Believe me, if pre-injury Mr. Thurman could see the way he looks right now, he would not be pleased.
Alyssa gives me the all-important job of tracking down exactly how much poop has come out of Mr. Thurman this morning. But before she goes, she has one final set of words of wisdom for me.
“By the way,” she says. “Mrs. Jefferson had an elevated white blood count two days ago. You missed it.”
I stare at her. “What? I didn’t miss anything.”
Alyssa nods. “You did. The labs you wrote down in your note for that day were from the day before.”
I pause for a second, contemplating how this mistake could have happened. The answer is: easily. I saw a set of labs and wrote them down, not bothering to double check the date on them. I can just see how I might have done it.
Of course, half of Alyssa’s job is to look at labs. Sometimes I catch her in the computer lab, just sitting there reviewing labs for large chunks of time. So the missed lab was as much her fault as mine.
Maybe even more her fault than mine.
But I don’t say that. Instead, I say, “I’ll culture her and start antibiotics.”
_____
I’ve noticed the nurses don’t particularly like me. It’s not that they dislike me, but they definitely don’t like me even though I’m fairly polite and respectful to them. Here’s the thing: if you were doing a job for over twenty years and then some 25 year old came in and you were expected to take orders from her, how much would you like that person? Not a whole lot, that’s how much.
Unless, of course, that person was incredibly handsome, like a certain surgery resident I could name.
A nurse named Patti flags me down on the telemetry floor in the afternoon and has a pile of annoying questions for me.
“Doctor,” she says. “I need to talk to you about the new patient Mrs. Levy.”
“Okay,” I say, bracing myself.
“We need to open up a bed on this floor,” she says. “Mrs. Levy already had two sets of cardiac enzymes that were negative, so can we move her to the regular floor?”
“What about the third set I ordered?” I ask.
“We didn’t draw it,” she admits.
I raise my eyebrows.
“It wouldn’t be back yet anyway!” Patti says.
“Well, it definitely won’t be back if you never draw it.”
Patti just glares at me. But seriously, she knows I’m right. The rule is three sets of negative cardiac enzymes before they can leave telemetry.
“Also,” she says, “Mr. Gregory in room 204 wants to eat.”
That’s a patient I’m cross-covering so I check the sign-out. He’s supposed to have surgery today, which means he can’t eat.
“Sorry,” I say. “He’s NPO for surgery.”
“But he’s really hungry,” Patti whines.
I want to ask her if this is a serious question. I’m sure Ryan would be screaming at her by now. Actually, he wouldn’t, because she wouldn’t dare ask him such a dumb question.
I glance down again at the sign-out for Mr. Gregory to see if they’ve added any helpful hints. In addition to the note about the surgery, the resident had typed: “If patient is agitated, give him a dose of fativan.”
Fativan? As far as I know, there is no such medication. There is, however, a sedative called Ativan. Presumably, the intern meant Ativan, which calms you down. Unless he really meant fativan, which… I don’t know, makes you fat? Or less fat?
“You can give him some Ativan,” I say generously.
Patti nods, somewhat placated.
I get a page and hurry off to answer it. It turns out that now Mrs. Jefferson is having chest pain. She’s never leaving us. Welcome to your home forever: County Hospital.
Hours awake: 5
Chance of Mrs. Jefferson getting to go home this week: 15% and falling
Chapter 31
“It’s been coming on all morning,” Mrs. Jefferson explains to me. “And I feel like it’s a bit hard to breathe, you know?”
Mrs. Jefferson’s EKG is normal. I’m waiting for the chest X-ray to show up online, but she doesn’t look that bad. She just looks worried. Thomas Jefferson is sitting at her bedside, holding her hand, looking equally worried.
“You’re going to be okay,” I promise her. “You get angina, right?”
“Not like this,” she says.
I nod. “Okay, well, we’re going to do a bunch of tests, wait for your labs to come back, but I don’t really think anything bad is going on.”
