Code Blues (4 page)

I slept fitfully that night.

Alex never called back.

Chapter 3

At 7:25 a.m., I stepped through the ER's
automatic doors on the east side of the hospital, near the bike
racks. I promptly spotted ten people on lime-green plastic chairs,
dozing or watching the TV in the waiting room on my right.

Ten people already. Happy Canada Day to
me.

On my left stood one black-uniformed
security guard in a cubicle. Beside him sat two women behind desks
with computers, supposedly registering patients, but really
chatting with each other. Triage was a little Plexiglas alcove
straight ahead, empty except for an examining table and a stray BP
cuff machine, but even so, I didn't feel right cutting through the
triage room.

I turned left, down a little hallway, hoping
it would lead to an alternate entrance.

"Excuse me, miss," called one of the
receptionists. "You're not supposed to go in there. That's for
stretcher patients."

People never thought I worked here. I turned
and smiled. "Hi, I'm one of the new residents."

"Oh. Sorry," trilled the middle-aged
receptionist. Her mascara had smudged under her eyes, giving her a
Goth look.

"It's July first," the older one muttered.
"All the new residents."

"Oh." They giggled together. Way to make me
feel welcome.

At the end of the hallway, I saw the
ambulance bay, and took a right, pushing open the teal emerg doors.
Made it.

Two people bent over charts at an extra-long
desk on my right. On my left was an examining room with an eye
chart and then two empty resuscitation rooms, their monitors off,
oxygen masks and tanks hanging unused on the wall, and the
stretchers covered in clean white sheets.

Nurses in pink uniforms chatted at the
large, octagonal nursing station in the middle of the room. Along
three walls surrounding the nursing station, blue-gowned patients
sat in beds or rooms clearly labeled from one to 14, and more
patients lay stretched out on beds beside the station and along the
wall.

I took a cautious sniff. People often
complain about the smell of hospitals, but unless it's bloody
stool, pus, or a newly-disinfected room, I don't notice much
anymore. St. Joe's smelled fine to me.

I walked up to a nurse with snapping brown
eyes and a big smile. She looked to be about my age, and although
she was wearing pink scrub pants, she had a blue and brown striped
top. I said, "Hi, I'm Hope. This is my first day here."

She shook my hand. She had quick, bird-like
movements. "I'm Roxanne. Let me show you the residents' room." From
the windowsill, she plucked a two-foot long yellow stick with a key
dangling from the end of it. It looked like a potential weapon. I
stared. She laughed. "That's so we don't lose it."

Behind the nursing station, she showed me a
small hallway with a kitchen, a bathroom, a conference room, and
two little call rooms, one for the residents and one for the staff
doctors. "The staff one has a shower. Yours is the one on the left.
Have fun."

I shed my bag in the residents' room, which
was a basic white box with a bed, a desk, and a few hooks for
jackets. I wound my stethoscope around my neck and jammed a pen, a
pharmacopoeia, and my trusty navy notebook into my pockets. It was
just past 7:30.

Dr. Callendar turned out to be one of the
guys I'd passed at the desk when I came in. I now knew that this
was the ambulatory side of the emerg. Dr. Callendar looked
fifty-something, with a black crew cut, beat-up Nikes, and a white
coat over his greens. When I plopped into a chair beside him, he
kept on writing a note on a brown clipboard.

After a full minute, without looking up or
putting down his Bic pen, he grunted, "Who are you."

"Hi, my name is Hope Sze, I'm a first-year
resident, and this is my first emergency shift—"

He glanced up, wearing extra wrinkles across
his forehead. His nose was too blunt-tipped and his lips too thin
for him to be handsome "You got oriented?"

Not really. "Well, we walked through the ER
yesterday—"

He handed me a clipboard. "Start seeing
patients."

Automatically, I took the clipboard, but my
brain had stalled out. As a medical student, they took pains to
orient me and make sure I was comfortable before I worked. As a
first year resident, a.k.a. an R1, it was obviously sink or swim.
Not to mention the fact that Alex told me my shift didn't really
start until 8 a.m., so I was here voluntarily early.

