Wednesday, July 10, 2002.
My little Sun Su is: 7 weeks old!
Congrats to Jeff
on his little Kwan!
And a belated congrats to Ryan
and his little Zachary!
MY 4th OF JULY
Being July, the new first year residents (a.k.a. interns) have started in the hospital. Lots of new yet-to-be sleep deprived faces. Lots of fresh barely-worn white coats, awaiting bodily fluid stains of every color EXCEPT white (one would hope).
Overheard in halls:
INTERN: "Sorry it took me awhile to get back to you. I thought you were paging me to some room, instead of … to this phone number."
In patient charts one of the last things we write in a daily note is the "Assessment and Plan" or as we usually abbreviate it - "A/P".
One intern took it upon himself to make his own abbreviation in the notes though:
"Ass/Plan".
No, I didn't correct him. Sometimes that's a pretty accurate assessment of the day's plan itself.
FRAGMENTED MAN
Fifty three year old black man in a paralyzed vegetable state. Urinary tract infection.
History: Anoxic encephalopathy - as in "what happens when you don't get enough oxygen to your brain for too long." CPR'd four years ago from a heart attack.
His eyes, aimless, flickering. His wife watches him, focused but without expectation.
It seems to be enough for her.
I write in the chart, "Patient awake. Non-verbal. No complaints."
Well, duh.
Same as yesterday.
ENDANGERED
"You don't have the Fourth of July off? When's your vacation?" the grandmotherly Mrs. Eagle says from her hospital bed.
"My vacation starts Saturday. I have two days off," I say flipping open her chart.
"Oh, that's too bad. … They say 95% of my heart muscle is dead," the old lady states with no awareness of the irony in her reply.
"Yeah … well, you look a lot better in person than you do on paper." She thinks it's sweet of me to say that.The truth is I am amazed she is still alive each day I've seen her. She's a DNR - Do Not Resuscitate, per her own wish. It's appropriate. If she ever CPRs again, she won't have enough heart muscle left to keep her vital organs perfused, much less her brain.
If she died right now, right in front of me, I could only stand there. It would be what she wants; it would be the most humane thing to do. It's eerie.
"We'll just go day by day for now. We have to get you off this Dobutamine first," I point to the I.V. pump currently keeping her heart pumping effectively.
"I go minute by minute," she reminds me daily. "Each night I go to sleep and wonder if I'll wake up happy, in heaven. Or if I'll be getting poked again for blood tests in here," Mrs. Eagle laughs under her magnified eyes and adds,
"You're a good person. I hope Jesus is your savior."
"… Thank you," I say after a pause. For once she is quiet, as if she were expecting a different answer. I am genuinely moved ... but I really think she should save her prayers for herself. This kind woman needs them more than I do.
She thinks God is keeping her alive. I would say she is right - assuming her god's name is Dobutamine.
LAND OF THE FREE
"Seems like every doctor here is from the Middle East," the 70-year old Sean Ornery eyes me suspiciously.
"What's YOUR name?"
"Liles, it's English in origin. And your other doctor is Indian actually. The nurse says you want to leave already."
"What am I doing here? I'm just sitting around! I can do that at home."
I explain what and why we need the tests we do, in plain English. He still wants to leave (5-6 drinks a night per his history) and honestly, not seeing this guy tomorrow would do wonders for my blood pressure. Sensing his incomprehension of what's at stake here, I switch tongues,
"… But it's a free country. You can leave anytime you want. Against medical advice, of course. Your insurance company won't like that much."
Mr. Ornery decides to stay. He understands the language of money - especially his own. Who says most Americans aren't bilingual?
HOME OF THE BRAVE
"I can't go in that MRI, doc. Impossible," one of my amputee patients adamantly states shaking in fear.
"We can sedate you," I try to convince him.
