"Every exit is an entry somewhere" -- Anonymous porn actress.

I'm wearing my Corean tie pin, it just didn't get in the pic. Sadness.

ABC's

“Dr.Scott, please call #####” blared over the speakers of St. Azrael Hospital. There are only two reasons they page doctors overhead here:

Your pager isn’t working, and my pager was definitely working, or

…“This is the SICU (pronounced “sick you”, Surgery Intensive Care Unit). Your patient in 7272 is crashing. We’re about to call a CODE.”

Oh, man.

I make a brisk jaunt into the hall and then run toward the elevators. It’s just not a good “stairs” day for me today.

Technically, he wasn’t “my patient.” It was a neurosurgery patient I was consulted on to manage his high blood pressure and low potassium, et cetera. But neurosurgeons aren’t as available as hospitalists in the hospital so I was the man to call.

The patient's story was kind of sad. 50-something years old, came in with a heart attack. Got his heart cathed, stented and fixed. Then the next day, a pool of blood leaked into his brain from the anti-platelet medications they put him on to keep the tiny stents in his heart open. Vegetable city.

Isn’t this what the CPR team is for? I wonder while sliding around a corner. I felt like an intern again hoping I would not be the first doctor there. I can’t remember the last time I ran a real CODE. Remember your ABC’s.

Inside the patient’s ICU room, there are lots of blue scrubs milling about. And of course, I am the first doctor there.

A nurse is already doing compressions on the fat unresponsive man's chest. A drain sprouts from his head like some bioprosthetic alfalfa sprout.

A is for airway. He already has a tube down his throat.

B is for breathing. The respiratory tech bags oxygen into his endotracheal tube.

C is for circulation.

“Does he have a pulse?” I ask, the second time louder than the first.

“No,” a tall blonde nurse with cute brown eyes says.

We put a finger into each yeasty groin fold and feel for opposing femoral pulses. Some relationships aren’t even that romantic. No pulse.

D is for dread. Or dead, in some cases. Just not yet.

Heart rhythm + No Pulse = PEA or Pulseless Electrical Activity. That one’s easy. Start with Epinephrine.
“I already gave him an amp of Epi,” the nurse says.

“We got a pulse back.”

E is for elation.

“Lost the pulse again.”

F is for “fuck.”

“Pulse is back.”

G is for “good.”

He’s ventilated. Good. He has a pulse. Good. He’s got good I.V. access. Good.

“Do we have a pressure?” I ask. He does and it is good.

Hmm. Shall I have ham on rye or wheat today?

H is for “headache” as I try to figure out what happened.

“So what happened here?” I inquire, noticing the resident CPR team over my right shoulder. The senior resident is a good guy but I bet he’s probably wondering if he can go back to his call room soon.

I dust off the scroll of Pulseless Electrical Activity in my head. Mechanical causes first, like pericardial effusion, massive pulmonary embolism (always a good bet), tension pneumothorax. Then there’s low blood volume, hypothermia ….

“His pupils are blown,” the neurosurgery nurse says.

I is for “I am an Idiot.”

Well, duh. He’s bleeding into his head again and the blood is putting a rear naked choke hold on his respiratory center. It doesn't take a brain surgeon to figure that one out.

J is for joke. Did you hear about the new bird virus? It’s a canarial disease. They say it’s un-tweet-able. Yeah, it’s lame. I heard a male nurse telling it to a patient. Got the patient to laugh. Or go home, at least.

K is for “Kan I leave now?”

“You guys can take off. Thanks for coming,” I tell the CPR team of on-call medical residents. The surgery residents are already gone. They left as soon as they saw that the patient had a central line in. Just like at my old hospital, The Empire. Some things are universal.

The nurses call Radiology. The soonest they can do a CT scan is fifteen minutes; they already got a trauma queen from the ER on the table. Or maybe it’s a donor-cyclist.

I look up at the clock – almost 5 P.M. I look at the list of patients I still have to see today. I still might make it to my 7 P.M. Brazilian jiu-jitsu class.

“CT says he [the patient] has to have a doctor with him down there. They’re nervous,” the caller says.

I guess I won’t be making it to jiu-jitsu class tonight. I bet Royce Gracie never had this problem.

L is for landslide.

The neurosurgery nurse practitioner or physician assistant or indentured servant or whatever must have told the family outside how bad things looked. So they come in to look for themselves.

The wife loses it. Crying. Throwing herself over her husband like a whole body precordial thump. Ow, he’s gonna feel that in the morning. Or not. Nurses and family pull her off and her grown children huddle around her like a meat shield against the artillery of reality.

Then one of the adult sons goes up to his unresponsive father’s face, and gives him a long smooshy kiss on the cheek. A chill sweeps over me--I recognize that kiss. It’s the unabashed kiss of adoration and pure love of something too precious to give up. It’s the kiss I give Sun Su every day. I try not to imagine my own sweet Sun Su giving me that kiss someday as I clench my eyelids shut and a river of damp emotion drips into my sinuses, washes the back of my throat, and floods the chambers of my heart.

Sun Su being sweet. There must be a dead body or something under the table.

M is for Magic password.

“They’re not opening it. Is this the right door?” the elfin nurse says as we arrive in the shadowy land of radiology.

“Yeah, the other CT is down,” the old battleaxe nurse explains.

“Well, just push it in,” the burly tech says, “We said we’re not coming down here just to wait.”

“I’ll go check inside,” I slipthrough the control room door nearby.

Dark room, bright monitors. A pair of legs stick out of a big white donut like an extradimensional monster finishing its sacrificial snack.

“We’re almost done with this one,” the radiology techs tell me. I inform my party outside. We wait to be let into the room where minds are read, one computerized slice at a time.

N is for neophyte.

While the radiologist reviews the sushi cuts of bleeding brain, Dr. Clockheart, an old-school cardiologist comes into the room and takes the chart out of my hands without a second thought. He’s short, shriveled, and fueled by ire for all the lesser underlings of the world. Like I said, he’s old school.

“I looked at the EKG and his echo. He’s infarcting alright (i.e., having a heart attack). Nothing we can do about it. Can’t anticoagulate him. That’s how he got like this in the first place. I wrote a note,” and Dr. Clockheart is gone.

I look at the note he just wrote and smile to myself. At the end of it, barely legible, it says, “Discussed with intern.”

The “intern” would be me. Like eight years ago.

Oncology is right next to the Chapel. This was no accident.

O is for Odyssey.

We wheel our accidental and unresponsive tourist back to his ICU room and my odyssey with him ends shortly thereafter. He’s stable. His CT is done. And my work is done there. The rest will be up to neurosurgery and the family. Onto my next patient.

"I think I need a few days off," the nurse sighs.

"Tell them you have a case of anal glaucoma," the burly tech quips, " ' cause you can't see your ass coming into work tomorrow."

O is also for oubliette.