Her lifeless blue eyes gazed upwards to the heavens, a view obstructed by the vinyl ceiling tiles of her hospital room. She was still and quiet as, well, death. I stared at her for a few seconds but quickly realized I couldn’t entertain any sort of existential thoughts because they would cause me to turn sharply towards the door to her room, proceed swiftly to the automatic doors of the hospital, hurl myself into my gray Toyota Corolla, and drive 28 hours until the next door I ran through was the one leading to my childhood bedroom.
I knew what had to be done, not that I’d actually done it before. I approached my patient and placed my stethoscope on her immobile chest. I left it there for well over a minute, an eternity. I swore I heard a heartbeat and re-started the 60 second count twice. I stared at her chest for any sign of breathing — dear God, did she just move? I re-started that count three times. Pulses — absent. Corneal reflexes — absent. I looked at the watch I had bought just before my internship. It had very prominent second hand tick marks that I thought would be helpful for checking pulses and counting respirations.
“Time of death: 2010.” I looked over to my right, and, thank God, a nurse had come in at some point while I was performing the death exam. That would have been embarrassing.
“Dr. Green, there are multiple forms for you to fill out. Her family needs to be called. You need to…” I zoned out briefly in horror. I had known this patient for all of 10 minutes. And I had been a doctor for about 11 minutes.
The start of my internship had not been ideal. No intern wants the dreaded news that she will be starting her career on night float. With the changes in hour restriction policies over the past several years came the advent of the night intern, the novice doctor who ran the show, overseen by senior resident physicians, from 7 pm to 7 am. This doctor’s success was contingent on the quality of the “sign-out,” the sacred time when the exhausted day intern sat down with the bright eyed night intern at the start of the night shift to give an overview of his patients and their active issues with the contingency plans if things went wrong overnight. Most sign-outs were fairly straightforward: if the patient’s blood pressure gets too high, give x medication at x dose. Other sign-outs, however, were more complicated, and, frankly, horrifying.
“This patient had a catastrophic stroke yesterday and is imminently dying.”
“This patient has been intermittently seizing all day.”
“This patient with a terrible pneumonia has been heading toward transfer to the intensive care unit all day.”
After picking up my 50 plus patients, the pages started.
“Dr. Green, this patient just had four beats of sinus tach on telemetry while he was watching TV.” Sinus tach (short for “tachycardia”) is a fast heart rate — all of us have elevated heart rates from time to time, which isn’t generally concerning until this rhythm becomes sustained or is associated with other symptoms. Patients on telemetry are attached to a heart monitor, so every abnormality is reported to the physician on call. I wanted to respond: “Ma’am, I have been in sinus tach since I stepped into the hospital this evening.” Instead, I politely thanked the nurse for letting me know.
Some pages, however, were in reference to the aforementioned horrifying sign-outs. My first page of the evening had been: “Dr. Green, this patient has… well, she’s dead. You need to pronounce her.”
Later, it was the patient with a bad pneumonia. I took one look at him and his vital signs and immediately called the ICU. In the meantime, I hovered like this gentleman’s mother would have, checking stat EKGs, cranking up his oxygen until it wouldn’t go any higher, putting in stat orders for chest X-rays and blood work. This was Sick with a capital “S.” He was not responding to questions other than with intermittent groans. He watched my every move. I had the white coat, and I was in charge — a sweaty, 5”3’, 26-year-old with hair flying all over the place after a night on the run. My voice remained calm, but he knew what was happening. He was intubated about an hour later in the intensive care unit in hopes that a breathing tube would help him overcome the stress his body was under. He passed away a few days later.
My pager showed no mercy. I spent part of my evening with a sweet 90-year-old delirious lady who told me that I looked “very clean.” I almost hugged her. Then the seizing patient — I woke up the Neurology fellow for him. And a lovely, elderly patient with a bleed originating somewhere in her GI tract — I woke up the Gastroenterology fellow for her. He was at least only mildly annoyed. And my favorite intern moment: waking up the Hematology/Oncology fellow for a patient with a parameter that was actually within the range of normal. Happy Friday night, my friend. Please immediately forget my name.
But nothing compared to the worst call that night, the first one I made. This call was to my deceased patient’s husband, the man who had spent the greater part of his lifetime with the woman with the lifeless blue eyes.
As he answered the phone, I could hear the dread dripping from his voice into my ear. He knew this was coming. His wife’s death was expected, and the daytime medical team had prepared him well for it. “Sir, I’m sorry to tell you that your wife passed away at 8:10 p.m.”
“OK.” A long pause. “I guess I will start making calls.”
His voice became thicker and thicker as he asked me more questions. He sounded so alone. All I wanted to do was give this man a hug. He couldn’t make it to the hospital because he lived a few hours away. He was 90 years old and didn’t drive anymore.
“What’s your name again?” the patient’s husband asked.
It took me a second to remember my role in his life’s drama. “Dr. Green. I’m the doctor who took care of your wife this evening.”
“OK. Thank you.”
I garbled something about understanding that he couldn’t make it in so late, that it was safer for him to stay home, and said I hoped he had a nice evening or some similar pleasantry that likely wasn’t entirely appropriate for the situation. I knew he wasn’t listening, though. I’m not convinced he had comprehended anything past my opening line. I hung up the phone and squeezed my eyes shut as if to make the whole awful situation go away.
I went back to my deceased patient’s room briefly after the call to her husband. I felt like I needed to. I pretended to be looking for something in her room when assorted hospital staff came in a few seconds later to move her to the morgue. I don’t think I had any well-formed thoughts, other than the fact that this woman would always be important to me. I silently thanked her.
And then my damn pager went off again.
This essay received honorable mention in this magazine’s 2013 Young Alumni Essay contest. To see the winners, visit magazine.nd.edu/news/45034/.