The Devil Wears Scrubs (21 page)

It’s so unfair.

Ryan pulls away from me, and studies my face. “Jane, are you
crying
?”

I wipe my eyes.
“No. I mean, maybe just a little.”

“What the hell?” he snaps.

I grab a tissue from the box that’s next to my bed.
“I just… I feel bad…”

Ryan jumps up off the bed, glaring at me.
“You’re kidding me, right? This is
exactly
why I haven’t told anyone about this.”

“Sorry,” I mumble.

His blue eyes meet mine. “You don’t need to feel sorry for me.”

“I don’t,” I lie.

He knows I’m full of it though. He shakes his head at me, and storms out of my room, slamming the door behind him. I guess that’s the end of me and Sexy Surgeon.

Hours awake: 4

Chance of Sexy Surgeon dying
young of a neurodegenerative disease: 50%

Call #5

As I’m waiting for the elevator to go into the hospital, a mother and her little girl pass by. The girl says to her mom, “Look, Mommy! A doctor!”

She meant me.
How cute.

Things go downhill after that.

I discover that on my day off, Mrs. Jefferson developed a fever and her white blood cells are elevated.
She was supposed to finally go home tomorrow, but now it looks like that plan is at least temporarily on hold.

Just my luck.
I mean, just
her
luck.

There’s already an admission waiting for us from the night service.
I meet Alyssa in the resident lounge to get sign-out from the overnight resident who did the admission. She looks decidedly pissed off when she sees me. But what else is new?

“How come you didn’t do the discharge paperwork on Mrs. Rogers?” she demands to know.
“She went home yesterday and I had to write her discharge while covering both your patients and Connie’s.”

“Mrs. Rogers was discharged?”
I’m shocked. As of two days ago, she looked like she was practically dead. Well, she
smelled
dead, at least.

Alyssa just shakes her head at me.
“In the future, if you know a patient is going home on your day off, you need to do the discharge summary in advance.”

I also need to develop psychic abilities, apparently.

“Sorry.”
I can’t help but ask, “Did you ever figure out why she smelled so bad?”

Alyssa looks horrified by my question.
“
Excuse
me?”

“Well, she had that smell,” I say, “and it was really bad, like the whole hallway smelled
horrible, and nobody knew why…” I stop short, aware that Alyssa is glaring at me. “Never mind,” I mumble.

I guess I’ll never find out what that smell was.
Damn.

“Also
, Mr. Dugan had a headache this morning,” she says. “I wrote an order for some ibuprofen for him.”

“Actually,” I say, “
that’s probably not the medication I’d pick, considering he’s got renal insufficiency.”

Alyssa gets quiet for a minute.
Finally, she says, “Yes, that’s true. Switch it to Tylenol.”

Score!
Alyssa actually admitted I was right about something. This may never happen again. I need to savor it. Ahhh.

I hear a loud whirring noise coming from outside and a large scooter navigates into the lounge.
Sitting atop the scooter is a resident named Jim, who was the senior admitting overflow patients last night. Why he’s sitting on a scooter is beyond me. I saw him no less than a week ago darting around the hospital on his own two feet. This is just bizarre.

“Jesus Christ,” I say.
“What happened to you?”

Jim’s face lights up, clearly loving the attention of zipping around in a scooter.
“You won’t believe this,” he begins. “So you know that big dumpster behind the hospital…”

Alyssa clears her throat loudly.
“I’m sorry but we don’t have time to socialize right now. Could you just tell us about the patient, please?”

“Spoilsport,” Jim grumbles as he fumbles through the papers in the basket on his scooter.
Seriously, this is so weird. And what did Jim do in that dumpster that landed him in a scooter? “Aha, here we go. The patient is Richard Thurman, 38 years old. At about 4 a.m., he was FOOBA.”

I frown.
“FOOBA?”

Jim winks at me.
“Found On Ortho, Barely Alive. The guy had a severe traumatic brain injury from a motorcycle crash, but orthopedic surgery was keeping him to nail his femur fracture. He was looking pretty puny last night, going in and out of a-fib, his blood pressure all over the place, his blood sugars completely uncontrolled. He’s still pretty sick, so you better keep a close eye on him.”

Alyssa does not look pleased.
“Maybe he’d be better off in the ICU if he’s that sick.”

“Nah,” Jim says.
“Frankly, his worst problem is that he’s FOS.”

I raise my eyebrows.
“FOS?”

