Here’s what’s going on right now.
I’m eating an apple. By all appearances it’s a Red
Delicious. But it tastes too good. It’s not mealy, and it’s sweet plus tart.
I can measure my life, maybe, in Red Delicious apples. I
remember when they were just like this, when I was a child. They were my
favorite apple, the quintessential fruit. No wonder Eve and Adam fell into sin.
But then, a result of grafting the same monoclonal stock onto millions of trees
over decades, it was lost. They became mealy, bruised. No longer shiny. I lost
interest.
And now this? A last-minute resurgence?
I’m taking a break from my upstairs life. I wandered down a
few minutes ago to the doctor’s lounge and found this apple.
Clinic this morning was a mess. Several complex medical
patients were either very vague historians to the point where I realized 20
minutes into the interview I still had no idea what we were talking about, or
they had stopped taking their medications and but wouldn’t really tell me that
until I asked three different ways. For reasons clear to no one I had 6
patients booked in the last hour before I went on call. I’m not sure I ate
lunch.
Clinic work spilled into the afternoon because everything in
the hospital could be managed by phone. Triage called and I logged into the
remote monitor so I could watch a patient’s strip while dictating at the same
time.
Then GB called.
“Hi, how are you?”
“I don’t know.”
“Oh, okay. Well, I’m about to put the kids down for a nap.”
“Cool?”
“So I just wanted to see how your day was.”
“Um, busy. I’m on call.”
“Okay. Well, T.P. was jumping out of a mulberry tree four hours ago and cut his hand.”
“Okay. Well, T.P. was jumping out of a mulberry tree four hours ago and cut his hand.”
“Wait, what? Is it bad?”
“Well, yeah, it’s pretty deep. I mean, it’s not into the
tendons or muscles I don’t think, and it didn’t bleed much, and I just put a
bandage on. So should I just put him down for a nap?”
“Um, I should probably at least look at it. Can you bring
him in?”
So they came in. And it was deep. Into the fat on the palm
of his little right hand. And of course I decided to sew it up.
Why? I don’t know. The ER would be a long wait, and the
wound had already been gaping for hours. But a teeny part of me thought I’d do
just as good a job. And that if I didn’t, I’d only have myself to blame. And
that if I had someone else do it, I’d have to go through the work of comforting
him anyway, and then be powerless to fix the problem.
Yeah, I don’t know. I just did it.
He made a big fuss of it until finally we just held him
still and gave him some lidocaine. Then he kind of got into watching the
suturing.
The triage phone barrage thankfully held off until almost
the end of that.
Next I had to go to the hospital. I checked in with a
tachypneic baby and a laboring mom, and sent some other people home.
I was in the hallway trying to remember where I was going
next when I got sent to assist on a stat c-section
on a trauma patient in the main OR. I put on some scrubs and
jogged downstairs to the doctors lounge. I passed some bored-looking orthopedic
surgeons and confirmed I was heading the right direction.
At OR 2 the scrub nurse was getting ready. Then I saw that She,
my nemesis, would be the primary surgeon. She chatted perkily with Swiss, my
pediatrician friend, who looked a bit panic-stricken. The patient was nowhere
to be seen.
She left, and Swiss looked at me. “Why do we have to do it
in the main OR? They said she’s only 31 weeks, and we don’t even have a warmer
down here. I can’t even find the elevator to get the kid to the peds floor if
we need.”
So we talked with the nurses who brought down a
warmer. We went through the masks and tubes and checked the suction and bag
mask until everyone descended at once in the OR.
The patient writhed in pain, blood and stitches all over her
face. Her left leg was in a splint. We moved her to the operating table and she
screamed. I didn’t know yet that she had a femoral fracture. Lines went in. They forced a bag onto her
face, white milky propofol into her veins. She went limp.
Shenemesis and I hurried out to scrub, the quick kind where
you use that gel from the wall instead of water. I gowned myself while She got
her gloves. Then gloves for me too. Next the drape while the intubation was
finished. Then skin, fascia, bovie, muscle. Bladder blade, uterus, bulging bag,
child. Limp, little.
The sewing started. The uterus was floppy and I kneaded it
constantly. The bleeding slowed.
