The Real Doctor Will See You Shortly (26 page)

“Really?”

“Yep. Found it on the Internet. Read some testimonials that it cures hep C, so he thought he'd give it a whirl.”

I shook my head. “That's kinda weird.” Earlier in the year, I had learned a bit about inhaled nitric oxide therapy after a patient in my clinic with sickle cell disease asked about it. It turned out there was a black market for the stuff and people were trying it for all sorts of diseases. But it wasn't a treatment for hep C.

Dr. Brickow covered his mouthpiece and gave an order to someone in the ER. Something about a CAT scan.

“So,” I said, “I assume his wife knows he's—”

“That's the other thing…says he hasn't told his wife anything. And the second kid just arrived a month ago.”

“Oh.”

“Yeah, and I gotta warn you, he's going south quickly. Blood pressure is tanking. Probably need to tube him. I don't know if it's the nitric oxide or what.”

“All right,” I said, “send him on up. I'm ready.” It was the only acceptable response, but I was fighting nerves. This scenario was a blank area on my canvas.

A few minutes later, the ICU doors burst open and a team of emergency room physicians and nurses wheeled Dan Masterson into the last open bed in the unit. Unlike Columbia's ICU, there was no unlucky corner pocket at the Allen. Frantic energy filled the room. “Lost the pulse,” someone shouted as I scrambled over. “Start chest compressions,” said another. My new admission, my first new patient, had flatlined en route to the ICU.

I quickly scooted up to the head of the stretcher and crashed into Dan Masterson's sternum with the heels of my hands. Before I'd even seen his face, before I'd noted what color hair or eyes he had, I had cracked one of his ribs. Probably two. I pumped up and down on his broken chest as another physician barked out orders, and in the midst of the madness—as a breathing tube was quickly snaked down his trachea and a nurse pumped adrenaline into his lifeless body—I stole a quick glance at my new patient. Dan Masterson looked nothing like what I had imagined. The man was large—well over six feet tall—and he had a barrel chest and thick, muscular arms. He had short blond hair, stormy green eyes, and tattoos all over his chest and abdomen. He looked like a youngish, healthy guy, not someone we should be trying to pull back from the brink of death.

A tall, slender ER physician stood at the foot of the stretcher, calmly leading the resuscitation as I furiously mashed on Masterson's chest. “I need calcium, insulin, and bicarb,” the doctor said to the nurse next to him. Addressing the rest of us, he said, “The patient has been asystolic for three minutes. Please continue CPR.”

Sweat accumulated on my forehead as I smashed my hands into Dan Masterson's sunken, lopsided chest. A few drops trickled off the tip of my nose and hit him in the neck. Soon the drops were landing on his face. After five minutes of compressions, my scrub top was drenched. As the minutes ticked by, I found myself smashing harder and harder on the lifeless body, searching in vain for a flicker of life in his eyes. But there was nothing. Just an expressionless face that was gradually becoming drained of color.

At some point during all of this, my supervisor appeared. He was a boyish forty-something named Dr. Jang, who had been tending to patients on a different floor. He was pudgy—one of the few doctors I met who could be described as overweight—and we exchanged a brief grunt of an introduction as I continued to pump away on Masterson's chest.

Every few minutes, just when I thought my arms were going to give out, Jang would nudge me aside and take over compressions. During those moments, as I stood behind him trying to catch my breath, I wondered what role nitric oxide had played in all of this. What was happening inside Masterson's body? And how long were we going to attempt to revive him? I'd never seen a team go beyond thirty minutes. But this guy was young and had a wife and two kids at home. How could we ever stop CPR? As I stood hunched over, with hands on my knees, I thought,
Don't let him die. Don't let this fucking guy die
.

Over the course of the year, I'd developed a belief that if I had touched a patient—if our flesh had made even slight contact—that person was my professional responsibility. This admittedly unusual view of the doctor-patient relationship had started sometime after my interaction with the drug mule, when I reflected on how absent I'd been during my exchange with her. That was me at my worst, a doctor just going through the motions, unmoved by the plight of a frightened young woman. That was not the physician I wanted to be. It wasn't the
person
I wanted to be. Once my palms had slammed into Dan Masterson's chest, I considered him mine. My patient. My responsibility. My problem.

