At around midnight, I get a page I’ve never gotten before. It’s a nurse I vaguely recognize with a no-nonsense New York accent. “Dr. McGill,” she says. I don’t hear the scare quotes when she says “Doctor,” which makes me feel good about myself, until I hear what she has to tell me: “Mr. Hoffman just died.”
I stare at the phone, my heart pounding. “What? Why didn’t you call a Code Blue?”
The nurse sighs. She’s like a nurse version of Alyssa. “The patient was Comfort Care. Terminal colon cancer.”
“Comfort Care” means just that. The patient is no longer being treated medically, but we are keeping him comfortable until he passes away, which is expected to be imminent. Pain medications are all right, but CPR or antibiotics are not.
“So what do I do?” I ask. It seems like my work is over if the guy’s dead. I mean, that’s what I’m here to prevent.
“You have to come over here and declare him dead.” “Oh.”
I march over to the floor where Mr. Hoffman is located. I somehow expected things to be a little more somber because a man just died, but it pretty much looks like business as usual. Two of the nurses are having a loud conversation about laxatives.
The nurse who called me, Kaitlin, is waiting for me at the nurse’s station. I’ve worked with Kaitlin a few times before, and have always been incredibly intimidated by her. She’s got at least two decades on me in age and experience, and it shows on her thin, lined face. She always wears her gray-laced black hair in a tight bun that reminds me vaguely of Julia, and today she’s wearing solid purple scrubs.
“Dr. McGill?” she asks. None of the nurses know us by our names yet—we probably all seem identical to them.
I nod.
Kaitlin crooks her finger at me and leads me to Mr. Hoffman’s room, which is the last one in the hallway. The lights are dimmed inside and it’s very quiet, at least for a hospital room. There isn’t one machine beeping or alarming. I’ve never met Mr. Hoffman before, but he looks like he was pretty sick (obviously). He’s got huge hollows in his cheeks,
gray stubble across his chin, and his toothless mouth is parted in a silent
O. Just before a really sick patient dies, their mouth often opens that way. It’s called the “O sign.”
Kaitlin folds her arms across her chest and waits for me to proceed. I stand there for a minute, biting my lip.
Finally, I break down and ask, “Um, what do I do?”
Kaitlin raises her eyebrows. “You’ve never done this before?” I shake my head.
She sighs. “Okay, feel for his pulse. But you won’t feel anything.”
I press my fingers into the grove of his wasted wrist where the radial artery runs. At first I almost think I feel a pulse, but then I realize it’s my own pulse. “Okay…”
“Now you listen to his chest and make sure you don’t hear anything.
You won’t.”
I place my stethoscope on Mr. Hoffman’s still chest. Silence. “And now you check his pupils.”
I reach out and lift his eyelids up with my fingertips and shine a light in his pupils, which are slightly obscured by his cataracts. They don’t budge.
Yep, this guy’s dead all right.
The next part of the process involves paperwork, which is now my area of expertise. Essentially, I am discharging this patient. But instead of discharging him to “home” or “nursing facility,” I check off the box to discharge him to “expired.” Even I can’t screw this one up.
As I’m flipping through the sign-out given to me on Mr. Hoffman by the intern taking care of him, I notice that under “code status,” he has written: “Full Code.” Full Code means that in the case of Mr. Hoffman going into cardiac arrest, a Code Blue should have been called.
We were supposed to try to save him. And then I have a heart attack. “Kaitlin!” I scream.
She drops what she’s doing and rushes over to where I’m sitting. “What’s wrong?”
I point out where the intern had written Mr. Hoffman’s code status. My heart is pounding. If we were supposed to try to save this guy, then… well, it’s not my fault. They told me he was Comfort Care! Why oh why didn’t I check the sign-out before I let him just die? Wait until Alyssa finds out about this…
“Oh,” Kaitlin says, looking unconcerned. “Mr. Hoffman’s definitely Comfort Care. That intern is the biggest idiot in the hospital.”
Then she flips through the chart and shows me where the patient signed the Do Not Resuscitate paperwork. I’m relieved, mostly that I didn’t accidently kill someone tonight. And that apparently the biggest idiot in the hospital isn’t me. (Alyssa may beg to differ.)
