Doing Harm (8 page)

At the end of the lecture, Dr. Collier thanks the presenter and reminds the residents and medical students that, for those of us who recently volunteered to be participants in a University Medical School research study of a new experimental drug, the first round of dosages are going to be administered immediately after the meeting in the hallway outside the conference room.

I duly recall that I volunteered to be one of the human guinea pigs for this study, so after Dr. Collier formally dismisses us, I shuffle with the rest of the exiting crowd through the doorway and out into the hallway, where I line up behind some of the other residents in front of a folding table on which are placed a series of hypodermic needles, each labeled with a series of apparently random numbers and letters. Two guys wearing white coats and ties—one younger, the other older—stand behind the table.

Younger Guy looks bleary-eyed and tired. Older Guy, clearly a senior professor, is beaming rather greedily at us in a creepy kind of way.

A chair sits to one side of the table. As each subject sits down in the chair and rolls up their sleeve, they give their names to Younger Guy, who matches the name to a printed list, selects one of the hypodermic needles, then administers a shot.

Luis and GG fall in line behind me in front of the table.

“Is Mr. Bernard better today?” I ask Luis hopefully.

“No,” he replies. “I’m afraid he’s worse. He threw up this morning, and his urine output dropped again overnight. He really looks like shit, Steve.”

“Creatinine?”

“It’s 4.5.”

“Shit. That’s up from 3.1 yesterday.”

“Yeah.”

I’ve reached the front of the line. I give my name, sit down, and dutifully roll up my sleeve. Younger Guy nods, checks his list, and chooses a syringe labeled
10032.
He vigorously rubs my shoulder with an alcohol swab. It’s cool, and my skin tingles.

“Renal ultrasound?”

“Normal.”

“Drain output—
Ouch!
Son of a
bitch.
What
is
that stuff?”

“We don’t know,” Younger Guy says, withdrawing the needle from my shoulder and applying a Band-Aid.

“What?”

“What my colleague means to say,” Older Guy offers, smiling broadly and rocking back and forth on the balls of his feet, hands clasped behind his back, “is that you may be getting the placebo, or you may be getting the active drug. We don’t know which. You’re part of a double-blind, randomized Phase II study.”

“And the active drug is…”

“A melatonin derivative. It doesn’t have a name yet. Very exciting stuff. Works to modify the body’s response to sleep deprivation and disrupted sleep cycles. We think it helps allow people to function more effectively on less sleep. Sleep-deprived young people like you—overworked residents and senior medical students—are the perfect test subjects.”

“Why not just let us sleep more?”

He beams at me and rocks back and forth on his feet.

“Okay,” I say, rubbing my sore arm as I switch places with Luis. “So why can’t we just take a pill?”

“Bioavailability issues,” Younger Guy replies, selecting a syringe marked
10033.
“We can only administer it IM or IV. For now, it’s IM. We’re working on the oral formulation.”

“And why did I agree to be part of this study again?”

“Probably because we’re paying you a lot of money.”

“Fair enough.” I turn back to my junior resident. “So. Luis. Drain output?”

“Zilch.” Luis doesn’t bat an eye as the researcher jabs the needle into his shoulder and injects the contents of the syringe into his beefy deltoid muscle. “I don’t think he’s leaking urine from the reconstruction.”

“Is he dry?”

“Maybe. It’s tough to tell. Intravascularly, he’s down. But he’s net positive.”

“Shit. Okay, so his acute renal failure is worsening. Why? We’ve ruled out most of the surgical causes. What do you think’s going on? I need some answers.” At this rate, Mr. Bernard’s going to need dialysis soon.

Luis screws up his face as he rises from the chair. “I honestly don’t know. Should we get renal on board?”

“Yeah. Good idea. Get a renal consult first thing this morning.”

Luis jots down a notation on his worksheet.

“For you,
10034,
” Younger Guy says. I watch glumly as GG sits down and receives her shot without protest, placidly staring off into the distance, as still as a statue.

Kidney failure.

Shit,
I think to myself, absently massaging my sore shoulder.

I
hate
kidney failure.

