Bloodletting and Miraculous Cures (28 page)

“Doctor, it's a thing I have: good news first.” He wipes the sheet at his forehead.

“The good news is that we have a treatment for your problem.”

“What problem?”

“That's the bad news. You're having a heart attack.”

“I disagree,” he says. “That can't be.”

I say to Jill, “Two IVs, he's had aspirin? Great. Nitro point four q five times three, chest X-ray, trop, coags.”

“He's got no veins,” says Jill.

Mr. Santorini is a big man. Not huge, but big in the pudgy-fleshed way that makes it difficult to get intravenous lines into veins.

Jill says, “Lenny! Lenny, come here, you try his other arm.”

Lenny draws the curtain open. “What?”

Jill says, “He's infarcting. I can't get an IV. Try the other side.”

Lenny says, “Oh.” Then he disappears.

Mr. Santorini says, “It's not a heart attack. It's something else. I rollerblade like a fiend—you should see me. An hour a day, like a maniac. I'm an exercise
addict,
I can't be having a heart attack.” A bead of sweat is suspended at his chin.

“Exercise is great, Mr. Santorini.” I have the clot box out. I draw up sterile water to mix the thrombolytic. “Jackrabbit Johansen, you know him? Legendary skier. Phenomenally fit. Died of a heart attack. Listen, I have to tell you about something. We have what's called thrombolytic, a great treatment for your problem. It's a clot-busting drug. A heart attack occurs when a clot is stuck in your coronary artery, and this medication opens that up, could save your life. There's a little risk with it. Just a very small danger, but we have to inform you of it. A very small,
tiny
number of people who get this drug have a stroke.”

“Wait a minute? Stroke? What are you saying? Can you die from stroke?”

“That's possible, but unlikely. Rare rare
rare.
”

“I can't be having a heart attack. You should see me on blades. Flash, they call me. Listen, I need a phone. I need to make a phone call.”

“The thing about this treatment is that we have to give it as soon as possible.”

Jill yells out, “Lenny! Where is Lenny? These damn agency nurses, why can't this hospital staff the place properly? You know, Dr. Chen, this place is so screwed up.”

I stand out of Mr. Santorini's field of vision and hold a finger to my lips at Jill. She giggles. This seems very funny to her.

I say to Mr. Santorini, “We have a motto: time is muscle. Time's ticking, and it's your heart muscle. So you see, I really want to give you this treatment, as long as you accept this incredibly small risk of stroke.” I inject water into the vial of powdered thrombolytic.

Jill has got the needle into a vein. I see flashback: blood in the barrel. The metal has bitten the vein and we're on our way. Jill says to me, “All day it's been just myself and this unbelievable agency nurse, this Lenny character. Am I supposed to do everything? It gets to the point that people will die, and there's nothing I can do about it.” Mr. Santorini's arm jumps as she begins to feed the cannula and the needle jolts. Jill keeps it in the arm with her thumb, says, “Sir, don't move.”

I say, “It's very important we get the IV into you.”

“Jeez, that stings.”

“We need the IV to give you the heart attack medicine,” says Jill, as she connects the tubing to flush the line.

“Are you people listening?” asks Mr. Santorini. “I can't be having a heart attack.”

“You got it?” I say to Jill. I swirl the vial of powder and water to dissolve it. The box says to swirl, not shake.

The line doesn't run. She says, “It's blown. This is pathetic. Am I alone?” She says louder, “What does it take to get some help in here?”

I stand again where Mr. Santorini can't see me. I wave my hands, bare my teeth, and mouth
stop it!
at Jill, who laughs.

Lenny appears. He says, “I can't find any IV sets—the cart is empty.”

“Good Lord. Get Wanda. Page Wanda.”

Lenny says, “Just tell me where. Is there a stock?”

“Lenny, just page Wanda to come do it.”

Mr. Santorini suddenly cringes at his chest, puts a fist to it. “Oh, wow. Yesterday I fell. Maybe I pulled a muscle or something. Give me something for the pain and I'll go home.”

On the twelve lead monitor, I see his ST segments rising, his heart being starved of oxygen, the muscle becoming liquid and dark like an apple with a soft, rotting core.

