Tiredness wins out as usual, however, and I do manage to squeeze in a couple of hours of sleep before my pager wakes me around 7 a.m. I have another ten minutes left until my alarm goes off, but I figure at this point I better just get up. I make only a halfhearted attempt to look respectable by straightening out my ponytail, but I don’t even bother with the finger brushing. Even though Alex Chandler left the hospital, I now have nine patients to see before we round with Dr. Westin, who we’re meeting at 8 a.m. By Alyssa’s logic of allowing thirty minutes per patient, I should have started rounding at 3:3O a.m. So I’m way behind right now.
By some miracle, I get everything done and arrive at Dr. Westin’s office only a few minutes late. Naturally, everyone is already there, and Alyssa is looking at her watch with an annoyed expression on her face. I want to take her watch and flush it down the toilet. But I can’t because I don’t have time to go to the bathroom anymore.
“Why didn’t you page me when Alex Chandler left AMA?” Alyssa snaps at me the second I enter the room.
“I told the nurses to page you and let you know,” I say.
“The nurses?” Her voice is dripping with contempt. “You should have called me. Yourself.”
Okay, the truth is, I knew I should have called Alyssa and told her myself what happened. But it was three in the morning, I was already shaken about Chandler going off on me, and I didn’t feel like getting screamed at on top of it. So I made the nurses do it. I mean, he was already gone. There was nothing we could do about it.
“Sorry,” I say.
“You should have called me,” Alyssa says. “If anything happens with a patient, you call me. You should know that by now.”
“I understand,” I say.
“She’s right, Jen,” Dr. Westin says. “Listen to Alyssa. She knows a
lot.”
I hate everyone in this room.
We get up to go round on all our patients. I feel like I’m in a bit of a
daze, and half the time when Dr. Westin asks me a question, my answer
is, “What?” At one point, he just shakes his head at me and says, “My, my, my.” I can tell I’m not really impressing anyone here.
When we get to Mrs. Jefferson’s room, her big toothy smile makes me feel better for about half a second, right before Alyssa lays into me right in front of her and everybody. “How much fluid did she put out last night?”
Because she has bad heart failure, we are monitoring Mrs. Jefferson’s “ins and outs,” meaning, we record everything she drinks (“ins”) and everything she pees (“outs”). As much as I feel sorry for myself right now, I feel slightly more sorry for the nurse who has to keep track of how much pee Mrs. Jefferson makes.
I fumble through my notes. “Um… two liters? No… three liters?” “Which is it, Jane? Two or three?”
I just stare down at my notes. At this point, anything I said would be a guess and she knows it.
“It’s your job to know the patient’s ins and outs,” Alyssa says. “It’s not my job. It’s your job.”
“Sorry,” I say.
“My, my,” Dr. Westin says.
As the rest of the team walks out of the room, Mrs. Jefferson says to me, “Hey, Jane?”
She’s not supposed to call me by my first name, but I don’t mind it right now. It’s better than “Doctor” with the scare quotes.
“What is it?” I say.
“Don’t you let them get to you,” Mrs. Jefferson says. That puff of gray hair on her head makes her look very wise all of a sudden. “I know you’re doing a good job, sweetie. You’re a good doctor. And I know because I dealt with lots of doctors.”
I nod.
“Don’t worry,” she says. “You’re real sweet now, but in a year, you’re going to be like a cougar. Just like that tall lady doctor who yelled at you. You’ll see.”
I can’t help but laugh.
“One other thing,” Mrs. Jefferson says. “Would you mind giving my husband a call, just to tell him what’s going on with me? His number’s in the front of the chart as my emergency contact.”
“Sure,” I say, putting it on my checklist to make sure it gets done. At least I can manage to not screw that up.
We finish up with rounds and I find a quiet place to get my work done, and after a few minutes, Nina joins me. I have to admit, I look around for Ryan. I know that nothing is going to happen right this minute, me with a ton of paperwork to do and him with… I don’t know, surgery to do. But I want to see him. Maybe sneak one more kiss in the elevator.
I hate myself for liking him so much.
I’m working my way through the long checklist of things I need to do before I can go home and go to sleep when an intern named Dave wanders over to us. His brown hair is sticking straight up and he looks really freaked out.
“Hey,” he says to me, running his hand through his hair, making it stick up even more. “Have you seen Connie?”
I shake my head. Connie is very focused on getting out of the hospital as fast as she can, which means when I see her, she’s often just a blur.
“She signed out to me an hour ago,” Dave says, “but then one of her admissions from last night got his third set of cardiac enzymes back and it was elevated. So… that means he’s having a heart attack. Right?”
“Right,” I say. “I think so.”
I glance over at Nina, who shrugs.
“So I paged Connie to tell her and ask her what to do,” Dave explains. “But she’s not answering, so… I don’t know what to do. What do I do?”