“I believe you, Dr. Jane,” she says. “I know you always do a really good job. I know you’re looking out for me.”
I feel a stab of guilt about missing that elevated white blood count the other day. But she doesn’t need to know about that.
I make it out of the room and as far as the nurses’ station before Thomas Jefferson catches up with me. He’s got a crease between his eyebrows. “Dr. Jane, I’m worried about my Markie.”
“I understand,” I say in my most understanding voice. “She’s going to be okay. We’re going to get to the bottom of this.”
“You don’t get it,” he says. “Through this whole ordeal, no matter how bad things got, she always told me everything was going to be fine. But today she didn’t say that. She said to me that she thought she was never gonna leave this hospital.”
“I’m sure that’s just because she was so close to going home,” I say. “And I promise you, she will go home.”
Thomas Jefferson looks skeptical.
“I promise you,” I say again.
“Okay,” he finally says. “I believe you, Dr. Jane.”
I watch him walk back into his wife’s room. I feel good about the fact that I reassured him. One thing I’ve been realizing lately is that people bounce back pretty easily if you give them a chance. Mrs. Jefferson is sick today, but I feel certain she’ll be going home soon. Thomas Jefferson isn’t a doctor (he’s a Founding Father), so he just doesn’t know that.
I locate Alyssa in the radiology reading room. She’s flipping through X-rays done on our patients from the last few days. “Hey,” I say. “Is Mrs. Jefferson’s chest X-ray up yet?”
Alyssa nods. “Yeah, I just looked at it. It’s negative.”
“Oh,” I say, disappointed. A pneumonia would have given us an explanation for her fevers. “Can I see it?”
Alyssa whirls around with her classic “why are you wasting my time” expression.
“Never mind,” I quickly say. It’s far too early in the call to be pissing off Alyssa.
_____
For the first time all month, the call is going smoothly. It’s a miracle.
I’ve got all my admissions tucked away by midnight, and I manage to retire to my call room before 1 a.m. I might even get a full night of sleep while on call. I actually seem to be getting the hang of this whole doctor thing.
At 1:45 a.m., things start to fall apart.
My pager goes off and I know before I even answer it that it’s about Mr. Thurman. He’s been tottering on the brink of something awful all day, and it makes sense that he waited for the very moment I fell asleep to start crumping. “Hello, this is Dr. McGill,” I say.
“Hi, Doctor,” the nurse says. “I’m calling about Mr. Thurman.”
Naturally.
“His blood pressure is low,” the nurse says. “It’s 81 over 53.”
“And what are the rest of his vitals?” I ask.
The nurse hesitates. “Um, hang on.”
I sigh, but then get freaked out by how much I sounded like Alyssa just now. I start getting my shoes on because no matter what the nurse tells me, I’m going to be heading over to see Mr. Thurman. I expect he’s going to make a journey to the ICU tonight.
After the nurse reports back to me, I tell her I’m on my way, then I page Alyssa to let her know. “Mr. Thurman’s really sick,” Alyssa says. No kidding. “I’m going to call the ICU and see if they’re willing to take him. He’s probably going to nee
d some pressure support. Does he have a central line?”
“No,” I say.
Alyssa swears under her breath, then hangs up the phone.
By the time I get to Mr. Thurman’s bedside, he isn’t looking good. His oxygen levels are dropping and his blood pressure is still low. I check the chart and confirm that he’s Full Code. Meaning we have to do everything possible to save the guy’s life, even though it’s not clear he’ll ever have any real quality of life ever again. It seems, in all honesty, like a bit of a waste. But I’m not going to argue the point right now.
It’s probably a blessing at this point that Mr. Thurman doesn’t really appear to know what’s going on. His head is lolling around and he grunts a few times as a sweat breaks out on his forehead. The reading on the monitor tells me his blood pressure is still dropping.
Alyssa materializes at the bedside and I feel nothing but relief. “Should we put in a central line?” I ask her.
