 (Sun Su turned five this month. No connection to this entry.) I call my
wife Amy and tell her I’m going to be late.
"How
much blood has she gotten?" I ask the intern that called me to the Medical
ICU. "Seven
packed cells today, not counting the platelets.
Two episodes of hypotension.” I walk
into the patient's ICU room. She's paler
than the average pale old lady. Her bed
slightly inverted with her head down like The Hanged Man in a Tarot card deck. It helps keep the blood going to the brain
when her pressure is low. Packets of
empty and full blood bags grapevine into her veins. "Mrs.
S?" "Ughhhhh...." I pick up
her vitals board. After each unit of
blood in, she craps another unit of bloody diarrhea out. I walk back outside. "Anyone
call the surgeon?" I ask. "Yeah,
I paged the resident on call and their attending the same time I paged you." It's just
me and this intern. Too quiet, as they
say. "The
family is in the waiting room," he says.
Out of
the frying pan and into the waiting room, I sit down with the family and tell
them what I know. The tall grey son with
the disconjugate chameleon's gaze is pushy.
His questions are loaded; each is a color-coded bomb wire. His temper is the timer. Eventually he's out of questions. Situation defused, for now. Just as I
page the surgery attending, the surgical resident shows up. As not seen on TV, the residents do not
babble on about their social lives during patient crises nor do they try to
impress you with third-year medical student rat facts. We fill
her in. She agrees that it sounds like
it has gone beyond medical, and is now a surgical issue. Medical magic can do wonders, but sometimes
you need to cut shit out. "Is
your attending coming?" I ask. "Yeah,”
the surgery resident grins sheepishly, “Dr. Shears is at home, getting ready. She was very annoyed when I talked to her. She's gotten lots of pages about this patient
already." Just
then, the phone that I paged Dr. Shears to rings. Perfectly awful timing. I pick it up, "Hi,
Dr. Shears, I just talked to your resident, sounds like you've already heard
about this MICU bleeder --" "If
I could stop getting paged for one minute, I just might be able to make it out
of the door today...." Yep, she's
annoyed and she lets me know for a little longer.
To be fair, I've spoken with Dr. Shears attending-to-attending before on the phone, and she's usually exceptionally nice. After the
surgeon hangs up, the surgery resident gives me a look of bemused empathy. I pop
into the family waiting room and lie, "Hi,
just wanted to let you know that the surgeon is almost out of the O.R. and will
be here shortly." Saying
their potential savior was still at home bitching about her pages just didn't sound very confidence-boosting. "I'll
stick around until you speak to the surgeon," I say and they appreciate
that. Dr. Shears
is a blonde woman about my age with a certain rough hewness about her you
will never see on TV. She goes straight
to the vitals board then the computer labs. "Well,
she's had plenty of chances to stop bleeding," Dr. Shears thinks out loud,
"Good job on keeping her kidneys working though." Dr. Shears
asks her resident what she thinks. There's
a moment of suspense here - a familiar dread that the surgeons will decide, "Sorry,
too sick for surgery," or "Keep transfusing," or "Not a
surgical candidate. Good luck with that." "I
think ... she needs surgery," the resident answers hesitantly. "Subtotal colectomy." The
medicine intern and I nod heads behind Dr. Shears. Invisible high-fives all around. "Die
in the ICU or die in the OR. Is this
what the patient and family want?" Dr.
Shears inquires her resident. "I
talked to them already and they're aware of the possibility of surgery," I
answer instead. "You
did? Are they prepared for an ostomy?" "We
talked about that possibility too." Dr. Shears
casts an obvious but silent look at her resident that says, "Now these
medicine residents think they're the surgeons." Sorry
to
steal your thunder, Thor, but someone has to talk to the mortals before
Charon asks for cab fare. (I'm mixing mythologies here, I
know. I blame Tzeentch.) Her look
reminds me that I haven’t told her I’m the medical attending yet. The interesting
thing about not telling other attendings that you're an attending is you get to
see them acting like a real dick sometimes and then you eventually watch them
get embarrassed, back peddle, or act like a different person the day they find
out you're an attending too. It only
works if (1) you still look young and (2) you don't have that "attitude"
going. I've got one white hair in each
temple these days, so these situations probably won’t happen for much longer. Shears
makes a call to the O.R., "Get it ready, we're coming down as soon as it's
ready." "The
family's in the waiting room. Should I
bring them in?" It was probably a
good idea to ask the family as well as the patient before you begin taking out her
colon. “Oh yeah, sure.” Ten
minutes later, Mrs. S. was gone. Two
hours later, so was her bowel. She
lived, give or take an ostomy bag and a colon.
EMAIL: scott_to_trot[at]msn[dot]com |
