Thursday, October 19, 2000:
Inevitability Index: 18.
Why So Sad? I have to go in
on Saturday and Sunday.
Latest PC game: Wizards & Warriors. <geek> Want to trade
player character sheets? </geek>
Say it Loud. Say it Proud. Say it when your foot gets run
over: Aiyah!.
BYRDY
"Her heart rate is 140 now and her pressure has dropped from 146 into the 80s," the nurse said.
She was in A-Fib (atrial fibrillation) and decompensating. Awesome.
Time for the electricity. It’s been so long since I’ve worn the Gauntlets of Raiden (i.e. the cardioversion paddles) that I’ve almost forgotten what it feels like; not that you could ever really forget a feeling like that. I don’t care if she’s 87 years old and 80 pounds, I’m going to shock the – then I remembered, and checked her chart again.
NO CPR.
NO CARDIOVERSION.
So much for the God of Lightning.
Damn. Damn damn damn. I do miss being on the CPR team sometimes. I really do.
At least little Mrs. Byrd was still breathing and holding her own.
"Give me ten of Cardizem I.V. push, and .25 of Dig (pronounced DIJ) while you’re at it," I told the nurse.
Channeling the God of Water isn’t nearly as exciting as God of Lightning but it is a bit more subtle. No one ever ended up smelling like burnt flesh and fried chest hairs via I.V.
It’s a bit more precise too. From the moment I connect the syringe to the I.V. port, I inject the agents of Sin (the medi’cine) into the Blood Stream until they reach the Quad Chambers of the Heart itself. There they infiltrate like ninjas in the night, temporarily paralyzing (blocking calcium channels) those anarchic rebels (arrhythmic smooth cardiac muscle), not all of them but enough, and effectively quelling the rebellion so that law, order, and regular rhythm can be restored by the rightful cardioemperor Asa Node (SinoAtrial node, the pacemaker) himself.
It’s not quite the Board Certification answer, but close enough.
Poor Mrs. Byrd. Eighty-seven years old, her veins formed little blue cracks in her scalp and chest like old marble. Her ability to talk and her right side were taken away by a stroke years ago. Her "good" side was shriveled and bent, like a bird’s claw. A balding head and receding jaw made her look every bit like a featherless bird. When I asked her questions she would listen and vigorously nod yes or no, sometimes with a chirp from atrophic vocal cords.
She reminded me of this bird I had found on the playground back in elementary school. It was one of those baby birds, still naked and wrinkled, that had fallen out of its nest prematurely.
It was clear after a day that the mother bird had already written the evolutionary failure off for good. My friends left pieces of white bread for it, but after a couple of days we found it had died during a recess period.
One of the class jokers saw our dismay as a cue for comedic relief, actually jumped on the dead little bird, and spun around on one foot, saying, "Just give it a twist!"
It was quite awful, even for a fifth grader. A couple kids laughed. One shouted at him. The whistle blew and recess was over.
I went back to the playground that night, and I buried the bird’s remains. I didn’t tell my friends, because I didn’t want to seem that sensitive to a group of kids whose favorite expression was "BOP! You suck the big one!" Plus I ruled at tetherball with an iron palm and the kids feared my leaden foot on the soccer field … 5th graders have to keep up their reputations, you know. Did I mention I was Class President then too? No kidding, I was. Ah, fifth grade, my last year as the popular boy.
Anyways, what I remember about the baby bird was the feeling of helplessness as we watched it reject our life-sustaining pre-soaked Wonder Bread. And the waiting for the inevitable.
No, this was not the Personal Essay for my medical school application or my reason for becoming a doctor (although it would have been if I had the faintest interest in vet school, which I do not). Please, it was a bird of all things.
Mrs. Byrd had that fallen out of her nest look. She had stopped eating and refused artificial tube feeds.
I stood there pushing the medication slowly for two minutes.
There was a warmth and a spark behind those eyes though. When I spoke to her, she would become attentive and listen. She’d even tilt her head when I touched her shoulder. Maybe she was still a young 10 year old girl, trapped in a broken old body. Or an 18-year old sneaking away from her parents to be with her boyfriend. The wrinkles deceive us. Make us think they’re inherently different and alien in some way. Old people. Someone’s mother. Someone’s daughter. Someone’s broken bird.
"She’s stable for now at least," the nurse said.
"Page me if she starts running fast again. Thanks," I said as I left to write the day’s notes.
"She was also refusing to eat her dinner last night," the nurse added.
"Fine."
Maybe we’ll try the Wonder Bread. I’ll wait and see how she is tomorrow.
SEVENTH FLOOR PLEASE
Whenever I’m in an elevator by myself … (hey, this sounds like a penthouse forum introduction) … I lean back and let myself fall.
When my shoulders thud against the wall, the elevator seems to rattle with the weight. I slump and exhale and close my eyes with my head turned toward the ceiling gaining comfort from the closeness of the wall while feeling the ascension (or descension.)
(I always look for gun shadows in the ceiling grid also, thanks to bad TV detective shows.)
For a second or two, I imagine I’m being taken to a better place. I feel it in my head and in my stomach.
When the elevator slows down, I stand straight up, and take a deep breath before the doors open into reality again. The only time I am religious, is in an elevator.
SMARTEST DOCTOR IN THE WORLD
I finally know what none of my colleagues know!! I know what STAT stands for. It is from the Latin word "STATIM" meaning "immediately." Thanks to Kate for making me
THE SMARTEST DOCTOR IN THE WORLD!!
(I always thought it stood for "Swifter Than A Trollop.")
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