The hardest part about moving far
away, aside from selling the house long distance, getting everything moved without
losing or breaking anything, finding a house, finding a new doctor, dentist or job,
or finding anything you used to have at your fingertips, is leaving friends. (See,
there was a point!) Sharon Farber is one friend we especially miss, but
we're still in contact. Her article from the previous Mimosa was well
received, and she's back with the promised sequel on life as an intern in a big city
- - - - - - - -
Tales of Adventure and
Medical Life, Part II
(In Which Our Heroine Finds a Dead Body)
by Sharon Farber
Sometime during the second year of medical school, we all put on our white coats for the first time, stuffed the pockets full of shiny, undented diagnostic equipment, and went across the street to the hospital. My group was met by a senior resident, who gave us a last minute briefing before we were to go in and meet a real patient and say the traditional words of greeting, "What brought you to the hospital, Mrs. Jones?" ("My brother's pickup truck.").
As we stood in the corridor, four well-groomed medical students receiving instructions with all the attentiveness of Moses getting the commandments, we were really watching a hall-monitor. This was basically an oscilloscope on wheels, attached by a very long line to a patient inside the room. It was not very useful -- you couldn't hear the beeping from the nurses station -- but served to reassure the family and the lawyers that the patient was being closely monitored. As we listened to the resident, the monitor went beep beep beep and then stopped. The little green line on the screen went flat.
Our jaws dropped in amazement and anticipation. Someone's heart had just stopped. We were going to see that most dramatic of hospital events, the code. The cardiac resuscitation. Where life and death meet, and doctors go mano a mano with destiny. Boy, this was going to be a great day!
The resident glanced at the now silent monitor with annoyance. She walked over, held up her fist and thumped it once.
Beep. Beep. Beep.
She looked at us. "Remember. Never panic."
I finally saw an actual code during my first week of third-year, on the neurology service at City Hospital. We were at morning rounds in the ICU, hearing about the admissions of the night before, when a nurse across the room turned from a twenty-year-old semi-conscious patient and casually announced, "His temperature's 106."
Immediately, everyone jumped on the patient and attempted to hold him down while the chief did a spinal tap to see if he had meningitis. My resident lay atop the thrashing man, laughing and saying, "Wrestling at the Chase." My fellow student (The Robot) and I were still not used to seeing doctors act this way. Did Marcus Welby crack jokes? Did Ben Casey subdue patients by sprawling over them?
(Wrestling at the Chase, I pause to explain, was a unique St. Louis institution -- a Sunday morning wrestling show, incongruously televised from an auditorium in the Chase Park Plaza, one of the classiest hotels in town. My hovel was in the shadow of the Chase, and wrestling fans lined up for hours before the show, sometimes spilling into the street and making it hard for me to get to my apartment. More interesting were the chunky wrestling groupies who hung out in the parking lot by the vans, waiting to meet their heroes. You ain't seen nothing til you've seen wrestling groupies.)
As six men held down the fighting patient, I did my bit by hanging on to his free arm. Then he got quieter, and I put my fingers to his pulse, and then lost it. I said, "Gee, I don't feel a pulse?" and then the code began.
The Robot and I were utterly useless. Actually, in a code, all but about six people are useless -- the guy who watches the heart monitor and gives the orders, the people doing the chest compressions and respirations, a nurse to find meds in the crash cart and another to administer them, and then a spare doctor, who amuses himself by drawing blood gases and offering suggetions. Everyone else just gets in the way. Codes are exciting, and since everyone goes to one, it's a good place to run into your friends, or see who's around. Codes are the social events of teaching hospitals. It's not uncommon to have the room packed so full of people that you literally cannot move or leave.
Anyway, while The Robot and I watched and tried not to be too underfoot, someone handed me a syringe stuck into a styrofoam cup full of ice, and told me to run it to the lab. So I did, feeling proud and happy that I had been chosen for this important task.
The lab was three buildings away, but I ran it, skidded to a halt inside the door, and gasped out, "Blood gas! From a code!"
One of the surly lab techs glanced up at me, pointed to a machine, and said, "Put it there." The others sneered at me, except for one short, foreign-appearing woman, who wore an expression of pity.
I ran back to the ICU. The code was still in progress, and I was handed another syringe. I figured that the purpose of all these blood gases must be so that one might later sit down and go over the results and see, in retrospect, how well one had done the code. It was quite a shock, a month later at the university hospital, to discover that dispatchers come to codes to run samples, and that the lab will process the gases on arrival, so that the results arrive by phone before the blood-runners have had time to get back.
