Sleepless at St. Vincent's
Gary Blanchard, MD(1:37 a.m.) "Hello, Dr. Blanchard. Mrs. Schilling is complaining of chest pain."
I don't order an EKG over the phone. I don't ask what the patient's vital signs are. I don't ask for three sublingual nitroglycerin to be placed at bedside. Instantly, I've already made three rookie mistakes before I even see my first chest pain patient as a physician (thankfully, the nurses look out for the newbies, and an EKG and nitro are evidently standard protocol when a patient complains of chest pain (good idea!) … not that I knew that at the time.). Knowing I am only 30 seconds away from the coronary care unit, I just utter, unconvincingly, "I'll be right there."
My shoes already triple-knotted, I amble out of bed, power walking a couple hundred feet down the hall, leaving behind my call room and my perfectly made, unused bed - pristine hospital corners still intact. At about the 20 second mark, I realize it would be helpful if I knew Mrs. Schilling's vital signs. I etch a mental note on the dry erase board that is my memory.
It is my first night on call overnight in the hospital as a doctor - in the intensive care unit, no less, where the sickest patients tend to congregate. I had been in bed for 30 minutes, unable to close my eyes. As the most junior doctor in the hospital, I feel tonight like I don't know very much, but I do know with some degree of certainty: I don't want to kill someone. It's not easy to get some shut eye under these circumstances.
Okay, whatever you do, don't miss anything that could kill this nice lady with the Polaroids of her great-grandchildren. Make sure her aorta isn't dissecting like John Ritter's, her lungs are inflating, she hasn't thrown a blood clot to her lungs, and, of course, she's not having a heart attack. And, hey, moron, get her vitals. Look at her face. Does she look sick? Scared? Dammit, you've worked up chest pain a hundred times before - although, maybe just once or twice acutely. Look confident, competent. Smile.
The hallmark beeps and blips of the ICU provide the soundtrack to my jaunt down the hall. Mrs. Schilling is in bed, sitting up, smiling, her skin rose-tinged even under a flickering fluorescent. The pain she had is gone, she insists, lasting for only a few seconds. "No, I'm not short of breath, dear." No, she said, the pain wasn't worse when I took a deep breath. No, already, the pain didn't migrate anywhere. She seems oblivious to my concern, evidently not aware she just used one of the buzzwords - "chest pain" - guaranteed to rustle me out of bed in the middle of the night. ("The worst headache of my life," "tearing, ripping back pain," and "I'm feeling a sense of impending doom, doc" are other foolproof ways to say hello to me.) Her vital signs, as it turns out, are fine, too.
Confident Mrs. Schilling is not having a heart attack (although I'm still tempted to ask the resident, my most immediate boss, to double check the EKG), and feeling better about myself than I did 30 minutes ago, I saunter back to the call room, a little hop in my step, the climactic crescendo of the Boss' "Born to Run" in my head. I just successfully worked up chest pain on my own. I can do this!
I look to my left, look to my right, making sure no one's around, and let out a squatting fist pump, Peter Benton-style. (It's too late at night to even know for sure if I'm being ironic.)
Someday, girl, I dunno when / We're gonna get to the place / Where we really want to go / And we'll walk in the sun …
In the middle of my barbaric yawp, though, another sound blares: suddenly, it's circa 1940 London during The Blitz. German warplanes must be incoming.
(2:22 a.m.) "Hi, doctor. Mrs. Martinez can't sleep. Can we give her something?"
She can't SLEEP? Tell Mrs. Martinez that people are having CHEST PAIN! "Okay, I'll just say hello to her and then give 'er something. Thank you."
… But till then, tramps like us, baby …
… We were born to ruuuuunnnnnnnnnnn …
At this point, though, part of me is just relieved that sound wasn't the nefarious code beeper, clipped loosely around the waistband of my scrubs, jousting for space with my regular beeper, pinching my love handle. I was afraid to take my sneakers off earlier out of fear that if it rang, or beeped, or shrieked, or wailed, or whatever ghastly sound it undoubtedly must make, I'd have to run somewhere. Because, tonight, if someone's heart should suddenly beat like a tone deaf drummer tripping on acid, or stop beating altogether, the code beeper - this little black box attached to me at the hip - will evidently produce an ominous sound. I expect the theme to "The Exorcist."
(2:23 a.m.) "Dr. Blanchard, I just wanted to let you know Mr. Wakefield just had a three beat run of v-tach [a funny rhythm of the heart that can lead to sudden death]. Do you want to do anything?"
(2:53 a.m.) "Hi. I'm sorry to wake you. Mrs. Arroyo's urine output is a little low. Do you want to do anything about it?"
(3:12 a.m.) "Hello again. Mr. Lowe's enzymes just came back."
Come the light of day, after the chest pain resolved, the funny rhythm righted itself, the abnormal blood tests remedied, and Mr. Lowe stopped giving me palpitations, my eyes are cemented with crust, my contacts arid and desiccated. When I wake up, I still have about six hours left on a 30 hour shift. I'm expected to be lucid, organized. Thankfully, everyone made it through the night. And only partly because I fielded these calls overnight from the ICU nurses, who look out for both me and the patients with equal dollops of wisdom and kindness, with the stock response, "Um, what do you think we should do?"
Call nights in the coronary care unit in August were unpredictable. Sometimes I watched nine innings of a Red Sox game when unstable patients behaved. Other times I didn't eat. One time I snorted an empty aerosolized puff of whipped cream for dinner. Another time, famished, I ate a patient's omelet, stuffing my mouth like Dr. Richard Kimble after surviving a 1000-foot jump off an aqueduct. I often just settled for the saltines meant for the patients.
I still very much look forward to going into work in the morning - and not just because I still don't know what the code beeper sounds like. Of course, if anyone knows how to turn down the air raid sirens on my other beeper …