“I told him I’d page you,” I say lamely. Alyssa has no answer for that, so I add, “I mean, it’s Connie’s patient, not mine, so I don’t really know him…”
“You don’t?” Alyssa says. “Jane, didn’t we round on all the patients this morning? This is why. So you know how to manage patients that aren’t just your own and not just always ask me for help. What were you doing while we were discussing the plan for Connie’s patients?”
I think I was half-asleep.
“Listening,” I answer promptly.
“Then what would you like to do for the patient?” she asks me.
I bite my lip. I look over at Nina, who is miming something I can’t quite catch. It looks like she’s telling me to go fishing. “Call cardiology?”
Alyssa sighs. “Let me talk to the on-call intern.”
Gratefully, I hand the phone over to Dave. I shake my head at Nina.
“I can’t believe this,” I mutter. “Connie screws up and I’m the one who gets yelled at. What’s wrong with her anyway? Why did she shut off her pager? Doesn’t she have any sense of responsibility?”
Nina chews the back of her pen. I had already pegged her as a pen-chewer, so it’s gratifying to see I’m right about at least one thing today.
“Don’t take this the wrong way,” Nina says, “but you need to watch out for Connie. Seriously.”
“What does that mean?”
“Connie’s got some evil in her,” Nina says. “I mean, she’s a derm resident.”
In medicine, there is something known as the ROAD specialties, which is an acronym for the four specialties that have the best reimbursement to hours ratio. Basically, great lifestyle with lots of money. ROAD stands for:
Radiology
Ophthalmology
Anesthesiology
Dermatology
Naturally, it’s competitive to land a residency in any of these lucrative specialties. But by far, the most competitive is dermatology because there are so few slots and the residency is especially cushy. You need the right combination of grades, board scores, letters of recommendation, and research. And medical students who want to end up as dermatologists will do anything to get there.
Even kill for it.
No, not really. They won’t kill. But anything short of that is probably fair game. Like they might trip you pretty badly or stab you a little bit. They will do just about anything to make you look bad in front of the people grading you so that they end up with the higher grade. They are experts at brown-nosing and squeezing out the highest grade they possibly can.
For example, there was a guy in my class named Ned who wanted more than anything to do dermatology, even though on every rotation, he swore that was the specialty he was interested in. For example, when he was on OB/GYN, he wanted to be an obstetrician, on cardiology a cardiologist, etc. When I was rotating on pediatrics with him, Ned looked up all the labs on my patients as well as his, so if I was missing any piece of information, he immediately had it ready. Just to make me look bad. It worked really well.
“Connie doesn’t seem that way to me,” I say to Nina. “She’s not competitive at all. She’s actually kind of a slacker.”
“Exactly!” Nina says, gesturing emphatically. “She’s obviously really brilliant and good at getting what she wants. And now that she’s landed the residency she wants, she’s applying all that intelligence and focus into doing the absolute least amount of work possible. She’s cutthroat about being a slacker.”
I start to laugh. “Nina, that’s kind of ridiculous.”
“Ridiculous or absolutely on target?”
“No, ridiculous.”
Nina shrugs. “Believe what you want. But just wait and see. The second you try to get Connie to do any real work, the claws are going to come out.”
God, I really hope not. There are more claws out than I know what to do with right now.
I check my to-do list and remember that I need to call Mrs. Jefferson’s husband. Considering this patient was the only person who’s been nice to me in the last 24 hours, I feel like I ought to do it. I locate her chart at the nurse’s station, and as promised, his phone number is listed under emergency contacts.
I dial the number and after several rings, I hear a male voice answer: “Hello?”
“Hello, is this…” I check the chart to read off his full name. “Is this… Thomas Jefferson?”
Seriously? Mrs. Jefferson’s husband is named Thomas Jefferson? And now I’m really sorry I didn’t check his name before calling because I have to clamp my hand over my mouth to keep from laughing.
“Yes, this is him,” Thomas Jefferson says.
“This is Dr. McGill,” I say. “I’m calling to give you an update on your wife Marquette.”