Nina and I exchange looks. “I think you’re supposed to start the patient on a heparin drip?” Nina suggests.
“Maybe you should call cardiology?” I say. Dave just stares at us.
And then I get this great idea. Connie has been Miss Perfect to this point. If I call Alyssa and tell her that Connie left the hospital before finding out if her patient was having a heart attack or not, that might deflect some of Alyssa’s anger from me. That would be awesome.
Also, we could figure out how to treat the patient. That would be helpful too.
Dave stands by while I page Alyssa. She answers quickly, which is one thing I can definitely say about Alyssa: she is prompt. “Dr. Morgan, returning a page,” she barks into the phone.
“Hi,” I say. “It’s Jane.”
“What is it?” she asks, preemptively disgusted by anything I have to tell her.
“So Connie left about an hour ago,” I say. “She signed out to the on- call intern. But now her patient ruled in for a heart attack. And she’s not answering her pager. So…”
“So…?” Alyssa prompts me.
“So the intern isn’t sure what to do,” I say. “And what did you tell him?”
“I told him I’d page you,” I say lamely. Alyssa has no answer for that, so I add, “I mean, it’s Connie’s patient, not mine, so I don’t really know him…”
“You don’t?” Alyssa says. “Jane, didn’t we round on all the patients this morning? This is why. So you know how to manage patients that aren’t just your own and not just always ask me for help. What were you doing while we were discussing the plan for Connie’s patients?”
I think I was half-asleep. “Listening,” I answer promptly.
“Then what would you like to do for the patient?” she asks me.
I bite my lip. I look over at Nina, who is miming something I can’t quite catch. It looks like she’s telling me to go fishing. “Call cardiology?”
Alyssa sighs. “Let me talk to the on-call intern.”
Gratefully, I hand the phone over to Dave. I shake my head at Nina. “I can’t believe this,” I mutter. “Connie screws up and I’m the one
who gets yelled at. What’s wrong with her anyway? Why did she shut off her pager? Doesn’t she have any sense of responsibility?”
Nina chews the back of her pen. I had already pegged her as a pen- chewer, so it’s gratifying to see I’m right about at least one thing today.
“Don’t take this the wrong way,” Nina says, “but you need to watch out for Connie. Seriously.”
“What does that mean?”
“Connie’s got some evil in her,” Nina says. “I mean, she’s a derm
resident.”
In medicine, there is something known as the ROAD specialties, which is an acronym for the four specialties that have the best reimbursement to hours ratio. Basically, great lifestyle with lots of money. ROAD stands for:
Radiology Ophthalmology Anesthesiology Dermatology
Naturally, it’s competitive to land a residency in any of these lucrative specialties. But by far, the most competitive is dermatology because there are so few slots and the residency is especially cushy. You need the right combination of grades, board scores, letters of recommendation, and research. And medical students who want to end up as dermatologists will do anything to get there.
Even kill for it.
No, not really. They won’t kill. But anything short of that is probably fair game. Like they might trip you pretty badly or stab you a little bit. They will do just about anything to make you look bad in front of the people grading you so that they end up with the higher grade. They are experts at brown-nosing and squeezing out the highest grade they possibly can.
For example, there was a guy in my class named Ned who wanted more than anything to do dermatology, even though on every rotation, he swore that was the specialty he was interested in. For example, when he was on OB/GYN, he wanted to be an obstetrician, on cardiology a cardiologist, etc. When I was rotating on pediatrics with him, Ned looked up all the labs on my patients as well as his, so if I was missing any piece of information, he immediately had it ready. Just to make me look bad. It worked really well.
“Connie doesn’t seem that way to me,” I say to Nina. “She’s not competitive at all. She’s actually kind of a slacker.”
“Exactly!” Nina says, gesturing emphatically. “She’s obviously really brilliant and good at getting what she wants. And now that she’s landed the residency she wants, she’s applying all that intelligence and focus into doing the absolute least amount of work possible. She’s cutthroat about being a slacker.”
I start to laugh. “Nina, that’s kind of ridiculous.” “Ridiculous or absolutely on target?”
“No, ridiculous.”
Nina shrugs. “Believe what you want. But just wait and see. The second you try to get Connie to do any real work, the claws are going to come out.”
God, I really hope not. There are more claws out than I know what to do with right now.
I check my to-do list and remember that I need to call Mrs. Jefferson’s husband. Considering this patient was the only person who’s been nice to me in the last 24 hours, I feel like I ought to do it. I locate
her chart at the nurse’s station, and as promised, his phone number is listed under emergency contacts.
I dial the number and after several rings, I hear a male voice answer: “Hello?”
“Hello, is this…” I check the chart to read off his full name. “Is this… Thomas Jefferson?”
Seriously? Mrs. Jefferson’s husband is named Thomas Jefferson? And now I’m really sorry I didn’t check his name before calling because I have to clamp my hand over my mouth to keep from laughing.
