My second admission comes just before lunch. She’s a 59-year-old black woman named Marquette Jefferson. She’s actually a transfer from the surgery service, having presented with an infection of her left foot that spread to the bone. They took off her leg below the knee, but the infection persisted, so they did a revision of the amputation and now Mrs. Jefferson only has a quarter of her leg left.
It’s not clear to me why we’re getting her. She’s sick, for sure—her diabetes is out of control, she’s got heart failure, she’s morbidly obese, and her kidney function is just short of dialysis. But it’s not clear why she has to be in the hospital. But nobody can take care of her at home, and her insurance won’t cover a nursing home, so somehow we’re stuck with her.
Meaning I’m stuck with her.
Mrs. Jefferson is what’s known as a “rock.” A rock is a patient who will be on your service forever, who will never ever leave. Mrs. Jefferson is the rock to end all rocks.
She’s a rock star.
But she’s nice, at least. When I introduce myself to her, her wide face creases in a big smile. All my patients are happy to meet me today. It’s a miracle. “Well, hello, darlin’,” she says. Her hair is entirely gray, but her face is surprisingly unlined.
“Hello, Mrs. Jefferson,” I say. “I’m Dr. McGill. How are you today?”
“Oh, just fine,” she puffs, because her oxygen levels are not “just fine.” They’re more like “barely adequate.”
I start the process of examining her. I place my stethoscope on her chest and hear the thump of a third heart sound—a sign of a failing heart. Her lungs sound mildly wet, but it’s hard to hear much through all the layers of fat. Mrs. Jefferson smiles up at me and I see one of her top incisors is gold. “You have the prettiest red hair,” she tells me.
“Thank you,” I say. I almost cry at the realization that this may be the first compliment I’ve received since my intern year started.
“And a beautiful smile too,” she says. “I bet the boys just love you.” “Not really.” And I can’t help but think of S*xy Surgeon. That one fizzled out quick. We haven’t spoken since he snubbed me at my door. I
have a feeling he won’t be “saving” me tonight.
Then she adds, “You look just like my granddaughter.”
I pull off my stethoscope and stare at her. Mrs. Jefferson has charcoal-black skin, while I’m as pasty pale as a gallon of milk.
“Well,” she amends. “She’s black, of course. But other than that, you two could be twins.”
Okay then.
After I’m done with Mrs. Jefferson, I discover that my first patient, Alex Chandler, has been moved up to a room on the main floor. I head over to see him, to make sure he’s gotten a dose of acyclovir and is feeling more comfortable.
Chandler does look better than he did earlier. He’s lying in bed, his brow still sweaty but not as markedly so. Again, I can’t help but think to myself that he looks like someone I would have gone to school with. I suppose it’s a mistake to stereotype people who get HIV. It can happen to anyone. Don’t they always say that?
“You look better,” I tell him.
He nods. “The morphine helped a lot. Thanks.”
“No problem,” I say. “It was criminal that they let you suffer like that.”
“Yeah, well…” He sighs. “I’m HIV-positive, so obviously I’m a drug addict to them.” He shifts in his bed and winces with pain. “You just don’t realize how fast your life can turn around.”
I’ve only got ten minutes before the cafeteria closes for lunch hours, but somehow this seems more important. Plus, I have to admit, I am super curious. How does a nice, clean-cut guy get HIV?
“What happened to you?” I ask.
“I’ll tell you what happened to me,” he says. “Never trust a woman.” He laughs weakly then winces again. “Sorry. I’m bitter, I guess.”
“It’s okay,” I assure him.
“My fiancé cheated on me,” he says, shaking his head like he still can’t believe it. “A bunch of times. Like an idiot, I didn’t have a clue. Two months before the wedding, she tells me. She’s HIV-positive. I never used a condom with her—I mean, why would I? She was almost my wife.” He sighs, and rubs his face. “I was about to get married, I was an investment banker—I had everything going for me. That was three years ago, and now look at me.”
I look at his face and see the dark circles under his eyes. I know he’s on Medicaid. I wonder if he lost his job. I feel like it would be wrong to
ask those questions, and all of a sudden, he groans and looks very uncomfortable again.
“Are you all right, Mr. Chandler?”
“No,” he gasps. “This is… the worst pain ever. Christ.”
“Do you need more morphine?” I ask. I calculate in my head how much he’s gotten. I want to relieve his pain, but not stop him from breathing.
“Demerol has really helped me before,” he says, between shallow breaths.
I nod then run out to write the order for Demerol. More than ever, I feel determined to try to help this guy. After all, if this could happen to him, it could happen to anyone.
The cafeteria is closed for lunch by the time I get down there. I almost cry until I remember the food cart parked in front of the hospital at all times. I know Alyssa has told me never to leave the hospital on penalty of death, but I think the food cart three yards away from the front door should be allowed. It’s either that or faint from hunger.
As I get down to the lobby, I expect to smell the usual stomach- curdling aroma of fried food from the cart, but instead I smell nothing. There is a white cart parked in front of the hospital, but it’s not the food cart. It’s an ice cream truck—it’s even playing the ice cream truck jingle. My choices right now include eating ice cream for lunch versus lasting another five to six hours without food.