She bites her lip. “I can’t. I’m not signed off yet.”
In order for a resident to be allowed to do a procedure independently, they have to be observed a certain number of times by an attending physician. At that point, they are “signed off” to do the procedure. Apparently, Alyssa hasn’t reached that level of skill with placing central lines.
“What about the ICU resident?” I ask.
Alyssa shakes her head. “She’s a junior. She’s done less than I have.”
Well, great. I guess we’re just going to have to let him die then.
“Call Surgery,” Alyssa says to me.
“Huh?” I say.
She grits her teeth. “Get the person on call for Surgery. They’ll put in a line. They’re great at it.”
“Okay,” I mumble.
I know before I even speak to the operator that she’s going to tell me that Dr. Reilly is on call for Surgery tonight because that is the kind of luck I’ve been having. I page him and sit by the phone, waiting for the call back. I don’t expect him to return the page. He never does.
So I’m pretty shocked when the phone rings: “This is Dr. Reilly, returning a page.”
“Hi,” I say. “Um, it’s Jane.”
Ryan is quiet for a minute. “Why are you paging me?”
“We’ve got a guy who needs a central line… urgently.”
He sighs. “Don’t you have a senior resident?”
“She’s not signed off,” I explain.
Ryan snorts. “What do they teach you guys over there, anyway?”
“Come on,” I say. “Please… just help us out…” Help me out.
There’s a long pause on the other line while I hold my breath.
“Yeah, fine,” he says. “I’ll be there in five.”
I expect him to take his sweet time getting over here, but once again Ryan Reilly manages to surprise me. A few minutes later, he arrives on the ward carrying a central line kit. He doesn’t look me in the eyes, and when he addresses me, it’s in a sharp monotone. Like I’m just some intern he’s never met before. “Where’s the patient?” he asks.
I lead him to Mr. Thurman’s room. He eyes the patient, with his wonky pupils, the drool pooling in the corner of his mouth, and the feeding tube in his belly.
“Jesus,” Ryan says. “What’s wrong with him?”
“Brain injury,” I say. “Motorcycle accident.”
Ryan shakes his head. “Maybe this is God telling you something…”
I stare at him. “What are you saying?”
His eyes finally meet mine. “You don’t think this is all a huge waste?”
“No, I don’t,” I say angrily. Although to be honest, I really sort of do. But I don’t want him to win this argument. “I mean, if it were you or your family member…”
“If it were me,” Ryan interrupts, “it would be over right now. Hell, way before now.” He glares at Mr. Thurman, as if he is furious at the man for having the gall to be alive. “That will never be me. Never.”
I don’t like what Ryan is saying. I swallow hard. “Look, can you put in the line, please?”
He nods curtly before gowning up to go inside the room. I’ve only seen a handful of central lines placed in my short medical career, but it’s obvious Ryan is very experienced with them. His hands are incredibly steady as he slips the catheter into place and slides out the guidewire. It takes only a few minutes, which is a good thing considering I’m practically holding my breath the whole time.
Ryan pulls his gloves off with a loud snap as he pushes past me out of the room. “Congratulations,” he says. “Your patient lives another day.”
I watch him as he grabs the patient’s chart to scribble a quick note about how he came in to save the day. I want to say something to him, apologize somehow, but I’m pretty sure anything I say will come out wrong. If I compliment the work he just did, he’ll think I’m patronizing him. Anyway, I’m sure he doesn’t think he did anything so spectacular just now. He’s a surgeon. Putting in central lines is probably like breathing to him.
As I wrack my brain to think of what I can say, I hear a loud voice booming overhead: “Code Blue in Room 327B. Code Blue in Room 327B.”
I’m not on the code team tonight so my first instinct is to ignore it. Then I remember: Mrs. Jefferson is in Room 327B. And then I run.
Hours awake: 20
Chance of Mrs. Jefferson living till morning: ?????????