“Full of shit.”
Jim snickers and my heart skips a beat. Please don’t let me have to do a stool disimpaction. “Don’t worry, Jane. I threw some Mag Citrate at him and I think most of it came out.”

Thank God.

After Jim zips away on his scooter, Alyssa and I go to pay Mr. Thurman a visit. When we see him, it’s pretty clear that his femur fracture is the least of his problems. Whatever happened to his brain was pretty bad. He’s two months out from the injury, and essentially in a minimally conscious state. His eyes look in two different directions and his only actions are to try to pull at his tubes, which is why his arms are in restraints. He has a long scar along the left side of his scalp and underneath a large chunk of his skull seems to be missing.

Per his chart, Mr. Thurman
was in a motorcycle accident and he wasn’t wearing a helmet. I’m not a risk taker and I’ve always thought motorcycles were scary dangerous. I mean, cars have a ton of metal protecting you, and then airbags on top of that, but when it’s a motorcycle, there’s nothing but air between you and the other cars (or the ground or a tree). So it seems like the least you could do is protect your skull with a helmet. But not everyone feels that way, apparently.

I’ve heard that motorcycle riders have lobbied against helmet laws, saying it’s a violation of their rights.
What I don’t understand is why wouldn’t you
want
to wear a helmet if you were on a motorcycle? What excuse could you possibly have? It’s uncomfortable? It makes you look uncool?

Believe
me, if pre-injury Mr. Thurman could see the way he looks right now, he would not be pleased.

Alyssa gives me the all-important job of tracking down exactly how much poop has come out of Mr. Thurman this morning.
But before she goes, she has one final set of words of wisdom for me.

“By the way,” she says.
“Mrs. Jefferson had an elevated white blood count two days ago. You missed it.”

I stare at her.
“What? I didn’t miss anything.”

Alyssa nods.
“You did. The labs you wrote down in your note for that day were from the day before.”

I pause for a second, contemplating how this mistake could have happened.
The answer is: easily. I saw a set of labs and wrote them down, not bothering to double check the date on them. I can just see how I might have done it.

Of course, half of Alyssa’s job is to look at labs.
Sometimes I catch her in the computer lab, just sitting there reviewing labs for large chunks of time. So the missed lab was as much her fault as mine.

Maybe even
more
her fault than mine.

But I don’t say that.
Instead, I say, “I’ll culture her and start antibiotics.”

_____

I’ve noticed the nurses don’t particularly like me.
It’s not that they dislike me, but they definitely don’t
like
me even though I’m fairly polite and respectful to them. Here’s the thing: if you were doing a job for over twenty years and then some 25 year old came in and you were expected to take orders from her, how much would you like that person? Not a whole lot, that’s how much.

Unless, of course, that person was incredibly handsome, like a certain surgery resident
I could name.

A nurse named Patti flags me down on the
telemetry floor in the afternoon and has a pile of annoying questions for me.

“Doctor,” she says.
“I need to talk to you about the new patient Mrs. Levy.”

“Okay,” I say, bracing myself.

“We need to open up a bed on this floor,” she says. “Mrs. Levy already had two sets of cardiac enzymes that were negative, so can we move her to the regular floor?”

“What about the third set I ordered?” I ask.

“We didn’t draw it,” she admits.

I raise my eyebrows.

“It wouldn’t be back yet anyway!” Patti says.

“Well, it definitely won’t be back if you never draw it.”

Patti just glares at me. But seriously, she knows I’m right. The rule is three sets of negative cardiac enzymes before they can leave telemetry.

“Also,” she says, “Mr. Gregory in room 204 wants to eat.”

That’s a patient I’m cross-covering so I check the sign-out. He’s supposed to have surgery today, which means he can’t eat.

“Sorry,” I say.
“He’s NPO for surgery.”

“But he’s really hungry,” Patti whines.

I want to ask her if this is a serious question. I’m sure Ryan would be screaming at her by now. Actually, he wouldn’t, because she wouldn’t dare ask him such a dumb question.

I glance down again at the sign-out for Mr. Gregory to see if they’ve added any helpful hints.
In addition to the note about the surgery, the resident had typed: “If patient is agitated, give him a dose of fativan.”

Fat
ivan? As far as I know, there is no such medication. There is, however, a sedative called Ativan. Presumably, the intern meant Ativan, which calms you down. Unless he really meant
fat
ivan, which… I don’t know, makes you fat? Or less fat?

