The Real Doctor Will See You Shortly (29 page)

I recalled the day I'd bumped into Baio at the vending machine, in the aftermath of my needle stick, when he said, “You'll get through it.” The words had meant something to me then, even after he'd conceded that he said that to everyone. I grinned at Benny and picked up one of his Babyface CDs. “A bunch of us are going to karaoke tonight. Maybe I should try this out. A little slow jam.”

Benny shook his head. “I would pay to see that.”

He turned on the television and methodically flipped through the channels, and I sighed. “Oh please, please not
Judge Judy
.” I felt my pager buzz. “Listen,” I said, “I gotta get to rounds. Last one as an intern. Gonna try not to go out with a bang.”

“I'm sure I'll see you around,” he said, extending a fist.

“No doubt.”

Walking out of the room, I glanced at a ripe banana peel in his trash can and smiled. “Benny,” I said as I closed the door, “you really are going to get through this.”

A few weeks later I found myself back in the CCU, standing in front of Carl Gladstone's old hospital bed, doing my best Baio impression. I was now a second-year resident, and before me were four anxious, enthusiastic interns—a new pod—waiting for rounds to begin.

I had spent the final weeks of intern year dissecting my initial struggles and had come to the conclusion that early on, I simply hadn't had the capacity to fully immerse myself in my patients' realities. I was so busy trying to master the medicine—to listen for a murmur or a wheeze rather than a note of despair—that I'd missed out on crucial opportunities to intervene in my patients' lives.

In my primary care clinic, I spent much of the year trying to ensure that my patients had all of the right medications—at times in excess of twenty different pills—and neglected to ask if this was ever too much. I failed to notice the wrinkled brow or the look of distress as I handed someone two dozen prescriptions to fill. But as the year wore on, I developed the ability to think outside the diagnosis, beyond the
science
of medicine to the
art
of medicine. I discovered that there is so much more to being a doctor than ordering tests and dispensing medications. And there is no way to teach that. It simply takes time and repetition.

There had been no ceremony to mark my transition from intern to supervising resident; I'd just shown up one day with a new assignment, a new list of patients, and a new group of exuberant, unwrinkled understudies. I wanted to see how far I could push them.

“Okay, Frank,” I said, pointing to a tall African-American man. “Twenty-four-year-old black girl is found unresponsive in her hospital bed. You're first on the scene. Go.”

Frank squeezed his stethoscope before running his hands down his crisp new white coat. “Twenty-four, let's see…twenty-four…and you said it's a woman?”

“The clock is ticking, my friend. And you're stalling.”

As my intern pondered the scenario, I turned to the group. “A wise man once said that when you arrive at an arrest, the first pulse you should take is your own.” They scribbled down the pithy statement, and I whipped my stethoscope around my neck. “Last year,” I went on with more than a hint of swagger, “my residents had a scoreboard. One column was for arrests, one for lives saved, and they actually had one for arrests called while pooping. I'm still waiting for—”

A voice from a speaker a few feet above my head screeched:
ARREST STAT, SIX GARDEN SOUTH! ARREST STAT, SIX GARDEN SOUTH!

A rotating schedule had predetermined that today, the day before my thirty-hour CCU shift, was my day to run any cardiac arrest that occurred within the friendly confines of Columbia University Medical Center. It was a day I'd been thinking about for months. Years, really. This was the first arrest where I was going to run the show.
Showtime
. I dropped my scut list and broke out in a sprint.

“Good luck!” Frank howled as I crashed through the CCU doors. “No pooping!”

I'd rehearsed this moment in my mind hundreds of times. I'd thought about it over dinner with friends, on the subway, at bars, on airplanes, in my bed. This responsibility, more than any other part of being a doctor, was what I fixated on. The stakes simply couldn't be higher.

I sprinted down the long hallway and up a flight of stairs, trying to stay calm. Or calm
ish
.

ABC, ABC

Time slowed down as objects from intern year passed me in slow motion. To my left was Dave's office, to my right the vending machine I'd abused after the initial feedback session. As I passed the elevator Dr. Chanel and I had taken in the aftermath of my needle stick, other physicians joined me in the all-out sprint to Six Garden South: Ashley, Lalitha, Mark, and Don. More followed behind them. It looked like a scene out of Pamplona, except we were the ones doing the chasing. When we arrived at the sixth floor, a nursing aide pointed down another hall and said, “Fourteen. Bed fourteen.”

As I entered the room full of people, Baio's voice caromed into my head:
You have to take command of the room.

“I'm Matt,” I said forcefully, “and I'm the arrest resident.” They were the words I'd said into a mirror hundreds of times, words that I hoped would establish my authority. A dozen heads turned in my direction, just as I had imagined, and I positioned myself at the foot of the bed. As I looked at the patient before me, an unconscious, middle-aged white woman, words were shouted in my direction.

“Ms. Cardiff, forty-seven-year-old with coronary artery disease…”

A stream of phrases continued at me like an additional stanza to Billy Joel's “We Didn't Start the Fire.”

“Hepatitis C in 1993.”

“Blood sugar 103…”

“Deep vein thrombosis in 2006.”

“Platelets 170.”

“No pulse.”

Those two words smacked me in the face. “Mark,” I said, addressing my colleague at the head of the bed, “do we have an airway?”

He held up an index finger and said, “Yes.”

“Is she breathing?” I asked, as calmly as possible.

He squeezed a bag of oxygen down into her throat and said, “Not on her own, but I got her.”

A team of anesthesiologists arrived a moment later and inserted a breathing tube into her trachea. “Lalitha,” I said, “does she have a pulse?”

My pod mate mashed down on the woman's groin. “No.”