Dr. Callendar had already turned back to his
chart. I took meager comfort in his stereotypically atrocious
handwriting. While I watched, he grabbed a giant rubber stamp,
pressed it in a blue inkpad, and stamped his chart with headings
for a complete history and physical, from "ID" to "Extremities" on
his chart. At least that was legible.

I glanced at my own chart. A twenty-year-old
woman, six years younger than me, who'd complained of burning,
frequent urination. It sounded pretty straightforward. The triage
nurse had even written, "Feels like UTI," or urinary tract
infection. Still, it was cool to knock on the door of room 2 and
introduce myself as Dr. Hope Sze for the first time.

By the time I returned, Dr. Callendar had
disappeared. All that remained of him was his rubber stamp. I found
him in the nursing station, rifling through green slips of paper.
He scowled at me, and shoved them in the pocket of his lab coat,
but not before I saw the patient names and numbers printed on the
slips. He was doing his billing for the night shift.

I pretended not to notice. "Dr. Callendar,
did you want to review the UTI before I send her home?"

"Of course!" he snapped. "All your patients
have to be reviewed. You're a resident!"

Thanks for sharing. And then he went on to
share some more. Did I ask about risk factors? Was she sexually
active? Had she had UTI's in the past? How recently? Did she wipe
from back to front or front to back?

I had asked some of these questions, but not
others, so I felt stupid but also annoyed; I doubted he was this
thorough when he was the one on the line. If pressed, he'd probably
just say it was a UTI for reasons NYD, not yet diagnosed.

At last he waved me away. "Go back and do it
right. You can follow up with Dr. Dupuis afterward. He's the one
coming on at eight."

Good news: Dr. Hardass was leaving. Bad
news: maybe Dr. Dupuis was Dr. Hardass II.

Granted, I was here to
learn as well as serve, but some doctors really like to put you in
your place at the beginning. I didn't look forward to
playing
Who's the Boss
for the next two years. Good doctors, secure doctors, don't
need to belittle you.

Sometimes I feel sorry for the patients at a
tertiary teaching hospital. You may have to battle your way through
multiple layers: med student, junior resident, senior resident,
staff. But it's all learning, and as a community hospital, St.
Joe's had a thinner hierarchy than most. I headed back to the
twenty-year-old to play another twenty questions.

When I came back, Dr. Callendar was doing
"sign out" with a thin, blond, stork-like man in glasses and
greens. They strode around the room, talking about patients'
results and what needed to be done.

When I got within a five foot radius of
them, Dr. Callendar flicked his fingers at me like he had water on
them. "Go see more patients."

The blond doctor laughed and shook his head.
"Wait a minute. You're a new resident?"

I nodded and held out my hand. "Hope Sze.
R1."

He shook it. "Dave Dupuis. Welcome
aboard."

"Thanks." At Western, once you were a
resident, and therefore, a fellow M.D., a lot of the staff
physicians let you call them by their first names. It sounds like a
small thing, but after four years of undergrad and four years of
medical school, I was ready for a tap on the shoulder.

Dr. Dupuis smiled down at me as if he were
reading my mind. "Are you interested in working the ambulatory side
or the acute side?"

Runny noses vs. potential heart attacks. No
contest. "Acute."

Of course, Dr. Evil had to step in. "Dave,
she's already started on the ambulatory side. She's ready to review
a UTI." Dr. Callendar gestured at the chart in my hand.

I opened my mouth to object, but Dr. Dupuis
was already on it. "Good. If you know that case, you can review it.
But if a resident wants to work the acute side, she should." He
turned to me and added, "Are you interested in emerg?"

"Yeah. I'm thinking of doing the third
year."

"Good woman," he said.

We grinned at each other. Dave Dupuis was on
my side. There was a hierarchy here, and Dupuis trumped Callendar.
Good to know.

Some people, you just know you're on the
same page. Like me and—Alex, I remembered, and my smile dimmed. But
for only a second. If he didn't call back and beg my forgiveness,
it was his loss. I had a job to do.

After sign-over, Dr. Callendar glared at me
like I needed deodorant and a brain transplant. "So what do you
think. Yeah, yeah, yeah. What do you want to give her? Okay." He
scribbled his signature after my note, tore out the green slip, and
stood up to go.