He tells me about how he lost his leg in the war, as I sit and listen in awe at his bravery. How his helicopter crashed years ago, with burning metal soldering itself to his flesh as he lay trapped watching the flames creeping closer to some sort of oil leak nearby. He was rescued before the wreckage exploded, which it did, according to him. Just like some hero in an action movie. Except the price of admission was a little steeper back then.
BORN ON THE THIRD OF JULY
The next patient is an older woman with several tumor masses in her brain. Her granddaughter is blonde with jean cutoffs and a red-white-and-blue T-shirt. She's also smiley and giggly and in a very good mood. Much better than fireworks at this point.
ME: "I'm just covering for today, but it looks like she's getting the tumors in her brain biopsied tomorrow."
TUMOR MOM: "I can't ... bleghghglghgh ... wait."
DAUGHTER: "Hehehe, aww mom, it'll be okay. Will they be putting her out for that?"
ME: "They should."
Unless, of course, the neurosurgeon's name is Dr. H. Lechter. (As in Hannibal.)
PARTY LIKE IT'S 1776
Overheard conversation at nurses station.
Doc 1: "I don't mind working holidays. Keeps me sober."
Doc 2: "Someday when you become more senior, you'll get to have your holidays off."
Doc 1: "That's called retirement."
WOMEN IN BLACK
BLACK NURSE 1: "I am not African. I am a Black-American. I've never even seen an African. I was born in Detroit, not Africa."
BLACK NURSE 2: "You are African. Not Africa the state, but African like the people."
BLACK NURSE 1: "I don't even relate to them and they don't to me. Jamaicans see us, and all they see are Americans. They don't see us as sisters. They don't even like us. So why should I like them?"
BLACK NURSE 2: "Well, they might if we were civil to them."
WHITE NURSE: [insert something embarrassing here]
BLACK NURSE 1 and 2: [stare at white nurse]
DÉJÀ TUMOR
I see my second person with a brain tumor that day.
When's the last time you were able to say that?
Actually, half of her brain is basically tumor at this point. There were a couple of things the neurosurgeon could do, but when asked pointblank if it would help her live longer, he said thoughtfully,
"Hmm … no."
I tickle the bottom of her feet and the toes on one side flare outward and upward. A sign of cerebral pathology. Newborn babies also have this reflex (in both feet). I was seeing the same response in my boy when he was one week old.
The half-brain half-tumor lady hasn't been able to say a word for three months. But today, her catheter is really bothering her and she yells out,
"OH JESUS!"
She's much more comfortable once we take the catheter out. On the other hand, she hasn't spoken a word since. (At least she's the "nonverbal, no complaints" thing again.)
ORNERY AGAIN
Back in Mr. Ornery's room. The one that thought everyone was Middle Eastern. The rest of his family is much more pleasant. Actually, the man's younger sister (in her sixties) has seemed to take a liking to me bordering on flirtation. Yeah, (the septuagenarian) chicks dig me.
60-YR OLD SISTER: "So handsome and so young. Are you married? Oh, darn. Do you have a family?"
ME: "We just had a little boy."
I explain the Corean thing and she loves his name.
60-YR OLD SISTER: "How precious. My brother here just became a granddad finally. His kids adopted a beautiful little Chinese baby."
SEAN ORNERY: "Yes. That little one's the love of my life."
ME: "Well, then that's even a better reason for you to stay for these tests, Mr. Ornery. So you can watch her grow up."
I still don't like him much. But I like little babies now. And besides, his (septuagenarian) sister thinks I'm hot.
... And so on and so on, until I'm done and head home.
LONE WOLF AND CUB
At home, I lie in bed next to my sweet 7-week old boy, Sun Su. I'm nearly as naked as he is. Usually upside down to him, face to face. We'd look like a lopsided yin-yang from above.
His curious dark eyes focus on me. They are warm like sunshine, with little universes in his pupils. At times they are wide with wonder, only to look bothered and concerned the next second. Sometimes with an inexplicable exclamation, as if in awe or realization.
"I know, little Sun Su. I had the same kind of day too."