Standing upright and straightening myself out, I again heard the voice of the ER doctor at the foot of the stretcher. “We have been performing CPR for twenty-two minutes. During that time the patient has remained pulseless. He has received three rounds of epinephrine and…”

I felt a tap on the shoulder and was instructed to resume chest compressions. More sweat fell as an IV was inserted into Masterson's groin
and dozens of medications were administered. At one point, perhaps twenty-five minutes into the resuscitation, there was a brief blip on the cardiac monitor, possibly representing ventricular fibrillation. It was a good sign, potentially a sign of life, and we were all instructed to stand back as Dan Masterson was shocked with 120 joules of electricity. But it did nothing. There was no pulse and the monitor showed a flat line.

The flicker of hope had given us reason to press on, but as the minutes ticked by, one intervention after another failed. I found myself inadvertently holding my breath as each new medication was given. As I prepared to step back in and resume compressions, Dr. Jang cleared his throat and asked, “Does anyone object to calling it?”

I froze. We had performed CPR for nearly twice as long as I'd ever seen it done, but still, I didn't expect to stop. Dan Masterson was my patient, my first solo patient. On tomorrow morning's rounds, I was responsible for presenting every patient who'd been wheeled in to the ICU on my shift, and now I'd have to get up and say that we couldn't save him. I imagined the attending ICU doctors exchanging glances as I fumbled through an explanation of why we had failed. I imagined the whispers:
Does McCarthy know what he's doing?
I didn't want it to end like this. Dan Masterson had too much at stake.

There's always someone in the crowd who wants to keep going. I looked around for that person, but no one spoke. That someone was me.
Let's shock him again,
I wanted to say.
Let's shock him ten more times if we have to.
But I knew that wasn't the answer. You don't shock someone with a flat line on the monitor and no pulse. You need a fibrillating heart to use a defibrillator.

“Are we sure?” I asked. My eyes scanned the room, looking for someone to speak up. I felt for a pulse one last time. Nothing.

“Does anyone object?” Jang asked again. Every head gently shook from left to right, except mine. I knew they were right, but I didn't want to formally acknowledge it. I didn't want to accept that we had failed. “All right,” Jang said, as he put his right hand on Dan Masterson's left foot, “time of death is ten twenty-one
P.M.
”

My head dropped. My first patient was dead mere minutes after I had met him. I couldn't help him. What did this say about me as a doctor? Sure, I wasn't responsible for what had happened before he arrived—and I hadn't been the one running the arrest—but I hadn't been able to step in and revive him. I wanted to believe that repetition improved all of my clinical skills, every single one of them, from diagnosing pneumonia to cardiac resuscitation. But that wasn't the case.

So many parts of medicine are about process, and resuscitations are no exception. We were taught an algorithm for advanced cardiac life support. If no pulse, begin chest compressions. Get the patient on a heart monitor to see what's going on. Is there no heartbeat or a fibrillating heart? The best doctors move seamlessly through the algorithm, and the doctor who had run Dan Masterson's resuscitation had done a bang-up job, staying clear and focused during the longest effort I had been part of all year. And I had, I thought, been a perfect cog in the wheel. The whole resuscitation was a feat of well-orchestrated doctoring. The only problem was that the patient had died anyway.

It was an object lesson in the appalling limitations of medicine. I followed the proper technique—compress at least two inches, allow for full chest recoil—and the patient either lived or died. There is no art to it, no nuanced way to inject life into a lifeless body. Just mash on the chest and hope it works out. Looking at Dan Masterson's body, I made a fist with my left hand and smashed it into my right. What was the point in having all of this training and technology if we couldn't make it work?

