Doing Harm (14 page)

I take a deep breath and start in on the paperwork.

It takes me a few hours to finish. I stop only once, to watch as Pathology Man wheels Mr. Bernard’s body, draped in a white sheet stenciled with University Hospital’s logo, past the nurses’ station and toward the service elevators at the end of the hall.

A patient walking the hall for exercise, a gaunt, older woman wrapped in a frayed pink bathrobe, listlessly pushing her IV pole in front of her, stops in her tracks and stares as Mr. Bernard’s body rolls by her on the gurney. She watches until the elevator doors close, snapping shut like a curtain falling at the end of a particularly grim play. She shakes her head, then resumes her walk with much more vigor and determination, leaning hard into her IV pole with renewed purpose.

By the time I’m done with the paperwork, it’s very late, way too late to make it worth my while to go home. I call Sally to let her know that I won’t be home tonight (but don’t tell her what happened), then trudge wearily to a far-flung corner of the hospital, where the surgery-resident rooms are located, on the third floor of one of the hospital’s oldest sections: a hundred-year-old forgotten bit of squat stone masonry poking sturdily and defiantly between the sleek, modern towers clawing skyward around it.

I enter the electronic combination of the gleaming modern door lock (apparently the only twenty-first-century update University Hospital has allowed for in this section of the building), which has been seared into my brain by countless prior nights spent in the hospital, open the door, and squeeze into the call room. I use the term “room” loosely, since it’s essentially a large walk-in closet crammed with a narrow, metal-framed bunk bed, an old sink, and a telephone perched on a rickety nightstand next to the bed.

Like an old photograph that’s slowly fading away, the call room seems drained of color and blurry at the edges. A tired fluorescent lamp hangs from the ceiling. The bulb sputters and gasps every few seconds, struggling to cast a semisteady, if anemic, stream of light. An ancient ventilation grate set in the wall above the bed blows a thin stream of cool air into the room. The rest of the walls, pockmarked in several places where the plaster has come loose from the underlying concrete, are otherwise completely bare except for a single mounted poster: a black-and-white picture of a kitten clinging to a clothesline with a caption reading “Hang in there, baby!” It’s as much a part of the room as the bed and sink and window: Rows of screws pin it to the wall; its surface is faded and dusty; and someone long ago poked holes in the pupils of the kitten’s eyes, which somehow makes it look more lifelike.

While I can only guess at the hanger’s original intent, I know that the only thing that’s been keeping that stupid kitten attached to that wall, at least since I’ve been at University, is a perverse sense of shared irony among the current crop of residents. Personally, I’ve wanted to tear it down for years. The damn thing gives me the creeps. I feel like the kitten’s eyes never leave me for as long as I’m in the room. Besides, I can’t stand cats.

A single open window covered by metallic bars, each one as thick around as my forearm, faces out onto one of the dingy side streets that ring the outer wall of the hospital. Outside, under the sickly orange glow of a streetlamp, I hear a drunk screaming in colorful yet surprisingly accurate anatomic detail about some of the things he’d like to do with the Queen of England and her various body cavities. With a grunt, I yank the heavy window closed, and the street drunk’s ranting abruptly ceases. In contrast to the newer wings of University Hospital—with their paper-thin walls that transmit even the quietest conversations from one room to the next with perfect clarity—the thick, century-old cement of this part of the hospital is remarkably soundproof. The room is like a bunker.

Through the half-open door behind me, I hear a noise in the hallway. It sounds like a woman giggling. I peek out through the crack between the door edge and the frame. Standing outside one of the other call rooms on the side of the hallway opposite mine is Dan McIntosh, the general-surgery chief resident Sally mentioned to me while we were drinking wine in the kitchen. He’s married to—what was her name? Natalie? No. Nancy. Sally’s new lawyer friend who invited us to a barbecue and thinks that potlucks are gauche.

Anyway, Sally’s friend Nancy is married to Dan; and Dan is now standing across from my room in the hallway with a cute, dewy, fresh-out-of-nursing-school brunette nurse I’ve seen around the hospital.