I’m getting ice cream.
As I walk to the truck, I nearly slam into Nina, who is coming from the opposite direction. Meaning, she has done the unthinkable—she has left the hospital while on call.
“Oh!” Nina says when she sees it’s me. Her cheeks turn pink. “Hi, Jane.”
“Were you… outside?” I ask in a horrified whisper.
“No, of course not,” Nina says. She tries to smile but keeps up the façade for exactly five seconds before breaking down. “Okay, I was. I went out. I had to.”
I just stare at her.
“Val—you know, my cat?” Nina begins. I nod. “He’s diabetic. He was all sluggish for a while and we couldn’t figure it out. I thought it was his thyroid but it turned out—well, anyway. He’s diabetic and needs
daily insulin shots, so I have to sneak out when I’m on call to give it to him.”
“You give your cat insulin shots?”
Nina nods. “Sure. It’s no big deal. I just pull the skin away and he doesn’t even feel it. It’s actually very easy. For a while, we were doing fingersticks too to monitor his blood sugar, but I just can’t anymore. I mean, I feel guilty about it, but as long as he gets the insulin, he should be okay.”
I laugh. I can’t help it—there’s just something funny about imagining Nina giving her cat fingersticks. “Maybe you missed your calling as a veterinarian?”
“Oh no,” Nina gasps. “I could never. It’s way too sad when something bad happens to an animal.” She frowns at the expression on my face. “That sounded bad, didn’t it?”
“Slightly.”
Her eyebrows scrunch together. “You won’t tell on me, will you?” “Of course not.”
Nina sighs in relief. “Thanks, Jane. I’m not even worried about my senior resident. I’m just worried about that witch of a roommate of yours, Julia. She’d rat me out to the program director for sure.” She looks over at the ice cream cart. “Let me buy you a popsicle.”
I can’t say no to that.
I take my sweet time selecting a popsicle, since this is apparently going to be my entire lunch. I haven’t eaten a popsicle in a long time, probably years. They all look so delicious. Finally, I pick out the orange creamsicle. I’m practically salivating when they hand it to me.
Nina laughs. “Did you skip out on lunch today?” “Am I that obvious?”
“The nurses usually will let you have some crackers from the nurse’s station if they like you,” Nina says.
“And what if they don’t like you?”
We walk back into the hospital as I rip the wrapping off my popsicle and take a bite. It’s so cold that it’s a little bit agonizing to have it in my mouth, but I’m so hungry that it tastes like the best popsicle I’ve ever eaten in my whole life.
I hear a noise blaring over the loudspeakers: “Code Blue! 3-South, Room 318. Code Blue!”
Nina looks at me. “Aren’t you part of the code team tonight?” Shit, she’s right.
And then I start running.
Hospitals are all about codes, and I spent several hours during orientation learning all of them:
Code Red: There’s a fire! Run for your life! (Or save patients, whatever.)
Code Yellow: Bomb threat. Holy crap.
Code Dr. Strong: Someone is beating someone else up.
Most of the codes vary between different hospitals, but Code Blue is pretty universal. It means someone is maybe dying and needs to be resuscitated. And I’m supposed to save them. Somehow.
Prior to my intern year, I took a course called Advanced Cardiac Life Support. Basically, it teaches you how to run a Code Blue. It teaches you how to give a patient’s heart an electric shock and administer life- saving medications. After the course, we took a test and I got 1OO%. I was so proud of myself.
That was about two weeks ago. I’ve now forgotten every single thing I learned in the class and I have absolutely no idea what I’m going to do at this code.
I run up the stairs because there’s just no time to wait for the elevator. I mean, how embarrassing would it be if I’m twiddling my thumbs at the elevator while a patient is in ventricular fibrillation? But the consequence is that when I arrive at the third floor, I’m seriously out of breath. I have to hold onto the wall for a minute while I cough and gasp for air. This is kind of pathetic. I’m beginning to worry they might need to call a Code Blue on me.
I do manage to catch my breath though, and I make my way to Room 318. The patient isn’t one of ours—it’s a man I’ve never seen before. He’s extremely yellow. I don’t think I’ve ever seen a non-cartoon human being quite so yellow in my life. He’s almost glowing.
He’s got IVs coming out of both arms, and pads on his chest to prepare for electric shocks if needed. Right now, there’s a male nurse pumping on his chest, as another nurse manually gives him oxygen.
Dr. Westin is at the head of the bed, running the code. Alyssa is a few steps back, watching him run the code. I’m pleased to find that I beat out Connie, who is nowhere in sight.
“Hey,” I whisper to Alyssa, eager to point out my promptness. “I’m here.”
Alyssa turns. She gives me an utterly disgusted look. “Are you holding a popsicle?”
Yes. Yes, I am.
Between my hunger and my eagerness to get to the code, I guess I never ended up throwing away my orange creamsicle. So here I am, in the middle of this patient being resuscitated, clutching a popsicle in my left hand. I’d probably be better off if I never came at all.
“Sorry,” I say.
A nurse taps me on the shoulder. I can tell she’s angry by the aggressive way she taps me.
“Did you do that?” she asks, pointing at the floor.
Hours awake: 8
Chance of quitting: 47%