A mere 45 minutes after I first saw her, I
handed my patient her prescription. It was the first time I'd
written a script without getting it co-signed, and it felt good for
about 60 seconds. Then Dr. Dupuis handed me a chart for a
seventy-five-year-old woman with abdominal pain. "Have fun."

I drew the dirty pink curtain around bed
number 11 before I began the interview. The patient's son helped
swish it around his side of the stretcher. My patient turned out to
be a tiny, white-haired, half-deaf woman who only spoke Spanish.
Her family spoke a little French, but not much. I found myself
yelling and playacting a lot. "Do you feel nauseous? Are you
vomiting?" Grab stomach, pretend to retch. "Do you have pain in
your chest?" Hands to heart, with tormented eyes raised to the
acoustic tile ceiling, like I was Saint Hope at the stake. "Do you
have diarrhea?" That one was hard. I made shooing motions around my
rear end. Even the patient laughed.

During the physical exam,
my hands traversed all over her abdomen, while I asked if it hurt.
"
Dolor? Dolor
?"

The family enjoyed this
demonstration of fifty percent of my Spanish vocabulary (the other
word I knew was
si
, or yes) and praised my excellent command of the language.
"
Très bien
!" The
patient beamed at me. She didn't look too pained. I was in the
middle of asking her to turn over for a rectal exam when I heard a
flat woman's voice from the speakers overhead, "CODE. BLUE.
OPERATING ROOM."

I froze.

"
CODE. BLEU. BLOC OPÉRATOIRE
."

The pink curtain ripped open, revealing Dr.
Dupuis' flushed face. "Come on!" he yelled.

We flew around the nursing station and past
the X-ray light boxes. He slammed the side door open with the heel
of his hand. We dashed down the narrow back hallway.

He punched open another teal door. As we
sprinted up two flights of stairs, one of my black leather clogs
almost went airborne. I jammed my foot back into it. Dr. Dupuis
ended up a half-flight ahead of me, but I caught up to him on the
landing.

We dashed left, and then another left past
the elevators, and then we were at the T junction of a hallway and
Dr. Dupuis was yelling, "Where is it?" at a guy in a white uniform
and a blue bonnet-cap.

The guy pointed back over Dr. Dupuis's
shoulder. "Men's change room!"

Dr. Dupuis doubled-back a few steps and
shoved open the door to a small, jaundice-yellow room.

Should I follow him in a men's room?

The door nearly swung shut again. I thrust
it open.

Beige lockers lined the four yellow walls
and made a row down the middle of the room. A wooden bench
stretched lengthwise in each half-room.

In the far half, wedged between the bench
and the lockers, I spotted a pair of men's leather shoes. The feet
sprawled away from each other. The scuffed gray soles of the shoes
pointing toward me.

Dr. Dupuis crouched at the man's head, blocking my view of
the top, but someone had yanked the man's charcoal T-shirt up to
his armpits, exposing his white belly and chest, above his brown
leather belt and khaki pants.

A black woman in a white coat pressed her
fingers against the side of the man's throat. "There's no
pulse."

"I'll start CPR!" I yelled, running toward
them. I'd only ever seen one code blue, on a sick patient in the
emergency room who didn't make it. I'd never heard of a code in a
men's room. We didn't even have gloves. Mouth-to-mouth wasn't my
first choice.

I knelt on the cold tile floor, my arms
extended, hands laced, and braced to do CPR. Then I finally saw the
man's face.

His features were mottled purple, his filmy
eyes fixed half-open, his jaw hanging open under his moustache.

The man was dead. Long dead. Cause NYD.

Dr. Dupuis lifted his stethoscope from the
man's hairy brown chest, his face grim. "I'm calling it. Eight
twenty-four."

He was calling the time of death. I had only
seen that once, after the code. After we had tried intubation, CPR,
drugs, and even a pericardiocentesis to try and remove any blood
from around the heart. It was too late to try, for this man.

Dr. Dupuis pressed his fingers against the
man's cheekbone. I flinched, but the purple color overriding the
face didn't blanch. "Livor mortis," he said.

I took a deep breath. I remembered that from
my forensic pathology course. After someone dies, gravity makes the
blood pool and discolors any skin that's not under pressure. I'd
just never seen it up close and personal. Now, avoiding the man's
staring eyes, I could see that his anterior flanks were also
blotched purple. He had died on his stomach.