They don’t see me. Which isn’t too surprising, really, considering that Dan is keying a combination into the electronic lock in the panel located next to the door handle with his left hand while deftly slipping his right down the front of the brunette nurse’s scrub pants. She closes her eyes and moans, arching her back and wrapping her left leg around his waist. The electronic combination clears with a mechanical click. Dan pushes the door open with his elbow, and the two of them tumble into the darkness beyond without closing the door behind them. I hear the rustling of fabric, a gasp, and then dewy brunette nurse begins to enthusiastically and rhythmically affirm Dan’s prowess. I can’t tell if she’s saying “Dan” or “yes”; either way, the sentiment is pretty clear. But then the door slams shut, and silence suddenly envelops the hallway.

I shut my own door softly, turn off the light, and crawl into bed, the ancient metal springs groaning in protest. Light from the streetlamp outside plays across the room, and in the semidarkness I can see the kitten on the wall, watching me.

God, I hate that cat.

I think of GG, sleeping a few hundred feet away in one of the medical-student call rooms. My right hand steals to the ring finger of my left, and I self-consciously twist my wedding band, reminding myself of how much I love my wife.

When sleep finally overtakes me, it’s not a good sleep.

CHAPTER 6

Tuesday, July 28

I wake up a few hours later, feeling like someone has viciously bashed my head in with a baseball bat. The phrase “waking up” applies only in a marginal kind of way since, despite how exhausted I am, I can’t tell if I really slept at all. Guilt, anxiety, fear, and self-pity have taken turns poking at my brain all night long with a sharp stick.

With a groan, I fall out of bed, splash water over my face, and brush my teeth using a course toothbrush and cheap toothpaste from one of the toiletry kits the hospital provides for patients. It feels like running a Brillo pad through my mouth.

It’s very early, much earlier than I usually arrive in the hospital. Without really thinking about it, I decide to skip my normal cafeteria routine and instead take the elevators upstairs, where I know Luis and GG will be meeting to round on our patients.

I find them at one of the nursing stations, gathering patient data and getting ready to start rounds. Luis doesn’t mention anything about yesterday. Neither does GG. Both of them avoid direct eye contact with me. We exchange awkward greetings.

At first I’m in charge, but that arrangement quickly falls apart as I fumble my way through the first few patients, calling them by the wrong names, giving them incorrect diagnoses, and hesitating over even the most basic medical decisions. My brain is like cotton, insubstantial and weightless.

Luis and GG, sensing my complete worthlessness, diplomatically brush me aside. I let them, allowing myself to fade into the background and become just an observer. Luis and GG run the rest of rounds like they normally would in my absence, ignoring me completely as the three of us walk from one room to the next. I watch as they examine the patients and make plans for the day. They don’t bother to ask me my opinions or what I think they should do. I’m merely a spectator.

At one point, we pass Mr. Bernard’s room. I stop and linger briefly outside the open door as the rest of the group continues on to see the next patient. The remnants of last night’s chaos are completely gone. The newly waxed floor sparkles. The furniture is neatly arranged. The bed is sitting in its usual spot by the window, and another patient—a young woman—is already in it, sleeping peacefully between crisp-looking sheets. Fresh bags of normal saline and other fluids hang on the IV pole next to her bed.

It’s as if Mr. Bernard never existed.

After speeding through several more patients, Luis pauses to check the typed list he carries in his hand.

“Okay,” he says with satisfaction, making a notation on the paper with his pen. “That’s everyone.” He hesitates, looks at me uncertainly, and adds, “Except for Mrs. Samuelson.”

“Let’s go,” I say quietly.

We walk to the SICU and gather around Mrs. Samuelson’s bed. Luis and GG examine the various plastic tubes and wires that connect Mrs. Samuelson to the array of life-support machines that cram her cubicle, while I log on to the computer next to the bed.

Things are looking pretty grim. I dig my front teeth into my lower lip and feel my stomach churn as I study her anemic life signs and read the electronic notes of the doctors and nurses who took care of her overnight. Their clinical observations are peppered with ominous-sounding phrases like “maximum pressor support initiated, concerned by worsening coagulopathy” and “end-of-life issues discussed with patient’s family.”

