An hour later, I’ve ordered the golden work-up for Mr. Petrovich. He’s being admitted to our service to rule out a heart attack, and if he’s not actively infarcting his heart, he’ll get a stress test in the morning. I have no idea how they’re going to explain to him what to do on the treadmill, but that’s their problem.
I page Alyssa to go over the patient with me. She says she’s back in the resident lounge, and I have to wonder if she’s been there the whole time with Connie, discussing wedding rings. It’s probably bad form to ask.
On my way to the lounge, I get a page and my stomach sinks. As part of my overnight call, I’m cross-covering the whole hospital. That means that if there’s any problem with any patient in the hospital, I’m the gal who’s supposed to solve it. It’s kind of cool. And by “cool,” I obviously mean it’s completely terrifying and I want to curl up in a corner and hide under a big pile of coats.
There’s a phone in the resident lounge, so I figure I can call back from there. I see Alyssa inside, sitting on the couch, waiting for me. Her legs and arms are both crossed.
“I have to return a page,” I explain. She nods. I’ve already displeased her.
I dial the number on my pager. “Hello, this is ’Doctor’ McGill,” I
say.
I really need to stop doing those scare quotes.
“Hello, ’Doctor.’ This is Jill on 3-South. I’m calling about the
patient in Room 321A, Mr. Benson.”
“Oh,” I say. I did get a sign-out on this patient, which I stuffed in my pocket. I pull out a bunch of papers from my pocket and start rifling through them. “What’s the problem?”
“We just checked his blood sugar,” Jill says. “And it’s 59.” “Oh,” I say.
“What would you like to do, ’Doctor’?” Jill asks me.
“Um…” I look up at Alyssa, who is actively glaring at me right now. “Could we give him some orange juice?”
“He’s NPO for a biopsy,” Jill explains.
NPO means nothing by mouth. It’s probably another Latin thing. Anyway, how do you give a guy sugar if he can’t take anything by mouth? Maybe I could give him some in the IV. But the guy’s diabetic so I don’t want to give him too much and send him into a diabetic coma.
“Hang on,” I say to Jill. I cover the receiver of the phone and look up at Alyssa. “Um, this patient has a blood sugar of 59 but he’s NPO. What should I do?”
Alyssa sighs really loudly. “You can give him one amp of D5O.”
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 18OO 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 1O 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:
- Contact Surgery to drain big ball of pus
- Order echocardiogram
- 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.
I look down at the form. There’s still no box for echocardiogram.
I might cry.
Hours awake: 17 Chance of quitting: 78%