CHAPTER 4

Friday, July 24

I’m changing out of my scrubs in the OR locker room, getting ready to head out after a long day. By now, our team has settled into a well-oiled routine. Luis continues to do a great job. And as for GG … well, GG is a bona fide superstar. Enthusiastic and effusive, her knowledge and skills are years beyond her level. She makes other University Medical School students—some of the best in the country—look like complete slackers.

But she’s more than just a great med student: She’s a machine. Absolutely fanatical. I’ve never seen anyone, med student or doctor, with such an all-consuming passion for medicine. Starting IVs, drawing blood, writing orders, checking lab and radiology results, helping out with operations—she’s seemingly everywhere at once; always in a good mood, always with a serene smile on her face. Every morning, she’s the first one through the hospital door; every night, she’s the last one to pack up and head home. That is, when she even bothers to go home. Most nights, she’ll stay in the hospital to help out the resident on call, catching a few hours of broken sleep in one of the doctor sleeping rooms.

Since her comment to me in the OR, she hasn’t said anything even remotely flirtatious. But, every so often, I catch her looking at me just a beat too long; and once, sitting in the cafeteria opposite her, I could have sworn she deliberately rubbed her leg against mine: up one side, then down the other. It was probably just my imagination; but in my own mind, at least, it’s enough to make me uncomfortable.

Meanwhile, after running a bunch of tests, the kidney specialists announced yesterday (rather pompously, I thought) that Mr. Bernard’s kidney failure was caused by a rare condition called allergic interstitial nephritis—brought on, unfortunately, by the antibiotic he accidentally received during his operation. That one stupid medication, Cefotetan, set in motion the molecular chain of events leading to his present state. The kidney guys told us that it’s only a temporary problem and that his kidneys should recover completely. Eventually. Luckily, he won’t be needing dialysis.

But compounding Mr. Bernard’s problems, and my own frustration, is that he’s now also suffering from a condition called ileus. Ileus is what happens when the intestinal muscles shut down, like gears freezing up in a machine. Soon after his kidneys had started to fail, Mr. Bernard’s abdomen became swollen and tense, simultaneously expanding like a balloon and tightening like a drum in grotesque disproportion to the rest of his body, like he had swallowed a basketball. Then he started puking his guts out.

There’s very little we can actually
do
to make ileus better. It’s frustrating as hell. The treatment for it is practically medieval. First, we keep the patient from eating or drinking, a treatment euphemistically referred to as
bowel rest.
Then we snake a plastic tube through the patient’s nose, down the esophagus, and into the stomach. Which pretty much sucks—for both the patient and the nurse or doctor putting down the tube. Then we wait for the intestines to start working again.

So now, with a plastic tube stuck down his nose, and a thick IV line plugged into his chest to pump liquid nutrition directly into his veins, Mr. Bernard sits in bed, patiently waiting for his kidneys and intestines to start working again. Meanwhile, as the days have dragged on, Dr. Andrews has been getting increasingly pissed off, looking for someone to blame. I’m at the top of the list. So, my job prospects on the line, I’ve been quick to deflect Andrews’s ire every chance I get toward the anesthesiologist who gave Mr. Bernard the antibiotic in the OR. I don’t think it’s working.

I decide to pay Mr. Bernard a quick visit before leaving the hospital for the night.

By design, luck, or both, Mr. Bernard has locked himself into a prime piece of hospital real estate: a highly coveted private room, perched atop one of the newest wings of the hospital, lined with bay windows that command a sweeping view of the downtown and waterfront. I usually find him these days sitting in a chair in front of the windows, gazing at the cityscape shimmering in the thick summer heat, watching the rest of the world continue on without him.

Which is where he is tonight. He manages a smile as I walk through the door, as he always does, but it seems a bit frayed. In fact, he looks rotten. He beckons to an empty chair next to his and asks me what I’m doing still in the hospital.

“Working,” I respond tiredly, settling reluctantly in the chair. I don’t want to stay too long.

“Things going okay, Steve?” Despite the way he must be feeling, his expression and tone express a genuine concern.

I like Mr. Bernard. I like him a lot. But I don’t like it when patients call me by my first name. It’s weird. It places us on a level of familiarity that just doesn’t seem quite right, especially after I’ve had my hands inside their abdomens, pulling on their intestines. I don’t correct Mr. Bernard, of course. That would just be rude.