Mrs. Samuelson now clings to life by the most tenuous of threads, events having gone from bad to worse. Shortly after I dropped her off in the SICU, it became apparent that she had suffered a massive heart attack during the operation. What’s left of her weakened, stunned heart struggles feebly to pump blood to the rest of her body. Her blood pressure is dangerously low and requires massive doses of medications to maintain it at a life-sustaining level. She also has a bleeding disorder, called disseminated intravascular coagulation (DIC for short), which is causing her to bleed internally. She’s been getting blood transfusions all night, and still her blood counts keep falling.

Gnawing furiously on my lip, I step away from the computer, move to the side of the bed, and look down at Mrs. Samuelson. Her hair braid juts out from underneath a dense tangle of wires connecting her body to the various life-support machines that jam the cubicle. Her hair looks surprisingly fresh and neat—perhaps attended to by one of her daughters last night. It stands in stark organic contrast to all the harsh hardware she’s hooked up to and surrounded by; indeed, it’s the most human thing about the room.

I grip the metal handrail that lines the perimeter of the bed with both hands and squeeze. Hard.

There’s absolutely nothing I can do for her now except hope that she gets better. I feel helpless, just as helpless as I was yesterday in the OR and last night when I watched Mr. Bernard die.

I hate it so much, this helplessness.

God, how I hate it.

I stare at the braid and squeeze the handrail. Luis walks up behind me and places his hand lightly on my shoulder.

“Steve. Anything else, man? I’ve got to get going. I’ve got things to do before I scrub on my cases this morning.”

I look down stupidly at my hands, which remain wrapped around the handrail of Mrs. Samuelson’s bed. Both sets of knuckles are bone white. I let go. The blood rushing back to my fingers makes them tingle. I open and close my hands a few times and rub them together to make the tingling go away.

“Are you all right, Steve?” Luis is staring at me. So is GG.

“Yeah. Yeah. I’m okay.” I blink and rub my eyes, which burn as if someone has propped open the lids, dumped hot sand into them, then stirred the sand around with their thumbs. “Late night. I didn’t get much sleep. I’m just a little wiped. No big deal.”

“Sure,” Luis says neutrally. “Anything else?”

“No. There’s really nothing for us to do here except let the SICU guys do their jobs and wait for her to get better.”

“Right.” He runs his hand over the top of his shaved head. “Look, Steve—the OR schedule is pretty light this morning.” He coughs. “They’re all small cases. GG and I can cover them. Why don’t you just take it easy?” He rubs the top of his head again and tugs on his ear. His expression remains as aloof and unreadable as ever.

I’m grateful for the gesture and the opportunity for the much-needed rest it will provide.

“Yeah,” I reply. “Okay. Thanks. I mean … yeah, that’s what you guys should do this morning.” I stand up straighter and try to act a little bit more like I’m the one still in charge. “That’s what I want you guys to do this morning. Cover the cases. I’ve got paperwork to catch up on. Call me if you guys have any problems.”

“Sure, Steve.”

I leave the two of them there in the SICU and head down to the cafeteria, where I grab a doughnut and some coffee. I then walk to the small office I share with the other two chief residents. Luckily, I have the office to myself. One of my colleagues is on a medical mission to Africa for the rest of the summer, and the other is assigned to our sister hospital across town. I drop heavily into the chair at my plain wooden desk to finish some paperwork on the computer.

I once read that some species of shark must constantly keep swimming forward or they die. The forward motion allows them to move water over their gills, which allows them to extract oxygen from the water to survive. If they stop swimming forward, they can’t extract oxygen from the water, and they drown.

So it is with being a sleep-deprived resident: As long as you keep moving forward, the sleep deprivation won’t catch up with you, and you survive. I’ve stopped moving forward. The paperwork piled high on my desk and stretched across my computer screen is dense and boring. Anxiety over Mrs. Samuelson or not, yesterday’s events are finally starting to catch up with me.

I put my head down on the firm, battered wood of the desk and am asleep within seconds.

*   *   *

A few hours later, the fallout from yesterday starts raining down.

It’s my pager that wakes me up. The shrill scream is like an ambulance siren in the small office. I jerk my head up off the desk and out of a pool of saliva that’s accumulated underneath my cheek. The part of my cheek not submerged in spit throbs with pain from where a spiral notebook was sandwiched between it and the hard surface of the desk. I wipe off my cheek with my palm, and a stabbing pain shoots through the back of my neck as all of the muscles there conspire in unison to involuntarily contract.