“Sir,” I say. “Do you pay your taxes?” I fix my gaze on him, to take his attention away from Jill's new jab at his arm.

“Of course. I have a slick accountant, but sure I—”

I come close to his face. I look straight and unblinking into his eyes. “Do you know why you pay your taxes?” The drug in the vial is now dissolved. I draw up the clear liquid, a little more than the exact dose.

“I have to, otherwise—”

“You pay your taxes so that I can be here at midnight after having spent many years in school, and so that I can tell you without a shadow of a doubt that your heart is in the process of infarcting and
we need to use your tax dollars
to do something about it.” I say it nicely—like I would sell a used Hyundai if I were a car salesman.

“Oh,” he says.

Wanda rushes in. On each side, the nurses tourniquet and flick his arms, probe for veins.

“We have the state of the art, the best, the latest. This is the Cadillac, Mr. Santorini. This is recombinant thrombolytic. It was a breakthrough twenty years ago, it's been refined since then, and it's superb. Minuscule risk of stroke. Hardly ever happens. I want the best for you, because you are an upstanding citizen, a taxpayer, and a rollerblader. You owe it to yourself, and I owe it to you.” I flick the bubbles to the top of the syringe, squirt out the tiny pocket of air, and plunge the barrel to the exact dose. “You want to blade again?”

“Whaddya—”

“Yes or no. You want to rollerblade again, Mr. Santorini?”

“Of course I do.”

“Then you need this treatment. If you want to blade, you need this drug.”

I watch his arms, Jill on one side and Wanda on the other. Almost simultaneously, I see the red burst in each barrel of the IV sets.

“Got it?” I ask. They have. On each side, we have a line. Both run well.

Mr. Santorini suddenly arches his back, holds his chest. “Jeez, it's like a
moose
sitting on my chest. Oh my
God.
Okay, doc, whatever you think.”

“Twenty-three fifty-four, pushing the lytic,” I say,
plunging the syringe into the happily running tube in the right arm.

 

1:30—Twelve patients waiting, three hours behind

From midnight to three is running time. Tired and thirsty. The patients pace the waiting room, or shake their stretchers. This part of the night is for fighting. It has escaped the civility of day and evening, but has not yet slipped into the dreaming, drugged morning before light. These hours are the child who kicks and screams himself to sleep. The cop asks the nurse, How much longer? The patient says to the clerk, Where is the doctor? The nurse says to me, Come and see this guy first. He's driving me crazy. The patients develop additional medical problems while they wait. They construct opinions about how they should be treated. Opinions! Later it will be easier, because they will be like sedated animals and they won't care, but now it is all arguing and pushing. I sit when I'm in the patients' rooms, to promote the illusion of time. While I write in the charts, while I jot the orders, I stand because it forces me to keep moving.

 

2:20—Room 17. Mrs. Amin: thirty-nine years old with hiccups

I cure Mrs. Amin's hiccups by bringing her a large plastic cup of ice water and a thin white straw. I have her plug her ears tightly, pushing both her right and left tragus (that little triangle of springy flesh that arcs backwards over the ear canal).

I cheerlead, “Go, drink, go, go, don't stop!” She follows my instructions and drinks the entire glass of water through the straw without pause, without releasing the pressure over her ears. The hiccups stop. I love it.

“Miraculous,” she says, smiling. She does not hiccup.

I love doing this because hiccups are of no significance, because this entertaining clinical intervention works, and I have no idea why it works. There is delicious freedom in doing something I do not understand, which cures a condition of no importance.

After this long, drawn-out clinical encounter (six minutes), Mrs. Amin says, “While I'm here, could you look at this rash?”

“How long have you had it?”

“Four years.”

“We focus on emergencies.”

“I've been waiting three hours. You can't look at my rash?” Already, she has thrust her arms out, pulled up the sleeves to show me her angry, peeling elbows. It looks like psoriasis.

I say, “Looks like psoriasis.”

“I've got three creams, none work.”

“Great. See your family doctor.”

“I would like to see a dermatologist.”

“Wonderful. Your family doctor knows a good one.”