“You can give him some Ativan,” I say generously.

Patti nods, somewhat placated.

I get a page and hurry off to answer it.
It turns out that now Mrs. Jefferson is having chest pain. She’s never leaving us. Welcome to your home forever: County Hospital.

Hours awake: 5

Chance of Mrs. Jefferson getting to go home this week
: 15% and falling

“It’s been coming on all morning,” Mrs. Jefferson explains to me. “And I feel like it’s a bit hard to breathe, you know?”

Mrs. Jefferson’s EKG is normal.
I’m waiting for the chest X-ray to show up online, but she doesn’t look that bad. She just looks worried. Thomas Jefferson is sitting at her bedside, holding her hand, looking equally worried.

“You’re going to be okay,” I promise her.
“You get angina, right?”

“Not like this,” she says.

I nod. “Okay, well, we’re going to do a bunch of tests, wait for your labs to come back, but I don’t really think anything bad is going on.”

“I believe you, Dr. Jane,” she says.
“I know you always do a really good job. I know you’re looking out for me.”

I feel a stab of guilt about missing that elevated white blood count the other day.
But she doesn’t need to know about that.

I make it out of the room and as far a
s the nurses’ station before Thomas Jefferson catches up with me. He’s got a crease between his eyebrows. “Dr. Jane, I’m worried about my Markie.”

“I understand,” I say in my most understanding voice.
“She’s going to be okay. We’re going to get to the bottom of this.”

“You don’t get it,” he says.
“Through this whole ordeal, no matter how bad things got, she always told me everything was going to be fine. But today she didn’t say that. She said to me that she thought she was never gonna leave this hospital.”

“I’m sure that’s just because she was so close to going home,” I say.
“And I promise you, she
will
go home.”

Thomas
Jefferson looks skeptical.

“I promise you,” I say again.

“Okay,” he finally says. “I believe you, Dr. Jane.”

I watch him walk back into his wife’s room.
I feel good about the fact that I reassured him. One thing I’ve been realizing lately is that people bounce back pretty easily if you give them a chance. Mrs. Jefferson is sick today, but I feel certain she’ll be going home soon. Thomas Jefferson isn’t a doctor (he’s a Founding Father), so he just doesn’t know that.

I locate Alyssa in the radiology reading room.
She’s flipping through X-rays done on our patients from the last few days. “Hey,” I say. “Is Mrs. Jefferson’s chest X-ray up yet?”

Alyssa nods.
“Yeah, I just looked at it. It’s negative.”

“Oh,” I say, disappointed.
A pneumonia would have given us an explanation for her fevers. “Can I see it?”

Alyssa whirls around with her classic “why are you wasting my time” expression.

“Never mind,” I quickly say.
It’s far too early in the call to be pissing off Alyssa.

_____

For the first time all month, the call is going smoothly.
It’s a miracle.

I’ve got all my admissions tucked away by midnight, and I manage to retire to my call room before 1
a.m. I might even get a full night of sleep while on call. I actually seem to be getting the hang of this whole doctor thing.

At 1:45
a.m., things start to fall apart.

My pager goes off and I know before I even answer it that it’s about
Mr. Thurman. He’s been tottering on the brink of something awful all day, and it makes sense that he waited for the very moment I fell asleep to start crumping. “Hello, this is Dr. McGill,” I say.

“Hi, Doctor,” the nurse says.
“I’m calling about Mr. Thurman.”

Naturally.

“His blood pressure is low,” the nurse says. “It’s 81 over 53.”

“And what are the rest of his vitals?” I ask.

The nurse hesitates. “Um, hang on.”

I sigh, but then get freaked out by how much I sounded like Alyssa just now.
I start getting my shoes on because no matter what the nurse tells me, I’m going to be heading over to see Mr. Thurman. I expect he’s going to make a journey to the ICU tonight.

After the nurse reports back to me, I tell her I’m on my way,
then I page Alyssa to let her know. “Mr. Thurman’s really sick,” Alyssa says. No kidding. “I’m going to call the ICU and see if they’re willing to take him. He’s probably going to need some pressure support. Does he have a central line?”

“No,” I say.

Alyssa swears under her breath, then hangs up the phone.

By the time I get to Mr. Thurman’s bedside, he isn’t looking good.
His oxygen levels are dropping and his blood pressure is still low. I check the chart and confirm that he’s Full Code. Meaning we have to do everything possible to save the guy’s life, even though it’s not clear he’ll ever have any real quality of life ever again. It seems, in all honesty, like a bit of a waste. But I’m not going to argue the point right now.

