9
I’m on my way to catheterize a couple of people when my med students find me. “Survival five years status post gastrectomy is ten percent,”* one of them says. “But only fifty percent survive the operation.”
“Huh,” I say.
The upside of this information is that if Squillante does live through his surgery, his odds of surviving another five years are actually more like twenty percent than ten, because the ten percent figure presumably includes people who die during the operation. The downside is that Squillante has fifty-fifty odds of dying today, on the table. And calling David Locano down on me if he does.
The elevator doors open in front of us: Assman, getting returned to the floor in his stretcher-bed. Mostly to make it look like I’m doing something, I fall in beside him.
“How are you feeling?” I say.
He’s still lying on his side. “I’m f*ckin dying, you f*ckin a*shole,” he says. Or something like that. His teeth are chattering too hard to be sure.
It gets my attention. He certainly looks like he’s dying. “Allergic to any medications?” I ask him.
“No.”
“Good. Hang in there.”
“F*ck you.”
I follow him back to his unit and quickly write orders for a whole collage of antibiotics and antivirals, putting “STAT” on every one of them. Thinking: Should I go threaten Squillante some more? With what, and to what end? Then I go pull Assman’s CT scan up on a computer screen.
It’s calming, in a way. If you know what you’re doing, trackballing through a CT is beautiful. Probably even if you don’t. You rise or fall through the hundreds of horizontal cross sections, and the various ovals—chest, lungs, heart chambers, aorta— expand and contract like roiling weather patterns, passing through each other and tapering at different levels. But even then you always know where you are, because the inside of a human being has practically no two cubic inches that are identical. This is true even on a left-right basis. Your heart and spleen are on the left while your liver and gallbladder are on the right. Your left lung has two lobes while your right has three. Your left and right colon are different widths and follow differently shaped paths. The vein of your right gonad drains directly toward your heart, while the vein of the left joins the vein of your left kidney. If you’re male, your left gonad even hangs lower than your right, to accommodate the scissor motion of your legs.
So the two golf ball–sized abscesses on Assman’s CT are immediately noticeable, one behind his right collarbone and the other in his right buttock. On closer inspection they might have some sort of fuzz around the edges—a fungus or something. They look like what alcoholics get when they pass out and inhale their own vomit, then grow colonies from it in their lungs. I’m pretty sure I’ve never seen anything like it in muscle before.
I send my med students off to page Pathology. It tends to be difficult to pry those people out of their nasty little lairs, which are lined with bottles of human organs like the homes of the serial killers they chase on TV, but Assman is going to need a biopsy. I tell them to page Infectious Disease while they’re at it, since odds are neither service will answer us.
And once they’re out of sight I close out the CT screen on the computer and Google Squillante’s surgeon, John Friendly, MD, just to take one more depth reading on the shit I’m in.
But surprise: the word is positive. My man Friendly has either banded or reduced the stomach of every obese celebrity I’ve ever heard of. In fact, New York magazine—which should know, since its primary function is to transfer pathogens between the hands of people in waiting rooms—names him as one of the five best GI surgeons in the city. Friendly even has a book that’s doing not too sucky on Amazon: Eye of the Needle: Cooking for the Surgically Altered Digestive Tract.
I keep searching until I find a picture that confirms these people are really talking about the guy I met earlier, since it’s been that kind of morning. Along the way I find more happy articles. Apparently Friendly just did the colostomy on the guy who played the dad on Virtual Dad.
Like that guy must have said: what a f*cking relief.
I try to figure out just how much of a relief. Does this mean Squillante actually has a seventy-five percent chance of surviving the operation? If so, what are the odds he keeps his word and doesn’t rat me out if he lives? I get a page from a room where I don’t currently have any patients.
I stare at the number on my pager screen and wonder if it’s the new patient Akfal said something about to me three hours earlier. Then I realize it’s the room with Osteosarcoma Girl in it, and run to take the fire stairs.
The first thing I realize when I see her again is that, although she’s beautiful, her eyes really don’t look like those of my lost Magdalena at all. Then I feel embarrassed to be so disappointed.
“What’s up?” I say.
“What do you mean?”
“I got paged.”
She stops biting her thumbnail to point toward the side of the room where the door is. “I think it was the new girl,” she says.
Oh right. That curtain’s now drawn, and there are voices coming through. I pat Osteosarcoma Girl on her nondiseased leg, then knock on the wall and pull the curtain aside.
Three nurses are still setting up a new patient in the bed that was empty before.
It’s another young woman, though it’s hard to tell her age precisely because her head is shaved and bandaged, and the front left quarter of it is missing. Where it should be, there’s just an indentation in gauze.
Below it she looks at me with wild blue eyes.
“Who’s this?” I ask.
“New patient, Dr. Brown,” the senior nurse says. “She’s in from Neurosurgery.”
“Hi,” I say to the patient. “I’m Dr. Brown.”
“Ay a ly ly ly,” she says.
Naturally. In all right-handed people, and most left-handed ones, the front left lobe is where the personality is. Or was. The bandage over the missing part of her head starts pulsating from the effort of speaking.
“Just relax. I’ll go read your chart,” I tell her, and leave before she can answer.
Or respond to stimulus, or whatever you want to call it.
Head Girl’s chart is brief: it says she’s “s/p craniectomy for septic meningeal abscess s/p lingual abscess s/p elective cosmetic procedure + s/p laparotomy for calvarium placement.”
In other words, she got her tongue pierced and the infection ran to her brain. Then they cut her head open to get to it, and afterwards took the chunk of skull they’d removed and implanted it under the skin of her abdomen to keep it alive while they waited to see if the infection came back.