Chapter 32
It’s clear I’m one of the last to arrive. The room is packed with the code team and there’s a nurse inside who is pumping on Mrs. Jefferson’s chest, her massive body bouncing with each compression.
I race over, yelling, “She’s my patient! What happened?”
Naturally, nobody answers. And that’s when I see Thomas Jefferson, standing outside the room, wringing his hands together and tugging on his funny little beard.
“Dr. Jane,” he says quietly. His eyes are filled with fear.
I wince. I promised him less than 24 hours ago that his wife would be fine. Now I can see them preparing to intubate her. She’s so far from fine, it’s not even funny.
“What happened?” I ask him.
“I came to bring her a snack,” he says, holding up a brown paper sack. “And I couldn’t wake her up.”
“Still no pulse!” I hear someone yell from within the room.
Oh God. She’s going to die. Somehow at that moment, I know it with absolute certainty. I look over at Thomas Jefferson and I realize that he knows it too.
“Can you stop this, Dr. Jane?” he asks me. “Markie wouldn’t want all these people here. She’d just want to go quietly.”
I nod. “Is that what you want?”
Thomas Jefferson’s brow creases and I see the tears welling up in his eyes. “Yes, please.”
I close my eyes and brace myself as I walk into the room. The senior resident is attempting to intubate her, and she’s still flatline on the monitor. I walk over to the resident who seems to be running the code and tap him on the shoulder.
“Hey,” I say.
The resident barely glances at me. With a shaking hand, he’s holding up a cheat sheet of medications that can be used during a code. I’ve got an identical one in my pocket.
“What is it?” he asks in a distracted voice.
“Her husband wants us to stop the code,” I say.
The resident turns back to me and I can see the relief flood his features.
“Oh, okay,” he says. He addresses the crowd surrounding Mrs. Jefferson, which is substantial. There are so many people doing so many things to her that her body still seems to be in motion. “I’m calling the code. Husband wants us to stop.”
And just like that, it’s over.
I leave the room with everyone else, my heart still pounding in my chest. I see the miniscule Thomas Jefferson watching everyone exit his wife’s room. He catches me before I can get past him.
“Thank you, Dr. Jane,” he says, although I don’t know what he’s thanking me for. I told him his
wife was going to be all right and I was wrong. I let her die. I screwed up. I definitely don’t deserve to be thanked.
I don’t say any of that though. I just nod.
He glances into the room. “Can I hold her hand as she goes?”
“Go ahead,” I say, even though the reality is that she’s already gone.
Mr. Thomas Jefferson goes back into the room and sits at his wife’s bedside. Her gown has been pulled down by the code team and he gently rights it for her. He picks her limp hand off the bed and strokes her smooth, unlined face with his other hand. With her eyes closed, she seems so peaceful.
“It’s all over, Markie,” he says gently. He brushes away a strand of hair that has fallen in her face. “All your suffering is finally over. You’re free.”
I watch them for another minute before I race to the bathroom just in time to burst into tears.
Hours Awake: Oh, fuck it all to hell
Chapter 33
A few hours later, we meet for rounds with Dr. Westin like nothing happened.
I’m all cried out. My eyes are still puffy but everyone probably thinks it’s from lack of sleep. Nobody would believe I was actually crying over a patient. Even Thomas Jefferson has no idea. I was too embarrassed to face him again. In my head, I keep replaying that moment when I told him that his wife would be fine, that she’d definitely go home with him.
I promised him.
Alyssa sits next to me in Dr. Westin’s office. She’s got a list of all our patients in front of her and she’s drawn a line through the name Marquette Jefferson.
As usual, Connie goes through her patients before I do. She’s only got two of them left so it goes quickly. Then it’s my turn.
“My, my, my, unfortunate business last night,” Dr. Westin says to me. “You’re quite the black cloud, aren’t you, Jackie?”
A “black cloud” refers to a person who generally has bad luck on calls. I think the term could accurately be applied to my entire internship so far.
“Yep,” is what I say.
The Devil Wears Scrubs Page 19