Chapter 8
Tuesday, July 2, 1:35 a.m.
Wearily, Mitt walked down the long hallway from the elevator bank and entered the resident on-call area. On this occasion, the lounge area was empty. When he’d passed through four hours earlier there had been a group of residents including Madison Baker relaxing in the room. He’d stopped to say hello and had been introduced to several of the internal medicine residents who were also on call. He hadn’t joined them as he was tempted to do, but rather had gone into his assigned room, taken a quick shower, and tried to get some sleep.
Unfortunately, as keyed up as he’d been, he hadn’t been able to fall asleep before being called to the sixteenth floor to check on a patient who had allegedly fallen out of bed.
On that mission, he’d learned that the first-year resident was required by hospital policy to examine everyone who had supposedly fallen out of bed even though most often no one had fallen out of bed at all. Instead, what normally happened was that the patient had sagged to the floor on the way to the bathroom, while in the bathroom, or on the way back to bed. This had been the case on his first such mission as well as on a second one he was just returning from at that moment. As he keyed open his on-call room door, he imagined that checking on people who were said to have fallen out of bed was going to be a common occurrence for him as the year progressed.
So far, despite his concerns, his first night on call had progressed without any major disasters or even a minor problem. He’d completed the three admission histories and physicals without an interruption. Following Madison Baker’s suggestion, he’d tried to limit the history taking, but it was difficult. In contrast to his medical school experience, where he’d been encouraged to be agonizingly thorough, he had to consciously limit his delving into the patients’ family histories of disease and injury. Of the three people, he’d been the most impressed by Ella Thompson, a grandmotherly eighty-two-year-old Black woman. During the course of the history, Mitt had learned she was actually a great-grandmother with fifteen great-grandchildren. Mitt had been impressed with how cavalierly she seemed to be facing open-heart surgery in the morning. She’d had heart issues since she’d had rheumatic fever as a teenager, and she told Mitt she was looking forward to having it taken care of once and for all by having her leaky mitral valve replaced.
The other two workups hadn’t been as interesting or easy. Both had required translators, which made the process much more difficult. It had been Portuguese for Roberto Silva and Spanish for Bianca Perez, and both patients through the translator claimed to know next to nothing about their family’s or even their own medical histories. They were also both minimally cooperative, as if resenting Mitt’s efforts. Following Madison’s advice, he concentrated on making sure there was no immediate contraindication for their scheduled surgery, which there didn’t seem to be. Helping the process to a degree, all three had extensive medical histories in their EHRs, which included documented cardiac issues for Thompson, details about pancreatic cancer for Silva, and a long history of diverticulosis for Perez.
Following the completion of the three admission workups, Mitt had gone back to the on-call room but had been quickly called out on his first falling-out-of-bed episode. This was followed by being kept busy hour after hour with one minor problem after another, often involving a combination of dosage questions, IV issues, sleep medication requests, or demands for laxatives. He found the nurses very helpful and often apologetic at having to call him to solve such problems, which they were certainly capable of handling but couldn’t because of hospital policy based on legal constraints. He was now hoping for a breather, having just dealt with his second falling-out-of-bed episode, and he hoped despite his predictive fears he could get some needed sleep.
Once inside his room, Mitt eyed the bed and then looked over at the bathroom door while feeling totally exhausted from having been on the go for some twenty hours. His momentary confusion was stemming from a debate on whether to take another quick shower. Despite his feeling rather grubby, the bed won out. Without even taking off his white coat or slipping out of his shoes, he lay down, stretching his tired legs out to the end of the bed and briefly massaging his thighs. He figured he would just relax for a few moments before getting up and at least washing his hands and face. But it didn’t happen. In the next instant he was in a dreamless sleep.
When his phone rang in his pocket, Mitt bolted up into a sitting position, feeling momentarily disoriented to time, place, and person. Quickly he oriented himself to the on-call room before struggling to get the phone out of his pocket. As he answered, he noticed the time. It was 2:10, meaning he’d been asleep for maybe a half hour.
“Hello,” he said. His voice was so scratchy that he had to repeat himself.
“Dr. Fuller, my name is Helena Santos. I’m a nurse assigned to your patient Benito Suárez, the abdominal aneurysm repair. He is complaining about pain.”
“Okay...” Mitt said, trying to organize his thoughts. Knowing firsthand the extensive surgery the man had that day, he knew that his having significant pain was hardly surprising. When Mitt had gone by earlier in the evening to introduce himself to the patient and check on him, Suárez had seemed to be doing reasonably well. Mitt had managed to learn this even though there was a significant language problem. The man was Brazilian, and Mitt didn’t speak Portuguese, and the man’s English wasn’t very good.
When checking the EHR at the time of his visit, Mitt had noticed that the patient had what Mitt assumed was adequate pain medication prescribed on a PRN basis, a Latin term for pro re nata, or as needed. There was even a setup where the patient could administer the pain medication himself via his intravenous line, with some limitations as to how often. “Do you know if he has been using his pain medication?”
“Yes, he has,” Helena said. “Plus, following written orders, I was able to give him some additional pain medication if needed, which I did an hour ago. But he is again complaining, and it is way too soon for him to be given yet another dose.”
“What would you have me do?” Mitt questioned, unable to think clearly in his tired state.
“You need to come and check on him,” Helena stated with a hint of irritation.
“Okay,” Mitt said, realizing from her tone he had little choice even though he didn’t think his being there was going to provide any answers. “I’m on my way.” He disconnected the call, put his legs over the side of the bed, and stood up. A wave of dizziness hit him, but it quickly passed. Going into the bathroom, he splashed cold water on his face. He stared at his image in the mirror as he dried himself off. Dark circles were prominent under his eyes, while the whites had spiderwebs of tiny red vessels. He certainly wasn’t looking his best. To try to help his appearance, he pushed his hair into a semblance of order. As he did so, he wondered what he was going to look like a month from now if he appeared this bad during his first night on call.
Trying to rally his energies, he headed out of the bathroom but was still in a daze. As he passed his bed, he eyed it nostalgically. Leaving the on-call room, he made sure the door was locked behind him. By the time he got to the elevators, he felt a little better and more awake, especially after taking a few deep breaths waiting for one of the cars to arrive.
Reaching the night-darkened fifteenth floor, he stopped at the appropriate nurses’ station on his way to Mr. Suárez’s room. In contrast with earlier that evening when he’d done his workups, the area was peaceful, with only three nurses silently busy in front of separate monitors behind the counter. No one even looked in his direction until he called out.