“Don,” I said, “please start chest compressions.” Don had already started chest compressions.

“Too many people,” a nurse announced and shooed several medical students away.

I took a long breath and said to the nurse beside me, “Please give one round of epinephrine and one round of atropine.” The medications were at my side a moment later and inside the woman's pale, thin arm a second after that. I watched as Don continued to crack ribs, paced to the beat of the Bee Gees, as defibrillator pads were slapped on the woman's chest and back.

The unconscious patient was exceedingly thin, like a skeleton wrapped in a tiny layer of flesh. Perhaps she had a chronic illness—cancer, tuberculosis, or cirrhosis—that robbed her of excess muscle and fat. But there was no time to think about that. I knew all eyes were fixed on me. Someone handed me the woman's morning lab results. All normal. “Do we have central access?” I asked.

“Almost,” Lalitha said, brandishing a large needle toward the woman's groin. “Okay,” she said, “got it.”

“Epi and atropine are in,” the nurse said.

I looked at the cardiac monitor. “Please hold compressions,” I said, “and check for a pulse.”

As Lalitha felt the groin for a femoral pulse, we waited. And waited. Eyes slowly turned to me.

“I see a blip!” a voice near the door shouted. “We got a pulse!”

Lalitha looked at me and shook her head. No pulse.

“Definitely a pulse on the monitor!” said another.

They were making the same mistake I'd made a year earlier in the CCU. A blip on a monitor was not the same thing as a pulse. In fact, the two could be entirely unrelated, but that was a subtle point not always appreciated by physicians-in-training. “No,” I said firmly. “We do not have a pulse. Resume chest compressions.”

There were faint whispers in the periphery—students and residents
discussing my decision—as the team went back to work. More epinephrine was infused into the woman as a new intern named Claire tried in vain to acquire arterial blood from the patient's wrist, so we would know how acidic the lifeless body had become. She readjusted the needle time and again, trying to find the tiny artery, as beads of sweat formed on her forehead. Claire knew everyone in the room was now looking at her, watching her fail over and over.

She stepped back from the body, closed her eyes, and took a deep breath.
I've been there,
I wanted to say,
just stick with it
. Claire's freshly pressed green scrubs now had a small, rapidly expanding sweat stain under each armpit. A moment later, she was edged out of the way by Mark, who took the needle from her and immediately hit the artery. The syringe quickly filled up with blood, and he sent it off to the lab seconds later as the sweaty intern looked on, crestfallen.

I scanned the patient's chart for possible clues. Why had this woman suddenly lost her pulse? Nothing jumped out at me. And I didn't have time to give the chart a close read. I felt the glare of the room, knowing that they were waiting for me to make a decision, relying on me to figure out what to do. I felt the urge to say something, to dole out more instructions, but there was nothing to say. We were following protocol and it just wasn't working.

“Please hold compressions,” I said a minute later, “and feel for a pulse.” The room fell silent as Lalitha explored the woman's groin. Several minutes had elapsed since we had begun the resuscitation, and as with a missing child, hope diminished with every passing moment. I gritted my teeth as I awaited Lalitha's call. Two dozen people watched me watch her.

Please have a fucking pulse, please.

I imagined saying the words “Does anyone object to stopping the resuscitation?” as I waited. What if someone objected, would I have to listen? Did it have to be unanimous? I'd never seen someone object. This would certainly be an unfortunate time to be confronted with that—

“We have a pulse,” Lalitha said softly, “we definitely have a pulse.”

“We have a pulse,” I repeated.
Did everyone hear that? We have a pulse!
“We need a blood pressure,” I said calmly, as Don strapped the blue cuff around the woman's arm. “We need a pressure,” I said again.

“One ten over sixty,” Don said. “Yesssss!”

“We have a bed in the ICU,” a voice behind me whispered. It was Ashley. “They're ready. Let's move her.”

“Let's move her,” I said loudly, “ICU. Now. Lalitha, keep a hand on that pulse. Let me know if you lose it.”

She nodded. The crowd parted, and we wheeled the patient in the direction of the ICU. As we emerged from the room, I saw Baio, standing in a corner watching the events. He winked at me. At least I think he winked at me.

In mid-May, second- and third-year residents and a smattering of faculty gathered to celebrate the end of the academic year. It was a boozy affair, a chance to send off the graduating residents, roast the chief residents (I sent in more than a few suggestions), and thank our professors. We also doled out awards. Some were serious—Most Likely to Win the Nobel Prize, Best in a Cardiac Arrest—and some were lighthearted—Best Looking in Scrubs and Cutest Couple. As dinner was served and drinks mixed, faces of finalists, whom we'd all voted for, flashed on a large screen. It was an outrageously fun night and one of the few times we collectively socialized. It was perhaps the only time that we saw one another in cocktail attire and certainly the only time we might have caught the Badass doing a shot.

It was the end of my second year of residency, and seated at my table were Lalitha, Meghan, Ariel, Ashley, Heather, and Mark. “Can I refresh anyone's cocktail?” I asked the group.

I was decked out in the only suit I owned—the one I'd worn to my medical school and residency interviews—and the same one I'd pulled out of the closet a month earlier for my infectious disease fellowship interviews. I had briefly toyed with the idea of becoming a critical care doctor, responsible for running an intensive care unit, but I kept coming back to those moments on the ninth floor of the hospital, with Dre and Dr. Chanel and the needle stick. I'd had a glimpse of the world of HIV medicine, a small insight into what these men and women were dealing with, and I wanted more. I also wanted to understand why bacteria and fungi were ravaging Benny's body, attacking his lungs, his liver, and his sinuses. “Drinks?” I asked again.

“The table politely declines,” Ariel said, taking a gulp of Chardonnay.