Although what I really want to say is: Your name is Thomas Jefferson! How did your parents give you that name? Are you aware of how funny this is? I mean, I feel like he should at least acknowledge that, yes, he has the same name as our third president, and yes, it’s weird. He should volunteer that information upon meeting any new person. Because obviously it’s all we’re going to be able to think about.
“Oh, thank you, Dr. McGill,” Thomas Jefferson says. Then he writes the Declaration of Independence. (No, not really.)
“She’s doing okay,” I say. “She was having a little trouble breathing last night because of heart failure but we took off some fluid so she’s doing better.”
“It sounds like she’s in real capable hands,” Thomas Jefferson says. Then he makes the Louisiana Purchase. (No, not really.)
“Do you have any questions for me?” I ask him.
“No, I just appreciate you calling, sugar,” Thomas Jefferson says. Then he funds the Lewis and Clark expedition. Okay, I need to stop this.
Thomas Jefferson actually seems like a really nice man, so I hang up the phone on a good note. I’m nearly done with my checklist, and I’ve made it through Call #2. I’ve been a doctor for a whole week, I haven’t killed anyone, and I haven’t even cried.
Yet.
_____
The decision of whether or not to take a nap post-call is a complicated one. Many factors go into this decision.
I hate taking naps. When I was a kid, I really hated it. I remember being forced to lie on the mat in kindergarten, my tiny fists clenched tightly at the indignity of it all. I never slept. I just find it hard to sleep in the middle of the day. I also find it completely disorienting to wake up from a nap.
If I don’t sleep at all on call, such as during my last call, I pretty much am forced to take a nap, because I just feel too damn exhausted. But now I’m on the fence. I slept a solid three hours. I could probably make it till tonight without sleep. On the other hand, I am pretty tired.
Finally, I lie down in my bed and stare up at the ceiling, deciding to let my body dictate what it wants to do right now. After 30 hours of being in the hospital and having to bend to the whims of Alyssa, my pager, the nurses, and my patients, it feels decadent to just be able to do whatever I want right now.
A few minutes into my potential nap, my phone starts ringing. I check the number, hopeful it’s someone I don’t recognize. Really, I’m hoping it’s Sexy Surgeon, having tracked down my number. But instead, it’s the opposite of Sexy Surgeon: namely, my mother. I see the area code of her apartment in Queens and hesitate only a second before picking up.
I pick up. “Hi, Mom,” I say.
“So how’s it going?” she asks with breathless anticipation.
When I was young, my mother decided for me that I was going to be a doctor. The decision was not made lightly. She dropped out of college because she was getting married and hadn’t been particularly good at school anyway. She was a housewife, then a stay-at-home-mom, then she came to realize that her husband was an alcoholic compulsive gambler who didn’t particularly want to reform. They got divorced, he took off, and then she was left with a small child and not too many career options.
I can’t remember a t
ime in my childhood when my mother wasn’t working at least two minimum-wage jobs. She was always shuttling me off to my grandparents for free babysitting because paying for a sitter was just out of the question. But when she took me to my pediatrician for my annual visits, she saw a woman who made a great living, was well respected, and in no position to have her entire life wrecked by a deadbeat husband.
And that’s my secret. I didn’t become a doctor because of some great love of medicine and healing. I did it mostly because my mother convinced me that it would be a secure, stable career. Don’t tell the admissions committee at my med school.
“It’s going… okay,” I say cautiously.
“That’s great,” she says. “I’m so proud of you.”
I bite my tongue. Mom and I had always been super close, which makes it hard to conceal from her my growing dissatisfaction with my career. That is, with the career she picked for me. I don’t feel like an independent, intelligent, respected career woman. I feel exhausted, dumb, and mistreated.
And what really sucks is that while no man is in any position to destroy me financially, I’ve done a pretty good job of that myself. Thanks to college and med school, I am now a quarter of a million dollars in debt. Whenever I start to think about it, I feel a crushing weight on my chest. That’s a lot of debt. It’s going to dictate everything I do in life. I can never stay home with my kids because I’ve got to be working to pay back my debt. (Lucky for me, children are nowhere on my horizon right now.)
