.
Chandler does look better than he did earlier. He’s lying in bed, his brow still sweaty but not as markedly so. Again, I can’t help but think to myself that he looks like someone I would have gone to school with. I suppose it’s a mistake to stereotype people who get HIV. It can happen to anyone. Don’t they always say that?
“You look better,” I tell him.
He nods. “The morphine helped a lot. Thanks.”
“No problem,” I say. “It was criminal that they let you suffer like that.”
“Yeah, well…” He sighs. “I’m HIV-positive, so obviously I’m a drug addict to them.” He shifts in his bed and winces with pain. “You just don’t realize how fast your life can turn around.”
I’ve only got ten minutes before the cafeteria closes for lunch hours, but somehow this seems more important. Plus, I have to admit, I am super curious. How does a nice, clean-cut guy get HIV?
“What happened to you?” I ask.
“I’ll tell you what happened to me,” he says. “Never trust a woman.” He laughs weakly then winces again. “Sorry. I’m bitter, I guess.”
“It’s okay,” I assure him.
“My fiancé cheated on me,” he says, shaking his head like he still can’t believe it. “A bunch of times. Like an idiot, I didn’t have a clue. Two months before the wedding, she tells me. She’s HIV-positive. I never used a condom with her—I mean, why would I? She was almost my wife.” He sighs, and rubs his face. “I was about to get married, I was an investment banker—I had everything going for me. That was three years ago, and now look at me.”
I look at his face and see the dark circles under his eyes. I know he’s on Medicaid. I wonder if he lost his job. I feel like it would be wrong to ask those questions, and all of a sudden, he groans and looks very uncomfortable again.
“Are you all right, Mr. Chandler?”
“No,” he gasps. “This is… the worst pain ever. Christ.”
“Do you need more morphine?” I ask. I calculate in my head how much he’s gotten. I want to relieve his pain, but not stop him from breathing.
“Demerol has really helped me before,” he says, between shallow breaths.
I nod then run out to write the order for Demerol. More than ever, I feel determined to try to help this guy. After all, if this could happen to him, it could happen to anyone.
_____
The cafeteria is closed for lunch by the time I get down there. I almost cry until I remember the food cart parked in front of the hospital at all times. I know Alyssa has told me never to leave the hospital on penalty of death, but I think the food cart three yards away from the front door should be allowed. It’s either that or faint from hunger.
As I get down to the lobby, I expect to smell the usual stomach-curdling aroma of fried food from the cart, but instead I smell nothing. There is a white cart parked in front of the hospital, but it’s not the food cart. It’s an ice cream truck—it’s even playing the ice cream truck jingle. My choices right now include eating ice cream for lunch versus lasting another five to six hours without food.
I’m getting ice cream.
As I walk to the truck, I nearly slam into Nina, who is coming from the opposite direction. Meaning, she has done the unthinkable—she has left the hospita
l while on call.
“Oh!” Nina says when she sees it’s me. Her cheeks turn pink. “Hi, Jane.”
“Were you… outside?” I ask in a horrified whisper.
“No, of course not,” Nina says. She tries to smile but keeps up the façade for exactly five seconds before breaking down. “Okay, I was. I went out. I had to.”
I just stare at her.
“Val—you know, my cat?” Nina begins. I nod. “He’s diabetic. He was all sluggish for a while and we couldn’t figure it out. I thought it was his thyroid but it turned out—well, anyway. He’s diabetic and needs daily insulin shots, so I have to sneak out when I’m on call to give it to him.”
“You give your cat insulin shots?”
Nina nods. “Sure. It’s no big deal. I just pull the skin away and he doesn’t even feel it. It’s actually very easy. For a while, we were doing fingersticks too to monitor his blood sugar, but I just can’t anymore. I mean, I feel guilty about it, but as long as he gets the insulin, he should be okay.”
I laugh. I can’t help it—there’s just something funny about imagining Nina giving her cat fingersticks. “Maybe you missed your calling as a veterinarian?”
“Oh no,” Nina gasps. “I could never. It’s way too sad when something bad happens to an animal.” She frowns at the expression on my face. “That sounded bad, didn’t it?”
“Slightly.”
Her eyebrows scrunch together. “You won’t tell on me, will you?”
“Of course not.”
Nina sighs in relief. “Thanks, Jane. I’m not even worried about my senior resident. I’m just worried about that witch of a roommate of yours, Julia. She’d rat me out to the program director for sure.” She looks over at the ice cream cart. “Let me buy you a popsicle.”
I can’t say no to that.
I take my sweet time selecting a popsicle, since this is apparently going to be my entire lunch. I haven’t eaten a popsicle in a long time, probably years. They all look so delicious. Finally, I pick out the orange creamsicle. I’m practically salivating when they hand it to me.
The Devil Wears Scrubs Page 8