But then, the lab at City was famous for refusing to run samples unless properly labelled (and they invented new rules at a moment's non-notice), for losing samples, and for hiding the results. They say that when they cleaned out an unused dumbwaiter shaft in the lab, they found it full of tubes of blood.
I thudded into the lab again, panting and wheezing. Everyone ignored me except the small woman at the hematology station, her face more pitying than before. I put the styrofoam cup beside the last one, now leaking melting ice, and trotted back. The code was over -- the patient lived for a year and a half before committing suicide -- and now they were drawing multiple tubes of blood in order to find out why he'd gone sour.
I limped back towards the lab. As I came up the hall, the hematology woman looked up, saw the tubes in my hand, sprang from her bench, and before I was fully inside the doorway she had snatched the purple tube top from me and begun to process it. Somehow, I found this encouraging.
Two years later, when I returned to City Hospital as an intern, a year before the placed closed, relations with the lab had deteriorated even more. There was even a sign in the lab, telling techs who they were to notify if a doctor attempted to murder them. (Justifiable homicide, in our opinion.) One day, I was hunting unsuccessfully for some results, and in desperation approached someone sitting at a bench. "Can you help me..."
The woman spun around hatefully. "Find it yourself!" she snapped. It was the short foreign woman.
But enough about labs, except for this story. The lab at the VA hospital was said to be even worse. Every microscopic urinalysis came back with the nebulous results "0-3 red blood cells, 3-5 white blood cells," which could be interpreted in any way, so you'd have to repeat the test yourself. (It really meant that the lab techs had not really looked at the urine.)
Legend has it -- and I heard this from multiple people, the last being an attending cardiologist who swore he had interned with the doctor in question, meaning the story is probably about as reliable as your average tale of pulling swords out of stone -- Legend has it that an intern became tired of the VA results, and sent a sample of apple juice to the lab. It came back "0-3 rbc, 3-5 wbc". He took it to the administration, and they attempted to fire him for sending phony samples to the lab.
Another notable deficiency of City Hospital was the vital signs. Legend has it that you would find them charted for the next few shifts on patients who had died hours before. In fact, I myself once saw that. (Boy, that makes the story reliable, huh?) My chief resident swore that the nursing aide taking pulses had once called, "Hey doc, got the time?" He had no watch.
In defense of City, I might note that I have since heard similar stories about every other large, underfinanced, big-city charity hospital. But we used to joke about getting medic-alert bracelets that read, "Do not take to City Hospital."
A patient in the men's ward, an old skinny black man in a coma, had very noisy respirations. Whenever you stood on the floor, you could hear his loud gasping breaths.
One day, my first week, I came back from lunch and headed to the conference room to check a reference book. I stopped by the elevator. Something felt...wrong. Something was different. Cocking my head to the side, like a curious dog, I wandered into the men's ward. What had changed?
Then I realized what it was. No more loud agonal respirations. I went over to Mr. Jones' bed. He looked pretty much the same as before, aside from the fact that he wasn't breathing. The patients in the beds to either side of him were young, alert, healthy sociopaths with back pain. They looked up from their newspapers, saw it was just me, and went back to reading.
I said, "Mr. Jones, are you okay?"
I touched his shoulder. He wasn't cold, or stiff or anything. It's hard to describe what changes when a person dies. Try to think of the difference between picking up a seven-pound defrosted rump roast, and picking up a sleeping cat.
This was my first dead body, and I wasn't sure he was dead. He looked pretty bad, but he had never looked very good to begin with. I tried to find a pulse and couldn't, but I wasn't great at pulses yet. What if I declared him dead, and he was just in very deep coma, with minimal vital signs? Boy, would I be embarrassed!
So I took out my stethoscope, and tried to hear a heartbeat. Now, if you put your stethoscope to something silent, you can hear the ocean, and you can sometimes hear your own heartbeat. So it took me about five minutes to convince myself that the guy had boxed. Bought it. Gone to the eternal care unit.
I approached the nurses station. A large, mean-looking woman glared at me. The nurses hated new medical students -- we didn't know how things worked, and we didn't know our place. I said, "Excuse me, but Mr. Jones is no longer with us."
Abandoning euphemism, I said, "He's dead."
She looked bored. "Okay."
I went to the conference room. The chief resident was reading. "Mr. Jones is dead."
He perked up. "Yeah? What happened?"
"I don't know. I just found him."
"Does anybody know?"
"I told the nurses."
He scowled. "Dammit! You shouldn't of. We could've held a pool, to see how long it took them to notice."
I'd spoiled his fun. He didn't speak to me for the rest of the day.
Next: The best hospital food in town, and The Man Who Likes to Kill Women.
All illustrations by Charlie Williams