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 her 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.
“June!”
I look up and am horrified to see Dr. Westin grinning down at me. I have no idea what he’s doing on the wards. Attendings never show up on the wards—it would be like God coming down from heaven and just, like, hanging out at the mall. And of course, the one time he chooses to do it, I’ve got poop all over my finger.
“Hello, Dr. Westin,” I say politely, trying my best not to let my finger get contaminated. Or more accurately, not to let my finger contaminate something else.
“Is everything going all right?” he asks me.
“Great,” I say through my teeth. My finger is starting to ache, but there’s no way I’m going to tell him the dumb thing I just did. He’ll probably tell Alyssa and then I’ll never hear the end of it.
“I know intern year can be tough,” Dr. Westin says. “Yes,” I say. Is he done?
“Very tough,” he says. “Did I ever tell you about the time when…”
I keep a smile plastered across my face as Dr. Westin recounts the story of his first call as an intern. I swear to God, this is the longest story in the history of the world. Why won’t he leave me alone? Why does he have to choose this exact moment to take me under his wing?
“…and I’ve never been able to eat meatballs again after that,” Dr.
Westin concludes, chuckling at his own joke. “I’ll bet,” I say. Somebody shoot me.
“Well, I’ll leave you to it then, June,” Dr. Westin says. “You look like you’re in the middle of something important.”
No, I just have crap smeared all over my finger.
The second Dr. Westin disappears down the hall, I burst into the supply room. Keeping my finger elevated, I check every single drawer and shelf using my left hand. There is not one guaiac card in sight. This is unbelievable. Where are those goddamn cards?
Does poop expire? Do I have a time limit to get this crap smeared on a card before the results will be invalidated? God, I hope not.
Finally, I suck up my self-respect and approach one of the nurses, a tiny blonde named Angie.
“Hi,” I say. “I was wondering if you knew where the guaiac cards are?”
Angie looks me over, from my rumpled white coat and scrubs, to my gloved right hand with my finger still stuck straight up in the air. Then she bursts out laughing.
“Oh, Doctor,” she giggles. “You’ve got to go into the room
prepared.”
“Yeah,” I mumble. “I’ll keep that in mind next time. So, um, do you know where…?”
“I’ll grab one for you,” she says.
I stand at the nurse’s station, my blood pressure rising slightly when another nurse hijacks Angie on the way to get the card, forcing me to spend extra time waiting with poop on my finger. But finally she returns with about half a dozen guaiac cards and even a small bottle of developing fluid. “You can keep this,” she tells me, waggling the fluid bottle in my face.
“Thank you,” I say.
“That will make you very popular,” she says.
“I know,” I say. And I’m not even joking. Guaiac developing fluid is a scarce commodity.
I smear the card, and practically rip off my glove with relief. I put a drop of fluid on the smear and wait.
It’s negative.
I guess it’s good news for Mrs. Jefferson, but I’m a little peeved that I had to run around with poop on my finger for nothing. Not that I expected any other outcome.
I’m finding a trash to toss the contaminated card, when all of a sudden, I’m face to face with Connie. I’m pretty sure her one patient isn’t on this floor, so I don’t know what she’s doing here.
I can’t help but notice that Connie hasn’t dressed in scrubs today, but instead is wearing a fitted white blouse with a beige skirt, and knee- high boots. Knee-high boots has never been a look I could pull off. I always feel vaguely like an unhip cowboy.
“Can I talk to you for a minute, Jane?” Connie says to me.
“Sure,” I say. I locate a trash and toss the guaiac card inside. “What’s up?”
Unlike me, Connie isn’t wearing her hair in a ponytail, so she tosses her long, dark locks back behind her shoulders. She’s actually very pretty. Her best feature may be her skin, which is completely flawless. Why do all dermatologists have such great skin?
“I wanted to talk to you about the distribution of patients today,” she says.
“Oh?”
She nods. “I just… I think it’s a little unfair.”
I’m guessing she doesn’t think it’s unfair that I have eight patients and she has one. I suspect the unfair part is how there’s a tiny chance she’ll have to do more work than me today.
“You think so?” I say.
“I mean, an admission is a lot of work,” Connie points out. “You already know all your eight patients, but it’s going to take me forever to get through three admissions.”
“Well, I think Dr. Westin is worried about me going over the cap,” I
say.
“Yes, but isn’t Mrs. Coughlin being transferred to surgery soon?”
she reminds me. “Plus you have a couple of other possible discharges for tomorrow, right?”
I set my jaw. I know what she’s doing and I don’t want to let her do it. The attending decreed that she’s got to take three admissions today.
And damn it, she’s going to do it! “Not that many discharges,” I say. “Yeah, but if I take these three patients, I’ll have four,” she says.
“And if you have three of yours go home tomorrow in addition to Mrs. Jefferson, you’ll only have five. I mean, what’s the difference if you have one more than that? You definitely won’t hit the cap.”
“Well, not necessarily…” I say. No! I will not give in!
Connie studies my face for a moment. “Jane,” she says. “You seem really unhappy.”
I look at her in surprise. Well, yeah, I’m unhappy. I’m an intern. But I didn’t know I was so visibly, notably unhappy that other people would feel compelled to comment. “Well, I mean, it’s been a rough week…”
“You just don’t have a very good attitude,” she says. “I think that’s the problem.”
Oh, is that the problem?
“I was really looking forward to this year,” Connie says sadly. “I really wanted to learn as much as I could. And I feel like your bad attitude is just… it’s ruining it for me.”
My jaw falls open. I’m ruining her intern year? Is that really what she’s accusing me of? I don’t even know what to say. I want to tell her she’s full of shit (much like my finger used to be), but the truth is, I feel a little guilty. I hate the idea that I might be making everyone around me unhappy.
“So what are you saying?” I ask her.
“I’m saying you should do your fair share of the work,” Connie says, folding her hands across her chest. She’s wearing red nail polish, and unlike me, her fingernails aren’t bitten to shreds.
“It’s not even my decision,” I say. “Dr. Westin was the one who made the decision. This is what he wants.”
Connie raises her eyebrows at me. “Only because you complained this morning.”
I did?
“I talked to Alyssa about it,” Connie says. “She said if you agreed, we’d split today’s admissions evenly, two each. That would be more fair.”
My cheeks burn. If I made a similar request of Alyssa, she’d have given me the glowering of a lifetime. But she could never say no to Connie, naturally.