Sometimes I think I’ve made a huge mistake with my career and it’s all her fault.
“Did you get to save anyone’s life yet?” Mom asks.
I can’t help but think back to my one Code Blue, and how I spent the whole time cleaning up the mess from my popsicle. “Not really.”
“It’s just so exciting,” Mom sighs. “You’re going to have such a great life, sweetie. You’ll see. You made the right decision going to med school.”
Right now, I’m just having a lot of trouble believing that something making me so suffocatingly miserable was really the right decision.
Chapter 16
Short Call
The next day, I’m on short call, meaning our team takes new admissions until 1 p.m. at a maximum of two patients per intern. It means we can sleep in our own beds, but it’s still a rough day. Especially since we’re expected to meet Dr. Westin to round at 7 a.m. in order to leave time for everything else we have to do.
Since we’re meeting at 7a.m., I’m expected to have pre-rounded on all my patients prior to that. I have eight patients, so at Alyssa’s estimate of thirty minutes per patient, I should rightfully be showing up at 3 a.m. That is not going to happen. Instead, I come in at 6 a.m.
The first patient I go see is Mrs. Coughlin. Her biopsy came back, and it seems like her tumor is most likely pancreatic cancer. Pancreatic cancer is Bad Cancer. Not that any kind of cancer is good cancer, but pancreatic cancer has an especially poor prognosis. Dr. Westin broke the news to her, and I hid, because I was too scared to see her reaction.
Now oncology and surgery have decided that her best bet is a Whipple procedure, also known as a pancreaticoduodenectomy (say that ten times fast). Basically, it involves removal of part of the stomach, the pancreas, the small intestines, and the complete removal of the gallbladder. The surgery team is going to be responsible for getting consent, and then she’ll leave our service and they’ll take over her care.
“I’m going to have nothing left inside me!” Mrs. Coughlin says to me, but she smiles like she made a joke. She doesn’t seem as scared as I might have expected. Right now, she’s calmly knitting.
“You’ll have a few things left,” I say.
“Well, I hope so,” Mrs. Coughlin says.
“Someone from Surgery will come by to get consent,” I tell her.
“Oh, he already did,” she says. “Very early this morning. Dr. Reilly, he said his name was.”
Sexy Surgeon again. Sometimes I’m beginning to wonder if there are any other surgery residents in the whole hospital.
“That Dr. Reilly is so handsome!” Mrs. Coughlin says, clutching her chest. “Do you know him, Dr. McGill?”
“Sort of,” I mumble.
“And he’s single,” she says. She points to her left hand. “No ring. I told him he should ask you out.”
I groan. “Thanks.”
Mrs. Coughlin continues to gush about the handsome Dr. Reilly for several more minutes, until I finally interrupt her to listen to her heart and lungs. This is not my favorite way to start the day.
I just barely get through my work and am racing to Dr. Westin’s office, determined to be on time. Of course, I’ll never be earlier than Connie. She only has one patient again, somehow.
Connie has already finished discussing her one patient, so I start in on my huge list. It takes forever, because Alyssa won’t let me get one word out without interrupting me. I feel like I’m on trial, being cross-examined on the witness stand. “How come you didn’t mention the drop in Mrs. Jefferson’s hematocrit?” she demands to know.
“Uh…” I fumble through my notes to find Mrs. Jefferson’s most recent labs. Her hematocrit was 34 yesterday. Now it’s 32. “It only dropped two points.”
“She’s already in heart failure,” Alyssa says. “Do you really want to put more stress on her heart?”
“So…” I search Alyssa’s face, trying to figure out what she wants me to do. “Should we transfuse her?”
“Transfuse her!” Alyssa looks at me in horror. “Jane, you can’t be serious.”
No, I was just kidding. Ha ha.
“Um,” is what I actually say.
“Why don’t you start by doing a guaiac,” Alyssa sighs.
Medical jargon:
“Doing a guaiac”: Stick your finger in the patient’s rectum so you get some poop on your finger, smear the poop on a special card, and see if it changes color when you put a special solution on it, which would indicate the presence of blood.