It’s probably a blessing at this point that Mr. Thurman doesn’t really
appear to know what’s going on. His head is lolling around and he grunts a few times as a sweat breaks out on his forehead. The reading on the monitor tells me his blood pressure is still dropping.

Alyssa materializes at the bedside and I feel nothing but relief.
“Should we put in a central line?” I ask her.

She bites her lip.
“I can’t. I’m not signed off yet.”

In order for a resident to be allowed to do a procedure independently, they have to be observed a certain number of times by an attending physician.
At that point, they are “signed off” to do the procedure. Apparently, Alyssa hasn’t reached that level of skill with placing central lines.

“What about the ICU resident?” I ask.

Alyssa shakes her head. “She’s a junior. She’s done less than I have.”

Well, great.
I guess we’re just going to have to let him die then.

“Call S
urgery,” Alyssa says to me.

“Huh?” I say.

She grits her teeth. “Get the person on call for Surgery. They’ll put in a line. They’re great at it.”

“Okay,” I mumble.

I know before I even speak to the operator that she’s going to tell me that Dr. Reilly is on call for
Surgery tonight because that is the kind of luck I’ve been having. I page him and sit by the phone, waiting for the call back. I don’t expect him to return the page. He never does.

So I’m pretty shocked when the phone rings: “This is Dr. Reilly, returning a page.”

“Hi,” I say. “Um, it’s Jane.”

Ryan is quiet for a minute.
“Why are you paging me?”

“We’ve got a guy who needs a central line…
urgently.”

He sighs.
“Don’t you have a senior resident?”

“She’s not signed off,” I explain.

Ryan snorts. “What do they teach you guys over there, anyway?”

“Come on,” I say.
“Please… just help us out…” Help
me
out.

There’s a long pause on the other line while I hold my breath.

“Yeah, fine,” he says.
“I’ll be there in five.”

I expect him to take his sweet time getting over here, but once again Ryan Reilly manages to surprise me.
A few minutes later, he arrives on the ward carrying a central line kit. He doesn’t look me in the eyes, and when he addresses me, it’s in a sharp monotone. Like I’m just some intern he’s never met before. “Where’s the patient?” he asks.

I lead him to Mr. Thurman’s room.
He eyes the patient, with his wonky pupils, the drool pooling in the corner of his mouth, and the feeding tube in his belly.

“Jesus,” Ryan says.
“What’s wrong with him?”

“Brain injury,” I say.
“Motorcycle accident.”

Ryan shakes his head.
“Maybe this is God telling you something…”

I stare at him.
“What are you saying?”

His eyes finally meet mine.
“You don’t think this is all a huge waste?”

“No, I don’t,” I say angrily.
Although to be honest, I really sort of do. But I don’t want him to win this argument. “I mean, if it were you or your family member…”

“If it were
me
,” Ryan interrupts, “it would be over
right now
. Hell,
way
before now.” He glares at Mr. Thurman, as if he is furious at the man for having the gall to be alive. “That will never be me.
Never
.”

I don’t like what Ryan is saying.
I swallow hard. “Look, can you put in the line, please?”

He nods curtly before gowning up to go inside the room.
I’ve only seen a handful of central lines placed in my short medical career, but it’s obvious Ryan is very experienced with them. His hands are incredibly steady as he slips the catheter into place and slides out the guidewire. It takes only a few minutes, which is a good thing considering I’m practically holding my breath the whole time.

Ryan pulls his gloves off with a loud snap as he pushes past me out of the room.
“Congratulations,” he says. “Your patient lives another day.”

I watch him as he grabs the patient’s chart to scribble a quick note about how he came in to save the day.
I want to say something to him, apologize somehow, but I’m pretty sure anything I say will come out wrong. If I compliment the work he just did, he’ll think I’m patronizing him. Anyway, I’m sure he doesn’t think he did anything so spectacular just now. He’s a surgeon. Putting in central lines is probably like breathing to him.

As I
wrack my brain to think of what I can say, I hear a loud voice booming overhead: “Code Blue in Room 327B. Code Blue in Room 327B.”

I’m not on the code team tonight so my first instinct is to ignore it.
Then I remember: Mrs. Jefferson is in Room 327B. And then I run.

Hours awake: 20

Chance of Mrs. Jefferson living till morning
: ?????????