As I flip through Mr. Hoffman’s chart, I think about the fact that a man just died. I mean, he died. His life just ended right in front of me. And weirdly enough, I don’t feel that sad about it. If I’m being entirely honest, I don’t feel sad at all. I rented The Joy Luck Club last month and I cried way more in five minutes of that movie than I did over the death of a real human being. That’s pretty messed up.
I should definitely feel sadder over this.
I mean, someone should feel sad. Like I said, a guy just died. He had no family with him, nobody shedding a tear. Someone at least should cry a little bit. I should cry a little bit. If I cried over The Joy Luck Club, I definitely should be able to cry right now. I really should.
Come on, Jane! Cry!
I sit there for a minute, waiting for tears to come. Even just a single tear. But I can’t cry. I’m really just not very sad over this.
Screw it.
I flip to the front of the chart, where Mr. Hoffman’s emergency contacts are listed. He has one: his daughter, Carol. I dial the single number provided.
The phone rings several times, but nobody picks up. I’m about to give up when the perky voicemail recording clicks on: “Hi, this is Carol! Leave a message.”
“Oh, hi,” I say, a little thrown by the message. “Um, this is Dr. McGill at County Hospital. I just wanted to let you know that… your dad passed on. So, um, if you have any questions, you can just give us a call. Thanks.”
As I hang up the phone, it occurs to me that I just left a voicemail
that this woman’s dad died. What the hell is wrong with me? “Did you just leave a voicemail that someone’s dad died?”
I look up and see S*xy Surgeon perched at the nurse’s station, staring at me with an amused look on his face. My cheeks grow hot. “I didn’t mean to…”
He laughs. “Wow, that’s pretty classy. I thought you medicine interns were supposed to be all sensitive and shit?”
I glare at him. “What are you doing here, Ryan?”
“Looking for you,” he says with a wink. I notice he’s got a little indentation on his forehead where his surgical cap cut into his skin, and
his hair is adorably tousled. I wonder how long he’s been in surgery today. “Found you just in the nick of time, I think. It’s clear you’re in need of a break.”
“I don’t have time for a break,” I protest.
“Fifteen minutes,” Ryan says, putting his hand on my arm. And the second he touches me, I lose all ability to think rationally. I shall follow S*xy Surgeon to the ends of the Earth, if he so desires.
Fortunately, he only seems to want to go as far as the elevators. On the way to the elevators, we pass a skinny kid with disheveled brown hair and deep circles under his eyes. He looks young—even younger than me. Something about him screams out “medical student,” especially the way he seems vaguely frightened of S*xy Surgeon.
“Dr. Reilly,” the student says, his eyes widening. “I’ve been looking for you.”
“You found me, Ed,” Ryan says, rolling his eyes in my direction. “What’s going on? How was the emergency cholecystectomy?”
“Long,” Ed replies, rubbing his eyes. “Listen, I’m not on call, so… is it okay if I head home? It’s after midnight.”
Ryan looks him up and down, his eyes narrowing. “Didn’t you get the text page I sent you about the infected graft that’s coming up to the OR?”
“Yeah, but…” Ed looks at me, as if I might help him out. Fat chance, kid… I got my own troubles. “I’m not on call, so…”
“You’re not on call,” Ryan repeats, running the words over his tongue. “So… I guess that means you have no interest in learning?”
Ed’s mouth falls open. “I… I’m supposed to be here at 5 a.m. tomorrow to pre-round. I just…”
“It’s up to you,” Ryan says with a shrug. “Obviously, I think you should go to the surgery and learn something. But if you’d rather go home and go to sleep…” He says the words go to sleep rather contemptuously. Sometimes I wonder if Ryan ever actually does go to sleep. “It’s your decision, Ed.”
Ed just stares at him for a minute. I can tell he really wants to tell Ryan to go to hell, but he doesn’t dare say it. Finally, he mumbles, “I’ll go to the surgery.”
“Good boy,” Ryan says, a slow grin spreading across his face.
I wait until Ed is gone and we’re inside the elevator before I say to Ryan, “You’re a complete asshole. You know that?”
Ryan laughs. “Why?”
“You could have let that med student go home.”
“Well, that’s no fun.”
I glare at him. “Like I said, you’re an asshole.”
