“I am, but I prefer Mitt.”
“Fine and dandy, Mitt,” the woman said agreeably. Like Mitt, she was dressed in scrubs overlaid with a doctor’s white coat. She was holding a tray of food. “Mind if I join you?”
“Of course not,” Mitt responded immediately. By reflex he started to get to his feet.
“Don’t get up!” the woman commanded. She put her tray onto the table and took the seat across from Mitt. “My name is Madison, Madison Baker. I’m a second-year surgical resident along with Nancy Wu, who you met this morning.”
“Yes, we were on a case together.”
“So I heard. I also heard it went on a little longer than planned. I’m afraid you experienced a bit of trial by fire. Dr. Washington, bless his soul, isn’t the easiest person to get along with.”
“He and the scrub nurse weren’t seeing eye to eye.”
“So I also heard. Not unusual. He has a reputation for flying off the handle when things don’t go smoothly and then blaming everybody but himself.”
“That doesn’t surprise me,” Mitt said, trying to be diplomatic.
“Please,” Madison said, pointing at Mitt’s apple pie. “Don’t let me keep you from your dessert.” She then picked up her knife and fork and started to work on a pork chop on her plate. “I wanted to meet you because Dr. Van Dyke told me you were on first call tonight. I’m on call, too, so I’m your backup so to speak. We have a handful of ‘sickies’ sprinkled around the wards and in the ICU, so you might not get a lot of shut-eye. I hope you are prepared.” She took a bite of her meat and started chewing, giving Mitt a chance to respond.
“I have three workups to do,” Mitt said, more as explanation than an excuse.
“Yes, I know. But you should have time to get that done. No problem. During the early evenings, there are a lot of residents around, finishing up for the day. Same with a handful of attendings who do their hospital rounds after their office hours. If nurses have questions or problems, they turn to whomever is available. That will save you from running around doing stupid, insignificant stuff. Remember, the nurses here are an impressive group, which isn’t surprising since there’s been a nursing school at Bellevue for a hundred and fifty years. Anyway, are you interested in a bit of advice from someone who’s just finished her first year?”
“Of course,” Mitt responded. As nervous as he was, he could use all the advice he could get.
“With these admission workups, don’t take the time and energy to do a full medical school workup, like finding out what disease their maternal great-grandmother died of. Do you know what I’m saying? These patients have already been worked up to the nth degree and it will all be in their electronic health record, which you will have access to. Your job is to make sure that something hasn’t come up since they’ve last been seen in clinic that would make their imminent surgery problematic or contraindicated. For example, like they’ve developed a sore throat or a sudden fever, or, God forbid, you feel an enlarged liver that’s not in the EHR. Do you get my drift?”
“I think so,” Mitt responded. What she was saying about medical school workups rang true: All of his had literally taken hours and included very detailed medical histories.
“You can do a good admission workup in twenty minutes, a half hour tops, unless, of course, you find something abnormal and not already documented. If you do, the attending surgeon has to be called immediately and apprised.”
“I think I get it,” Mitt said. Her advice made a lot of sense. He was beginning to feel a modicum better about facing the night. Her confidence was encouraging. She’d obviously learned a lot in her first year of residency. Mitt could hope he’d be in a similar position a year from now.
“I also encourage you to go around and introduce yourself to the various head nurses. The more they know you as a person, the better off you’ll be. You can learn a lot from the nurses. Believe me!”
“I was planning on going around introducing myself,” Mitt said. “My partner, Andrea Intiso, advised the same.”
“Good advice! I see you’ve finished your pie, so don’t let me hold you up. I’m sure we’ll be seeing each other during the course of the evening. I assume you have a key to one of the on-call rooms.”
“I do.”
“Perfect. You might not have a chance to spend too much time in it, but at least it is there. Good luck.”
“Thanks,” Mitt responded. He stood up and lifted his food tray. “And thanks for seeking me out and offering the advice. I appreciate it.”
“You’re welcome. Try to remain calm. You’ll get through this.”
Mitt nodded and smiled, but it was a nervous smile. His intuition was sending warning signals that he was in for a struggle, and from experience he knew his intuition was rarely wrong.
After depositing his soiled tray at the appropriate window, Mitt left the cafeteria and walked to the elevator bank. His plan was to head up to the seventeenth floor, where the surgical inpatient rooms were, meet the head nurses, then do the same on the sixteenth and fifteenth floors before heading down to the tenth, where the surgical intensive care unit was located. In the process he’d find out the location of the three patients whose histories and physicals he needed to do. Well, maybe he would skip the ICU.
When the elevator arrived, Mitt was relatively surprised to find it almost full, not with house staff and nurses but with people of all ages, from crying babies to the elderly. As he squeezed into the cab, it dawned on him that it was the middle of normal visiting hours. Thanks to the crowd, the elevator stopped on almost every floor, but by some strange coincidence, by the time it reached seventeen, he was the only passenger still in the car.
As the doors slid open, Mitt hastened off but immediately froze in his tracks as though he had collided with a brick wall. But what stopped him wasn’t a physical impediment; he was assaulted by the worst and most nauseating smell he’d ever experienced. It was so bad it defied description, and he literally retched. Mitt clasped a hand to his mouth and pinched his nostrils shut to keep from vomiting. It was as if he’d been dropped into an open sewer, pungent and fecal.
Rapidly, his eyes darted around in search of the source of the revolting stench. But he saw nothing amiss. In the distance he could hear the normal sounds of a hospital. And then, as quickly as the smell had assaulted him, it dissipated as if a sudden wind had blown it away. But there was no wind.
Momentarily stunned, Mitt took in a few cleansing breaths as he continued to glance around the immediate area of the elevator lobby, still searching for an explanation. Seeing nothing abnormal, he carefully moved forward, watching where he was placing his feet lest he step in something revolting. Reaching the point of the intersecting hallways, he was able to see in three directions. The building’s footprint was a huge square, with the patient areas divided into the points of a compass, 17 East, 17 North, 17 West, and 17 South. All the patient rooms were on the building’s exterior, with windows, while all the support spaces were on the interior.
In every direction from where Mitt was currently standing, he could see snatches of busy, normal hospital activity with uniformed staff darting in and out of sight. He even spotted several food carts being pushed past his line of vision, announcing that it was the dinner hour in addition to visiting time. But most important, there was no explanation for the fleeting, horrid smell. None whatsoever. But as weird and revolting as it had been, at least it was gone.
For a few minutes Mitt remained where he was, struggling to make sense of what he’d experienced... or thought he’d experienced. Since there was no obvious source for the disgusting smell and the odor had vanished so quickly and completely, he wondered if perhaps his tired, overwrought mind had somehow managed to dream it up. Such thoughts begged the question: Was he having an olfactory hallucination? He had no idea but that was the only explanation his tired mind could conjure. He recalled the issue had come up in his medical school third-year neurology rotation. Like a host of other random facts that cluttered his brain from four years of medical school, he somehow remembered such an episode was called phantosmia. How he remembered, he had no idea, but he even recalled that a particularly strong phantosmia had its own name: cacosmia. With a shake of his head in mild disbelief, he thought that maybe he’d had his own cacosmia. If so, it was certainly a first.