Playing Doctor




Initial Visit?

Monday, February 13

Today

The next day, most of the patients I introduced you to left my service. Some were transferred to other services—the pancreatic cancer guy went to surgery’s and the batshit-crazy drunk lady went to psych—some were discharged—the snakebite guy.

The HIV guy did, in fact, have AIDS and Pneumocystis carinii pneumonia. (For those that strive to be hip with their toxonomy, it has been renamed Pneumocystis jiroveci. No More PCP, now PJP, which does not taste great with a glass of milk with its crusts cut off.)

He had to stay in respiratory isolation for a few a while to ensure he didn’t have tuberculosis, but he started to show some improvement even in those first few days. His CD4 count, for those of you who know about such things, was 13. I won the bet of the five physicians in that pool—closest without going over—I guessed 11.

The emphysema lady, the lady for whom I wrote impossible admit orders, bears some mentioning.

After I left, the nurse saw my impossible orders and asked Dr. Pasteur, the ICU resident, to amend the orders so the patient could be moved out of the ED and into her hospital room. Trying to help the nurse out and, I guess, believing I had made an error, he changed my orders and the patient was sent upstairs.

Around 5:30 am, she quit breathing.

A code blue was called. She was intubated and put on a ventilator. I arrived at 6 am as they were preparing the patient to be moved to the ICU. I looked at the patient and then at Dr. Pasteur.

‘Good call last night with her,’ he said to me, with a surprising amount of sincerity.

Now, I’m not a violent fellow. I’m not one to start—or even get into—fights. But hearing him acknowledge that I’d told him the patient was in no condition to go to the floor, that she would poop-out and quit breathing, that she would code if he didn’t intervene—and he did not intervene—was too much for me. I wanted to slam him against the wall. I wanted to grab the lapels of his white coat and twist them as I hissed into his face, mere inches from his nose, my spittle violating his cheeks and eyes that my call, that my judgment, my acumen was useless because of his impotence, his lack of insight, his writing orders on a patient who belonged to me.

But instead I’m just staring at him. I know he’s going to be publicly humiliated when the MICU attending reads my note from the previous night. I’m standing in silence for a full ten seconds, then ask, ‘who’s your attending this morning?’

I ask this, not because I don’t know who his attending is, because I do know. I ask him this because I want him to think about the intellectual tear down he’s about to receive. I want his nausea to begin now.

He tells me the name, closing his eyes and shaking his head, beginning to anticipate his berating.

‘You should probably,’ I tell him with faux compassion, ‘lube with K-Y now; he won’t spit when he tells you to grab your ankles.’

1 Comments:

2/13/2006
Anonymous Mike writes:

I worked for a while in a hospital -- the business office, no less. So I know what it's like to walk down the halls while laughing with co-workers even though there's a lot of sickness and death all around. To us, it was a place of work. I know it's the same for you.

On one hand, you show such compassion and passion (and knowledge) when it comes to your patient care, but taking bets in a pool on a patient's CD4 count? That just seems way too jaded.....

 


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