“I've been here four hours. You could call a dermatologist.”

“We don't have dermatologists.”

“Pardon?”

“This hospital has none. Even if we did, they wouldn't come at two-thirty in the morning. Dermatologists like to sleep. That's why I'm here, because I don't like to sleep so I have nothing better to do than look at your rash.”

“Excuse me?”

“That's right, I am so
happy
to look at your rash that I can't contain myself. Nothing else to do! I don't need to see the other fifteen patients who are waiting with their heart attacks and broken bones. Thank goodness for your rash, because I would otherwise be bored silly.” I am afraid that she will begin to hiccup again, but there is no sign of it.

“Doctor, isn't this an emergency ward?”

I can't think of anything to say except, “Yes.”

Mrs. Amin scrunches her eyes at me, says, “Isn't this an
emergency
ward?”

“Your psoriasis is
not
an emergency. It's not related to the hiccups, for which you came here and which I have cured although they were also not an emergency, so consider yourself very fortunate.”

Mrs. Amin stares at me.

I say, “I will now leave, shortly after which you must walk away from this hospital. Thank you.”

“What's your name, doctor?”

“Dr. Chen.”

“Can you spell that?”

“C-H-E-N. Let me write it down for you. I'm going to write my physician registration number, too, and the
name of the head of the department, and his phone number. Can I help you in any other way?”

“We'll be in touch.”

“I look forward to it. Move along, then.”

I feel satisfied, a wormy little righteousness. I hold the curtain, “Go on. Out.” She goes. I sit down to write the chart, and I document the encounter completely, such that there can be no question about the appropriateness of my words and actions. I describe our discussion of the hiccups, my differential diagnosis of hiccups, my successful hiccup treatment, and the follow-up plan for further hiccup care. I write that the patient mentioned that she had chronic psoriasis, that I examined the rash, that I informed her of our lack of a dermatology service, and that I encouraged her to follow up through her family doctor who is providing ongoing care. It is the most complete and verbose note I have written all night, and it is almost legible. There are fifteen lines of somewhat readable text to describe the nine minutes between 2:13 and 2:22.

 

2:45—Three patients waiting, less than twenty minutes behind

 

4:55—I feel strangely alert lying on this stretcher

At night, the minor area of the department is closed. I am in a darkened room, curtain pulled, socks dry-sticky on my feet. I have inclined the head of the stretcher upward because there are no pillows in the
department. My shoes are at the side of the stretcher. On the rolling steel tray, next to suture kits and vomit basins, is my jumble of accessories: pager, mask, Palm Pilot, pen, wallet, energy bar, extra pen, vial of stool test reagent, extra mask. With all of these things removed, I am suddenly weightless.

I am alert, I am aware, I think that the wavy blue curtain resembles water. Hallway light glows through it as if I were in a cave behind a waterfall. I feel so vivid and wired that I don't notice the approach to sleep.

 

5:25—Suddenly awake

“Dr. Chen.”

A face, a curtain pulled aside, I can't see who.

“Unnhh?”

“Dr. Chen!”

“Yeah. I'm awake!” A panic, a heart-pounding proclamation, “I'm awake.”
Did I say that twice?
I'm not sure what I said and what I dreamt.

“Brady at thirty. Pressure of fifty on nothing, ETA three minutes.”

The voice: I think it's a nurse.
Where're my glasses? Did I fall asleep?
Of course I did—that strange instant sleep I can't remember happening, where one second I had the awareness of waterfalls and curtains, then now this fuzzy face-voice.
Shit, where are my glasses? Brady at thirty. Probably new heart block.
Stumble into shoes. My feet night-swollen, I stuff my wallet, my Palm Pilot into pockets. The nausea.
Where the heck—Oh,
screw the glasses. No, I need the glasses, I can't run this thing blind.

Sick feeling.

I stand at the sink. Heave, dry heave, spit, gargle a little water. Feels a bit better. Stunned, echoing awakeness. Brady.
Jeez, couldn't wait a few hours?
I feel around the tray, then the cart next to it. I pad around until I feel the wire of my glasses. Aha! Once on my face, they make the light glaring, hard. Now that I can see, I realize my headache.