Calling a tongue piercing “cosmetic” is a bit of a stretch, since you don’t get one because it makes you look better. You get one because you’re so desperate for affection that you’re willing to gruesomely harm yourself to advertise how well you suck dick.
Christ, I think: I am in one bad mood.
Just to complete my research into the house of mirth that is Room 808W, I call up Osteosarcoma Girl’s chart.
Not much to learn there: a lot of “atypical” this and “high likelihood of” that. Her right femur sometimes bleeds, just above the knee. Other times it doesn’t. And she’s due to get the whole thing removed at the hip in a few hours.
The weirdest, worst shit happens to people.
I do Head Girl’s admission paperwork without looking at it, but before I’m done I get another page, this one to the room shared by Duke Mosby and Assman.
The deal, by the way, is this: Akfal and I are required to admit thirty new patients to the ward each week. How long we keep these people in the hospital is up to us. Obviously we have an incentive to get them out fast, so we don’t have to take care of them. But on the other hand, if they come back to the emergency room less than forty-eight hours after we’ve discharged them, we have to take them back onto our service. Whereas if they come back, say, forty-nine hours after discharge, they get assigned randomly, as if it were their first visit, and odds are five to one they’ll be someone else’s problem.
The art is in spotting the exact moment when a patient is sufficiently well to survive a full forty-nine hours outside, then flushing them. It sounds harsh—actually, it is harsh—but the second Akfal and I stop doing it, our job will become impossible.
It’s almost impossible already. Some insurance executive long ago found the precise line past which it won’t pay to push us—our own forty-nine-hour mark, if you will—and is doing an expert job of keeping us there. Between admitting new patients and discharging old ones, both of which are paperwork nightmares, we barely have time to manage the patients who are staying around.
This means that checking on any one of the patients we’ve already seen for the day—like Assman and Duke Mosby—is a pure waste of time. Unless the patient is in immediate, fixable trouble.
Which is always an outside possibility, and in this case sends me back to the fire stairs, then running down the hall to their room.
There’s a crowd just inside: the Attending Physician from rounds (of all people), Zhing Zhing, our four med students, and the Chief Resident. There are also two male residents I don’t recognize. One, who’s darkly handsome but also crazed-looking, has a giant syringe in his hand. The other one is birdlike and looks annoyed.
“No way,” the Chief Resident is saying to the one with the syringe. “Unh uh, Doctor.” She’s standing between him and the bed.
I say, “Hi,” and hold a fist out for Assman to knock with his knuckles, but he just glares at me. “Who are you guys?” I say to the residents.
“ID,” says the one with the hypodermic. Infectious Disease.
“Pathology,” says the other one. “Did you page me?”
“Maybe an hour ago,” I say. “Did you page me?”
“I did, sir,” one of the medical students says.
“This guy wants to biopsy the lesions,” the Chief Resident says to me, meaning the ID guy.*
“Okay,” I say.
“Okay?” the Chief Resident says. “This patient has an unknown pathogen that’s spreading, and you want to risk disseminating it farther?”
“I want to find out what it is,” I say.
“Did you think about informing the CDC?”
“No,” I say.
Which is true.
“It’s already gone from his glute to his upper thorax,” the ID guy says. “How much farther can it disseminate?”
“How about through my whole f*cking hospital ward?” the Chief Resident says.
The birdlike Pathology guy breaks in. “Why did you page me?” he says.
The Chief Resident ignores him and turns to the Attending. “What do you think?”
The Attending looks at his watch and shrugs.
“I’m going in,” the ID guy says.
The Chief Resident says, “Wait—”
But the ID guy gets an elbow around her and moves in with the needle. Taps twice on Assman’s upper chest, raising a scream with the second tap. ID keeps his finger there and sinks the needle in right next to it, then quickly tugs at the plunger. Assman’s howl rises in pitch, and the chamber of the hypodermic fills with blood swirled with yellow fluid.
“God damn you!” the Chief Resident shouts.
The ID guy yanks the needle out and turns to her, smug, but overestimates the distance between them. Actually there is no distance between them. As the Chief Resident gets knocked backwards, she and ID guy flail into a tangle and start to fall together.
Right toward me.
I shift sideways, but there’s a med student under me, yapping beneath one of my clogs. I jam into the wall, and all I can do to protect my face is raise a forearm. Which the hypodermic hits, sinking up to the plastic.
There’s a pause.
Then people start to get up, backing away from me. I stand too. Look down at my arm. The hypodermic’s sticking out of it, empty, plunger all the way down. Starting to give me that pain any large shot will give you, because it separates the planes of tissue. I twist the syringe out of my arm.
I snap the needle off and drop it into the drawer of a sharps box on the wall behind me. Then I take hold of the front of the ID guy’s scrub shirt and drop the hypo chamber into his pocket. “Scrape what you can out of this and analyze it,” I tell him. “Take the Path guy with you.”
“I don’t even know what I’m doing here,” the Path guy whines.
“Don’t make me hurt you,” I tell him.
“Dr. Brown,” the Attending says.
“Yes, sir?” I say, still looking at the ID guy.
“Give me a five-minute head start?”
“You left ten minutes ago,” I tell him.
“You’re a mensch, kid. Cheers,” he says as he leaves.
Everyone else stands frozen.
“Stat, you f*cking a*sholes!” I tell them.
I’m almost out of the room when I realize something’s wrong. Something else, I mean.
Duke Mosby’s bed is empty. “Where’s Mosby?” I say.
“Maybe he went for a walk,” one of the med students says, behind me.
“Mosby’s got bilateral pedal gangrene,” I say. “The guy can’t even hobble.”
But apparently he can run.