“At least I didn’t leave a voicemail to tell someone her dad died.” He’s got a point. Asshole.
When we head up in the elevator, I expect that Ryan is leading me to the call rooms and that our 15 minutes will be spent making out (nothing wrong with that). But instead, he takes me up a flight past the call rooms, to a door that appears to open to the outdoors. When he pushes it open, I realize that he’s taken me to the roof of the hospital.
It doesn’t look like we’re supposed to be up here. It’s mostly pipes and vents, although there’s a single garbage bin that seems to be filled mostly with cigarettes.
The July night air is pleasantly cool up here and I feel a breeze lift the hairs that have escaped my ponytail. Ryan takes my hand in his as he leads me to the edge of the building, and I can’t help but enjoy this sweet gesture. Holding hands with him makes me feel like we’re in a relationship or something, and he’s not just some guy that I make out with when either of us has a free minute.
“You’re not afraid of heights, are you?” he asks me.
I shake my head as I look down over the edge of the building at the tiny cars and people milling about below us, oblivious to the fact that we’re looking down on them. It’s a little dizzying, but there’s also something really peaceful about it. Being above it all, you know?
“Don’t jump,” he says.
I stick out my tongue at him.
He grins. “What? You’re an intern. I think it’s worth saying.” The sad part is that he’s probably right.
“Do you come here a lot?” I ask him.
“Yeah,” he says. “I like to spit on the people walking by.” “Very funny.”
His blue eyes widen. “It’s true. They usually think it’s rain.” “You don’t really.”
“Watch me.”
I hear Ryan starting to hock up some spit, and I smack him in the arm. He smiles winningly at me then leans forward to kiss me.
And then we’re kissing on the rooftop of a hospital. His body feels warm and firm against mine, and I can feel his hands sliding under my scrub top, touching my bare skin. He starts kissing me more hungrily, pushing me up against what I think is a drainpipe. This is so very hot. I don’t want this to ever stop.
And then, of course, our pagers go off. Simultaneously.
I check the number on mine then fumble for my phone. The reception on the roof isn’t very good. I notice that Ryan isn’t bothering to even attempt to answer his page.
“Don’t you need to call them back?” I ask him. He winks at me. “Nah.”
I sigh as I hold my phone up in the air, trying to see if I can get more than one bar of reception.
“I probably should go,” I say. “I’m covering about a million patients, plus I’ve got the biggest service in the hospital already.”
“Is that so?” Ryan asks.
“It’s so,” I confirm. “So don’t even think about trying to dump Mrs.
Coughlin back on me.”
“I’d say there’s zero percent chance of that happening.” “Really? How come?”
“Because she’s dead.”
I lower my phone and stare at Ryan. He isn’t smiling or doing anything else to indicate that he’s joking. “Are you serious?”
“Yeah.” He shrugs. “She died on the operating table.”
“Oh my God…” I cover my mouth with my hand. “That’s… horrible.”
“I guess so,” Ryan says. “I mean, it’s not like she was young and healthy. Even if the operation was a success, she still wasn’t going to last long with metastatic pancreatic cancer.”
He leans against the edge of the building, the wind tousling his hair.
I don’t see the slightest trace of sadness or remorse on his face. “How could you not care that she died?” I ask him.
He snorts. “Are you seriously giving me shit over this? Were you sad over that guy you just pronounced dead?”
“A little,” I lie. Ryan rolls his eyes.
“Anyway, that’s different,” I insist. “I didn’t know that guy at all.
You knew Mrs. Coughlin.” “Barely.”
“She liked you,” I say.
“So?” He grins. “Everyone likes me.”
I fold my arms across my chest. “I don’t like you.”
He tugs on the drawstring of my scrubs and I wait just a beat too long before I swat him away.
“Yeah, you’re just hot for me,” he says.
My pager goes off again, and I realize that if I don’t answer it soon, a SWAT team will be up here looking for me. I also know that getting S*xy Surgeon to show any real emotion about a patient is a lost cause.
The unsettling truth is, I’m not entirely sure how sad I am either. As I head back downstairs, I find I can’t squeeze out even one tear for her. But at least I’m trying.
Hours awake: 2O
Chance of S*xy Surgeon ever growing the hell up: 1%