“Yes, this is him,” Thomas Jefferson says.
“This is Dr. McGill,” I say. “I’m calling to give you an update on your wife Marquette.”
Although what I really want to say is: Your name is Thomas Jefferson! How did your parents give you that name? Are you aware of how funny this is? I mean, I feel like he should at least acknowledge that, yes, he has the same name as our third president, and yes, it’s weird. He should volunteer that information upon meeting any new person. Because obviously it’s all we’re going to be able to think about.
“Oh, thank you, Dr. McGill,” Thomas Jefferson says. Then he writes the Declaration of Independence. (No, not really.)
“She’s doing okay,” I say. “She was having a little trouble breathing last night because of heart failure but we took off some fluid so she’s doing better.”
“It sounds like she’s in real capable hands,” Thomas Jefferson says.
Then he makes the Louisiana Purchase. (No, not really.) “Do you have any questions for me?” I ask him.
“No, I just appreciate you calling, sugar,” Thomas Jefferson says. Then he funds the Lewis and Clark expedition. Okay, I need to stop this.
Thomas Jefferson actually seems like a really nice man, so I hang up the phone on a good note. I’m nearly done with my checklist, and I’ve made it through Call #2. I’ve been a doctor for a whole week, I haven’t killed anyone, and I haven’t even cried.
Yet.
The decision of whether or not to take a nap post-call is a complicated one. Many factors go into this decision.
I hate taking naps. When I was a kid, I really hated it. I remember being forced to lie on the mat in kindergarten, my tiny fists clenched tightly at the indignity of it all. I never slept. I just find it hard to sleep in
the middle of the day. I also find it completely disorienting to wake up from a nap.
If I don’t sleep at all on call, such as during my last call, I pretty much am forced to take a nap, because I just feel too damn exhausted. But now I’m on the fence. I slept a solid three hours. I could probably make it till tonight without sleep. On the other hand, I am pretty tired.
Finally, I lie down in my bed and stare up at the ceiling, deciding to let my body dictate what it wants to do right now. After 3O hours of being in the hospital and having to bend to the whims of Alyssa, my pager, the nurses, and my patients, it feels decadent to just be able to do whatever I want right now.
A few minutes into my potential nap, my phone starts ringing. I check the number, hopeful it’s someone I don’t recognize. Really, I’m hoping it’s S*xy Surgeon, having tracked down my number. But instead, it’s the opposite of S*xy Surgeon: namely, my mother. I see the area code of her apartment in Queens and hesitate only a second before picking up.
I pick up. “Hi, Mom,” I say.
“So how’s it going?” she asks with breathless anticipation.
When I was young, my mother decided for me that I was going to be a doctor. The decision was not made lightly. She dropped out of college because she was getting married and hadn’t been particularly good at school anyway. She was a housewife, then a stay-at-home-mom, then she came to realize that her husband was an alcoholic compulsive gambler who didn’t particularly want to reform. They got divorced, he took off, and then she was left with a small child and not too many career options. I can’t remember a time in my childhood when my mother wasn’t working at least two minimum-wage jobs. She was always shuttling me off to my grandparents for free babysitting because paying for a sitter was just out of the question. But when she took me to my pediatrician for my annual visits, she saw a woman who made a great living, was well respected, and in no position to have her entire life wrecked by a
deadbeat husband.
And that’s my secret. I didn’t become a doctor because of some great love of medicine and healing. I did it mostly because my mother convinced me that it would be a secure, stable career. Don’t tell the admissions committee at my med school.
“It’s going… okay,” I say cautiously.
“That’s great,” she says. “I’m so proud of you.”
I bite my tongue. Mom and I had always been super close, which makes it hard to conceal from her my growing dissatisfaction with my
career. That is, with the career she picked for me. I don’t feel like an independent, intelligent, respected career woman. I feel exhausted, dumb, and mistreated.
And what really sucks is that while no man is in any position to destroy me financially, I’ve done a pretty good job of that myself. Thanks to college and med school, I am now a quarter of a million dollars in debt. Whenever I start to think about it, I feel a crushing weight on my chest. That’s a lot of debt. It’s going to dictate everything I do in life. I can never stay home with my kids because I’ve got to be working to pay back my debt. (Lucky for me, children are nowhere on my horizon right now.)
Sometimes I think I’ve made a huge mistake with my career and it’s all her fault.
“Did you get to save anyone’s life yet?” Mom asks.
I can’t help but think back to my one Code Blue, and how I spent the whole time cleaning up the mess from my popsicle. “Not really.”
“It’s just so exciting,” Mom sighs. “You’re going to have such a great life, sweetie. You’ll see. You made the right decision going to med school.”
Right now, I’m just having a lot of trouble believing that something making me so suffocatingly miserable was really the right decision.