“Okay,” I say.
Alyssa eyes me critically. “You really need to read more, Jane.”
It takes me so long to get through all my patients that Dr. Westin actually feels a need to comment on the size of my service. It’s a bit of vindication.
“You’re treating half the hospital, aren’t you, Jan?” he says. And he’s getting ever closer to my real name too—only one letter left to go. Score!
I shrug modestly.
“Interns are capped at 12 patients, aren’t they?” Dr. Westin asks Alyssa.
“Yes,” Alyssa confirms.
“I think we better try to even things out a bit on this short call,” he says. “Jan, you can take one patient. Connie, you can admit three.”
Connie’s eyes widen for a moment, but she doesn’t say anything.
“That would really help,” I speak up gratefully. It’s actually the first nice thing anyone on my team has done for me, although it’s probably more because he’s worried I’ll hit my cap and not be able to take any more patients.
Still, it will be a huge relief to do only one admission today. My to-do list is already about ten times longer than Connie’s and it would be nice to get out of here sometime tonight.
The first place I go after I leave Dr. Westin’s office is to Mrs. Jefferson’s room. I figure I may as well get the worst of it over with first. Mrs. Jefferson is sitting in bed, reading a magazine, flipping the pages with her chubby fingers. Her gray hair is all poofed out as usual, but now it’s covered in little sparkly clips. The clips don’t seem to be controlling her hair in any way and appear to be merely decorative.
“Well, hello, Dr. Jane,” Mrs. Jefferson says, her face beaming with a big smile. “Come to visit me again, did you?”
“Hi, Mrs. Jefferson,” I say.
“Oh, didn’t I tell you to please call me Marquette?”
I nod, unable to bring myself to tell her about the rectal exam. “I like your clips.”
Mrs. Jefferson pats he
r head and laughs. “My granddaughter gave me these, so I got to wear them.” Her eyes light up. “Do you want to see photos of my grandkids?”
I don’t really, if I’m being entirely honest. I’ve got a ton of work to do. But I feign enthusiasm as Mrs. Jefferson fishes out her phone and shows me about two thousand photos of her grandkids doing every conceivable activity. She’s even got several of them on the toilet. Speaking of which…
“Mrs. Jefferson,” I say. “I’ve got to do a rectal exam.”
“Okay,” she says without batting an eye. Then she adds, “I’m sorry.”
“No, I’m sorry,” I say.
“Oh, honey,” Mrs. Jefferson says. “Don’t you worry about me. I’m used to it.”
I decide that Mrs. Jefferson has enough strength to turn herself with my help, so I don’t need to drag a nurse into the room. She grabs the bedrail and turns herself onto her side, while I spread her butt cheeks with my gloved hands.
Sometimes I really, really don’t like being a doctor.
Her buttocks are so large that I really can’t see anything. I fish around with my lubed finger, and I start to worry that my fingers literally are not long enough to reach her rectum. But then I find it, although not before Mrs. Jefferson laughs and says, “Don’t fall in!”
I’m sweating like a pig by the time I extract my right hand, carefully holding out my index finger to preserve the specimen. I reach into my white coat pocket with my clean hand to pull out a guaiac card and…
Oh no, where is it?
I’ve got a lot of junk in my pocket, but I’m sure I had a guaiac card in there. Still holding my poop-smeared right index finger in the air, I use my left hand to start emptying the contents of my pocket. I’ve built a three-inch high pile of crumpled papers, pens, sticky notes, and gauze on Mrs. Jefferson’s night-table by the time it becomes obvious that I do not have a guaiac card in my pocket.
Shit.
(Literally.)
“I’ll be right back,” I tell Mrs. Jefferson.
I walk into the hallway, my right index finger still stuck up in the air. I cannot believe this is happening. How could I have done a rectal exam without double-checking to make sure I was prepared? Now I have to walk around with poop on my finger, looking for a guaiac card. I’m not even sure where they are on this floor.
The Devil Wears Scrubs Page 11