“Just a little busy.”

“Why aren’t you going home? It’s Friday. I’ve seen you here every night late for the past week. Why don’t you go home? What about your rug rats?”

“Well, I’ve got a lot of responsibilities.”

“Oh.” His eyes narrow fractionally. “I get it. A lot of responsibilities. I guess I wouldn’t understand something like that.”

“That’s not what I meant, Mr. Bernard.”

“Yeah, I know. And I’ve told you a hundred times, Steve, call me Stu. Mr. Bernard’s my father. I swear, you doctor types are way too freakin’ uptight.”

He shakes his head and adjusts himself in the chair with a grunt and a wince, then folds his hands neatly on his lap. They’re craftsmen’s hands, worn and callused, but also graceful and dexterous-looking. Whenever we talk, whether he’s sitting in the chair or lying in bed, he usually has them folded self-consciously in his lap, like he’s guarding his livelihood. I guess the way he makes his living isn’t too different from the way I make mine, after all: with his hands.

“Don’t have a family myself,” he says. “Marriage and kids and all that. It’s not my style. Got a lady friend who lives with me. Been together a long time, my lady friend and me. She took some time off to be here for the surgery. Do you remember her?”

I do—a thick, sturdy woman with a bronze face as weathered as the paint on an old New England shore house and wispy blond hair beaten senseless by God-knows-how-many years of sun and salt. I remember talking to her in the waiting room after his surgery. She smelled like fresh sawdust. I smile and nod.

“She had to go back home for work. It’s tourist season, you know, and she’s been pretty busy at her bar.” His thick Yankee accent transforms “bar” into “bahhh.” “She calls me every day, though. I think she’s, ya know, getting a little lonely for some lovin’.” He winks at me, then smirks. His eyes dart down to his groin, and for a moment I think he’s going to grab himself to emphasize the point he’s making, but he doesn’t. I grin back. “Good thing it’s still attached, after what you did to me. Funny how I don’t remember anything from the operating room. You sure you people really saw what I wrote on my dick?”

“Absolutely.” We’ve been over this several times already. As I had guessed would happen, he’s completely forgotten our conversation from right before his operation, when I spotted the DO NOT REMOVE written on his penis. “It’s those drugs we gave you. They made you forget.”

“I wish I remembered the looks on your faces,” he says wistfully. He turns toward the window, his craggy face as inscrutable as a granite wall.

“I know how it is, though, Steve,” he rumbles. “I used to be busy all the time, like you. Too busy to sweat the little things. My lady friend and me, we talked a lot about traveling. Going to Florida. We’ve never been to Florida. I’d like to see alligators. You know, go to one of them alligator farms? Where them crazy guys actually wrestle those big bastards? We got plenty of money saved up. Never really had the time to get down there. Figured there’d always be time. But you know what happened then?” He faces me again, a rueful smile playing about his lips.

“What?”

“Then one day somebody told me I had cancer.” He pauses. “Someday, Steve, somebody might tell you that you have cancer.”

He turns away. We peer at the city in silence. The only sound is the mechanical whir of the IV machine, like the gears of an old-fashioned grandfather clock, spinning fitfully as it pumps life-sustaining fluids into Mr. Bernard’s veins.

After a while he asks, “Do you believe in God, Steve?” God comes out as “Gahd.”

The question catches me completely off guard. I’ve never had a patient ask me that before. “Ummm … well, honestly, I don’t think about it that much…”

“Do you go to church? Or temple, or something like that?”

“Uhhh, on Christmas, I guess. Sometimes.” My cheeks burn a little, and I’m thankful he’s still looking out the window.

“Do you ever think about death, Steve? I mean, your death?” He dismisses me with a wave of his hand before I can reply. “Nahh, of course you don’t. Young as you are. You’re surrounded by dying people every day, and I bet you don’t give it a second thought.” He tilts his head incrementally to one side. “Not that I blame you. I didn’t used to, either.”

“Huh.” After thirteen years of college, med school, and advanced medical training, I can’t think of anything more intelligent to say.

He’s quiet again for a long time. Then, just as I think the conversation has ended, he says, “I’m not afraid, you know.”

I slide back into my chair, from which I had started to rise. “Excuse me?”