Chopin A man says hello to me.
[Remember, I’m single.]
I say hello back.
The man asks me about my life, my hobbies, my interests. We talk. We get to know each other. He says I’m beautiful. He seems genuine and sincere.
We find that we have in common a love for Chopin’s piano music and that we both want to write fiction for a living someday.
[I’m not lying when I say this; I really do want to be a physician-writer.]
Then he asks me what I do for a living, you know, to pay the bills.
Then I tell him.
I don’t hear from him again. I figure, he must be busy. I give it a week.
I call him again, at which point, he says he is no longer interested.
He is a different man.
He says it’s my career that changed his mind about me.
It’s just not going to work, he says with a firm, cold lip. We have not spoken again since.
Senior resident
“Umm, the nurse just called me about Mrs. --- you know the longtime type I diabetic who’s in DKA again? Well, the nurse tried three times to get IV access, and now they say they’re not trying anymore, and well, she has a K of 2.9, she’s still getting fluids and insulin, and umm, I think she needs a central line…?”
The nightfloat intern, a prelim heading for PMNR in Chicago next year, looked at me with kindness and a little pity and smiled. She knew I had to be the one to do the line. She was not qualified yet to do it and I wanted to teach her how to do it, but the hospital was too busy to have its only two nightfloat residents doing a procedure in one patient’s room.
It was 4AM. I just admitted my fourth step-down level patient from the ER onto the medical floor because the hospital has no step-down unit, and I was exhausted. I had not slept in 2 months. My last month was q3 hour call in the medical ICU. The nightfloat intern was covering all the admitted medical patients on the floor; her pager went off at least every 10 minutes.
“Hello, Mr. ---? So sorry to wake you, but your wife, it seems, needs IV access for her fluids and potassium, yes, you understand, I know, but the nurses have tried her arms, and now I will need to try the veins in her neck… yes, it can be risky… no, I am the senior resident on call in the hospital tonight, and I have done these several times before… yes, it is a risk, but so is not treating her diabetes right now… OK… OK. Yes, someone will call you after the procedure is done. Yes, I will have someone call you.”
My pager went off. Another admission. I ask the intern if she wouldn’t mind pulling a central line kit from the unit and size 6 and a 1/2 gloves. Thank you so much, I say, also admitting to her that I don’t feel comfortable doing this right now, since I am so tired, and the hour is so early, but the patient needs it. I just don’t feel good about this.
“I can hold your pagers for you, while you do the procedure,” the intern offers. She hands me the central line kit and takes my two pagers which have so far been silent since the ER called.
As I’m walking down the dark corridor—they use generator electricity overnight to conserve energy-- I try to recall in my head the last 25 times I have done this procedure alone. Not all of those times were smooth and successful. I needed another resident or fellow to help me out at least half of those times. But now, I was it. There was no one above me anymore who was in-house. I was not going to wake the on-call attending. Most of them call the senior residents anyway for procedures in the daytime. I was it.
I call the ER to tell them I won’t be able to write orders for the new patient in at least an hour. The patient there is stable and will be in ER holding until the later morning. My head is cloudy, my neck and shoulders ache, and my legs feel like rubber from lack of sleep and general lack of daily exercise due to my current work schedule. I could kick myself for not being more in shape and wanting to be more awake and strong and less agitated, less grouchy. I see myself becoming this way, which naturally, any human being would become if placed in medical residency, but for some reason, I push myself to be superhuman, if only for the next hour.
I prep and drape the DKA patient, who is lethargic. I’m relieved to see her right-sided neck anatomy is just like in the textbooks. I keep my left fingers on the carotid pulse, and head for the right internal jugular vein with a very long needle. A pattern I’ve noticed from my non-successful attempts at right IJ’s is that I go too lateral to the carotid and miss the jugular completely. This time, I’m barely 2 centimeters in when a flash of dark red blood fills the syringe.
Oh, thank god. I’m in. The blood is not pulsating which means I’m not in the carotid artery. I place a triple lumen catheter, get excellent return from all three ports, suture in the line, order follow-up stat portable chest x-ray [which showed no pneumothorax and the tip of the catheter in the SVC] and politely ask the nurse to call the patient’s husband… and I’m off to the next admission. I’m much more awake.