In the baby’s corner it was still chaos. Swiss intubated,
then I heard a scuffle as anesthesia was upset for some reason. Another
pediatrician arrived. The baby needed to be ventilated, but no chest
compressions yet, so that was good.
A second layer of suture closed over the first on the
uterus. I followed the stitch, kept the uterus firm, dabbed blood off the
places She needed to see. “You’re a pro under fire,” She said, not bothering to
conceal her surprise.
“Yeah, that’s because I actually know what the hell I’m
doing,” I didn’t say.
“Sure, well, we do what we can,” I mumbled.
We talked about where I work, about kids. She called herself
jaded. I figured it was an honest admission.
Baby was stable enough to take upstairs, to get ready for
transport to the city. We finished up and closed the various layers, finishing
with a haphazard subcuticular, honestly the sloppiest layer She did.
Then, my work was done. There’s that satisfying “pop” when
you grab your scrub gown by the sides and break the string that ties it,
rolling it away from yourself until the bloody parts are inside a nice blue
ball. I retraced my steps upstairs as the ortho team set up. “We’re going to put
a big rod in the middle of the femur,” the jovial one told me when I asked.
“Should be quick.”
Upstairs my tachypneic baby still needed oxygen, so it was
time to investigate a bit further. I ordered some tests and visited him again.
He wasn’t working hard to breathe. He was eating fine. All the other vital
signs were stable. He was a chunky 8 pounds next to his 18-year-old mom.
I started to order the tests when the overhead pager went
off “Neo-code, room 3914.”
“Fuck,” I said, at the nurses’ station. I’ve never been
clear on whether or not this is appropriate to say at the nurses’ station.
I ran to the other ward. Swiss and the team were already
there, but the baby had lost his airway. The other pediatrician was bagging,
but it wasn’t going well. A very pregnant nurse tried to get IV access. RT was
arranging supplies for another intubation attempt. Another nurse dug through
the crash cart for meds, and another kept shouting about the vitals. “O2 sat in
the 40’s!” 17 other people stood all around.
“I need another mask!” Swiss said. I crowded past a few
folks and dug through the cabinet. No one knows where the hell anything is in a
code. We needed a smaller mask. We found one. Then no one could find the right
tube. Then the tube was in. Then we weren’t sure. O2 sats still low, kid
bradycardic. Bring out the epinephrine. Hard to ventilate. Get some surfactant.
Xray. Xray again. Look at the xray.
It wasn’t my code to run, thank God. But it’s hard to watch,
not able to do much. Mostly what I did was listen for what folks were saying
and try to bring them what they needed, or pass on a message. Because no one
else was doing that, maybe. It’s always hard to say.
Finally, there was an airway, a heart rate over 100, and
saturations in the 90’s. The transport team was on their way. There were still too many people around, so I
left.
I checked on a woman who was in the throes of labor. She
really wanted an epidural. The anesthesiologist, of course, was occupied with
the neo-code. “There’s been an emergency. We’ll try to get it as soon as we
can.”
Then I was in the hallway again, unsure of how I got there.
Some men were installing some kind of screen into the hallway. I had to find
something to eat.
I went downstairs to find bars over the cafeteria entrance.
I missed it. It must be late? I decided to visit the bathroom next to it.
I walked in and wasn’t alone. A woman, rail-thin, wild hair
down her back and a soul-less crazed look in her eye stared at me through the
mirror she faced. She furiously mopped up what may have been water from the
sink. Her pants fell halfway down her ass, and she had on no underwear. I
avoided eye contact, thought about leaving. Somehow, I figured she might be less
likely to kill me if I used the bathroom as planned and acted as though I
routinely find half-naked women shooting up in the bathroom. Or whatever she
was doing, totally normal, you know? I washed my hands next to her and she
turned back to the other stall and began vigorously cleaning the walls.
And then I walked past a couple of folks in biker leather
fighting with security. And then I hid in the doctor’s lounge, where Fox News
was playing, and I was the only one there.
And then I found this apple. And here I am.
I look at the clock. It’s 8. All this, in only 12 hours.
There have been many times, many calls in which I’ve felt
the world turns over in 24 hours. Not just one rotation of the planet, but a
lifetime goes by. I can measure my life, maybe, by a call or two I remember.
Will this be one of those?
Another bite, and nothing is left but a thin core. My phone
rings. A new life is about to begin. It’s time.
