I was about to hang up when I thought of something else. "One other thing. If he's never had digitalis — at least, not during the last two weeks— give him 1 mg. of digitoxin IV. But do it slowly. Straus, are you still there?"
"I'm here," he said.
"We probably should give him some diuretic as well, to get rid of some of his excess fluid. Try about 25 mg. of ethacrynic acid." I knew that stuff was so powerful it would wring pee from a stone. Powerful — my inner fear of diuretics made me think twice, and I changed my mind.
"On second thought, hold the diuretic until we're sure of the diagnosis of pulmonary edema. If he has pneumonia, it wouldn't help too much." The old lady with cancer whom I had killed with the diuretic haunted me for a moment; she had died of pneumonia. Finally I hung up the phone.
"Hey, Jan, that’s great." She'd been able to squeeze in all but one small book. The remaining volume was what we called a throwaway — one given out by a drug firm hoping to convince somebody that one of its drugs was the answer to all pathological evil. I'd never read it, nor did I intend to. Nevertheless, I jammed it into one of my already full suitcases.
Except for my shaving equipment and other toilet articles, the clothes I was going to wear in the morning, and the dirty set of whites I was now wearing, all my junk was packed. The shippers were scheduled to take my trunks in the morning; the suitcases were going with me, along with an array of hand luggage that included a large piece of coral. Finally all was ready. I could relax and enjoy what remained of my year in Hawaii.
Jan chose that moment to drop her bomb by abruptly informing me she was going home. Just when we could forget all the packing and be together, she decided she was leaving. Obviously, it came as a complete surprise, since I had blithely assumed we would sleep together, as usual.
"Jan, why in heaven's name do you have to leave? Please stay. If s my last night."
"You need a good night's sleep before your trip," she said evasively.
"Well, how about that!" I gazed into her tanned face. She looked at me with her head tilted slightly forward and to one side, flirting expertly and suggesting that her sudden coyness was based on complicated female reasons. Yet I wasn't sure. I could understand her desire to leave if it sprang from a disdain for the artificial last-night routine, from not wanting to reduce our love-making to a sort of ritual to celebrate a passing era. The closeness we normally enjoyed probably wouldn't have been there, anyhow, since we were both preoccupied with other thoughts.
She kissed me lightly, said she'd see me in the morning, and noiselessly floated out the door. It all happened too rapidly for mental digestion.
Fleetingly, I thought of going to the ICU, even though I didn't really want to, but ultimately I shrugged off the thought with the rationalization that Straus needed to stand on his own two feet.
So I decided to take a shower — and no sooner had I stepped in than the jangle of the telephone sounded. The only way I could drown out the ring was by putting my head directly under the nozzle. I shouldn't have left the bathroom door ajar. But habit won out. On the fourth ring I sprinted back to my room and picked up the phone, while a puddle at my feet rapidly expanded its periphery.
"Peters, this is Straus."
"What a surprise!"
"Guess what? Good news!"
"I'm certainly ready for a little of that."
"The pulmonary-edema patient I talked to you about turns out to be on the medical service, not surgical, and the medical intern has assumed control.
"What about his surgery?" I asked, quite surprised.
"He hasn't had any surgery. At least, nothing recent. The dressing was covering a colostomy he'd had put in years ago."
"Congratulations, Straus. Your first clinical success as an intern. But why don't you hang in there just the same? Unless, of course, you have something else cooking."
"Sorry, can't stay. I got a call from surgery. They've scheduled a kneecap removal. Automobile accident, I think. Unless you want to go, I'll head up there."
A patellectomy, an orthopedic case! It was becoming very clear to me how much I would treasure being a resident rather than an intern. Imagine being able to send someone else on a midnight patellectomy! That was true happiness.
"I wouldn't deprive you of the pleasure, Straus. You go ahead and scrub."
Orthopedic surgery really freaked me. Before med school, I had labored under the delusion that surgery was an accurate and delicate science. Then had come the holocaust of my first orthopedic scrub, where I witnessed the grossest nail pounding, drilling, and bone crunching I could possibly have imagined. Not only that — the mayhem had also been accompanied by comments like "Get X-ray in here so I can see where the hell that nail went"; then, after looking at the X ray, "Damn, missed the hip fragment completely. Let's pound in another one, but this time aim at the belly button instead."
Such experiences had quickly eliminated orthopedic surgery as a specialty for me. Neurosurgery had fallen away soon after, when I saw the best neurosurgeon in New York pause during a case and peer into the hole he'd dug in a patient's brain to ask, "What is that light gray thing?" No one answered — after all, he was only talking to himself — but that was the end of neurosurgery for me. If he didn't know where he was after twenty years, there was no hope that I'd ever learn.
With all my medical books packed, I didn't have anything to read to put me to sleep. Then I remembered the drug-firm throwaway I'd crammed into my suitcase. I pulled it out and settled back into the cool white pillow. Appropriately enough, it was titled The Anatomy of Sleep. Flipping to the back of the book, I learned it was a hard sell for a sleeping pill. I cracked open the volume haphazardly and began reading. With so much on my mind, I managed to finish a whole page before my eyes began to droop.
The harsh ring of the phone came at me even before I had a chance to start a decent dream. In customary panic, I snatched up the receiver as if my life depended on it. By the time the operator connected me to the nurse who had paged me, I was well oriented as to time, place, and person.
"Dr. Peters, this is Nurse Cranston of F-2. Sorry to wake you, but Mrs. Kimble has fallen out of bed. Would you come over and check her, please?"
The luminous radium dial of my alarm clock told me I'd been asleep for about an hour.
"Miss Cranston, we have a new intern tonight. Name's Straus. How about giving him a call on this problem?"
"The operator already tried," she said. "But Dr. Straus is scrubbed in surgery."
"Piss."
"What did you say, Doctor?"
"Is the patient all right?" I was stalling.
"Yes, she seems to be. Are you coming, Doctor?"
I growled something implying the affirmative and hung up. Clearly, I hadn't graduated from internship yet. Until I actually hauled my body out of range, there would always be one more patient to fall out of bed. Lying there thinking about it was a mistake. I drifted back to sleep.
When the phone rang again, I responded with the usual panic, wondering how long I'd been asleep. The operator enlightened me — twenty minutes, she said — and canny as she was, saved me the effort of making an excuse by suggesting I might have fallen back to sleep. After all, it happened to everyone, even on emergencies. If I didn't put my feet out on the cold floor immediately, my chances of getting up fell precipitously. For a while, my trick had been to place the phone several yards from the bed, out of reach, so that I had to climb out of the warm nest just to answer it. However, with so many laxative calls that I could handle while horizontal, I eventually abolished that ploy and returned the phone next to the bed.
After the second call, I hauled myself out straightaway and dressed rapidly. With luck, I could be back in bed in twenty minutes. My record was still seventeen.