I had seen so many patients brought back from the edge of death, so many saved when all hope was lost, but not this time. Baio had showed me what it was like to be special, to be a lifesaver, but tonight I was part of the losing team. And it made me wonder if I wasn't all that special without him. Or Don. Or Ashley. Or Moranis. Maybe I needed these more experienced doctors to effectively do my job. My arms and back ached, but my heart ached for Dan Masterson's family more.
Why did this happen?

I stepped away from the body, and Dr. Jang put his arm around my sweaty shoulder. He could tell I was upset. “Did everything we could,” he said.

“I know,” I said, my eyes welling with tears. “Just fucking sucks. You know?” I couldn't quite explain why I was so emotional. What was it about this Dan Masterson? I had seen many patients die—at times it could be an everyday occurrence—and I rarely got choked up. The fiftieth death just doesn't jar you the way the first or second one does. But most of the people I saw die were elderly, or had been sick for a long time. I had participated in several failed resuscitations before this, but they had involved octogenarians who probably shouldn't have had to go through getting their ribs cracked at all. Dan Masterson was a young, good-looking guy who'd just walked in off the street and died. “I know,” I said again. I wiped tears on my sleeve.

We looked back at Masterson's body as a nurse picked up the paper and plastic that had been chaotically strewn about the floor during the arrest, vial after vial of medication that had been administered in vain. There is something strange about acknowledging that life has exited a body. I don't believe in spirits fluttering up to the heavens or anything like that, but it did feel like something palpable had been taken away, extinguished and removed from the room as the pall of death slipped in. Soon, rigor mortis would set in and Dan Masterson's limbs would become stiff, his body cold. I focused for a moment on these biochemical processes to stave off the mental torment of his death and our failure.

“There's some paperwork that needs to be done,” Jang said. He pulled a scut list from his white coat and put on a pair of tortoiseshell glasses. The man had clearly moved on to his next task. Was this me in a few years? I didn't want to know what it took to get there. “Do you know how to formally perform a postmortem exam?” he asked.

“Yeah.”

“You also need to notify next of kin and request an autopsy,” he said. “Have you done that before?”

“Yes.” Death was a common, rarely unexpected part of my job, and a family member was usually nearby so the news could be broken in person. But I realized this next-of-kin conversation was going to be very different. I was about to call someone who didn't even know her husband was in the hospital. “I've never done it over the phone,” I said. “Never called someone I haven't met.” I tried to imagine how this might play out. Every scenario was horrible.

“You just gotta do it.”

“Right.”

“I know it's not helpful,” Jang said more firmly, “but you just gotta do it.”

As I tracked down Masterson's wife's name in the chart, my heart started to race. What would I say to her? These are the tasks—the heinous duties of being a doctor—that were never fully fleshed out in medical school, the awful moments you might never be comfortable with no matter how long you practice. We did occasionally practice delivering bad news—a new cancer diagnosis, or something equivalent—but nothing like this.

In that moment, as I slowly dialed her phone number, I wanted to disappear. I looked up at Jang after the final digit had been dialed. I felt like I was going to vomit. What should I say? What would I want to hear? If I received a call like this, I'd probably drop the phone and lose my fucking mind.

I heard the phone ring and took a deep breath. I still had no idea what I was going to say. Deliver the news fast, like ripping off a Band-Aid? Or slow, to give the woman time to wrap her brain around her new, horrific reality? The phone rang again, and I felt my pulse go even faster. I was now breathing rapidly and irregularly. Jang sat next to me, cracking his chubby knuckles.

After five rings, an answering machine picked up and I hung up the phone. “Do I leave a message?” I asked.

Jang shook his head. “Try again.”

I called back, and a woman immediately answered the phone. “Mrs. Masterson?”

“Speaking.”

“This is, ah, Dr. McCarthy from Columbia…from the Columbia University Medical Center. I'm calling about your husband.”

“Is he there? What happened? Is he okay?” A television could be heard in the background.
You just gotta do it.

“What's wrong with my husband?” she said quickly. “Tell me what's happening.”

Much like I had done for her husband, I started to imagine what this woman might look like—confused, exhausted, frazzled—perhaps as a way of stalling. Was she holding one of her kids? What did her hair look like? “Tell me,” she said again.