Chapter Fifteen

June

I switched off the light in the Mayo call room, adjusted the pillow, and closed my eyes. Finally! It seemed that every night I wasn’t moonlighting at St. Joe’s, I was on call at Mayo, and it was starting to get to me. I was nearing the end of my first year and had learned to deal with sleep deprivation, but I prayed the beeper would stay quiet for a few hours. I let out a long sigh and tried to settle in, but I couldn’t. Something was wrong. I had forgotten something. What was it?

Narc rounds. I had forgotten the damned narc rounds. I slapped my pillow aside, switched on the light, and tugged on my gym shoes. “Son of a bitch!” I jerked my lab coat off the back of the chair and stomped out the door. It was twelve minutes after 3:00—A.M.

“The order for all narcotic pain medicines must be renewed every forty-eight hours.” That was the Mayo Clinic rule and the responsibility for obeying it fell to the junior resident on call. Every night we were supposed to trudge up to the ortho floor and renew all expiring narcotic orders. If we forgot, the nurses couldn’t give the patients their pain meds.

Although narc rounds were our responsibility, we assigned them a low priority. Other, more important duties often demanded our attention. We may have had to assist in surgery, or go to the ER, or admit a patient. I usually tried to renew narcs before I went to bed, but that night I had been so busy it slipped my mind. Now it was 3:00 A.M. and I just wanted to lie down for an hour or two.

I got off the elevator and nodded to the janitor who was swishing a red scrubber back and forth across the soapy floor. “Careful, Doc,” he said, nodding at the floor. I waved a hand, tiptoed through the suds, and trudged toward the nurses’ station that shone like a beacon at the end of the dark, silent hall. Sure enough, when I got there I found nine charts lined up, waiting to be signed.

I had seen three consults that night, had two admissions, casted a ten-year-old kid with a broken wrist, and stitched up the leg of an old farmer who ripped his calf open on a piece of barbed wire. And now I’d been driven out of bed to perform a job a monkey could have done.

“Sign your name like a good monkey,” I muttered as I began the rite of scribblage.

“Pardon me?” a nurse said. I glanced up. It was Annie Cheevers.

“Oh, nothing. I was just encouraging myself to get these charts signed.”

Annie smiled pleasantly. She was used to bizarre nocturnal ramblings of junior residents—ortho dogs, we called ourselves.

Like a bored priest distributing communion I went down the line mindlessly scribbling on page after page:

Renew narcs

—MJ Collins MD

Renew narcs

—MJ Collins MD

Renew narcs

—MJ Collins MD

I never saw the patient, never looked at the rest of the chart, never even checked the name. I just took it on faith that the nurses had pulled the correct chart and I dutifully scribbled my name.

“Good monkey,” Annie said as I signed the last one.

I glared at her until I realized she was smiling sympathetically. Annie was a pleasure to look at, smart and pretty in her clean, starched nurse’s uniform. Her brown hair was pulled straight back and held with a pink ribbon. She and I had by then worked together several times. With her I had started IVs, run codes, changed dressings, and fortunately only once, had to pronounce someone.

What a strange word, and an equally strange custom: to “pronounce” someone. When a patient dies it isn’t good enough to say, “Yup, he’s dead.” A doctor, an MD, has to formally “pronounce” him dead.

Annie had paged me one night and asked me to go into a room to verify a patient’s death. I entered the room, and respectfully pulled the sheet from his head. Well, I thought, he’s cold, he’s blue, and he’s stiff. This narrows the diagnostic possibilities. To be official I felt for a carotid pulse, and then listened to the chest for a few seconds. For once the patient’s chest was colder than my stethoscope.

I turned to Annie and said, “He’s dead.”

Annie looked at her watch. My pronouncement had to be accompanied, as in a train terminal, by the time of departure.

“Dr. Collins,” Annie wrote in the chart, “pronounced the patient at 2:14 A.M.”

Patti and I had both grown up in large Irish Catholic families. I was one of eight kids. She was one of seven. We were used to large weddings and larger wakes. How sad, I thought, for someone to die alone in a dark hospital room, no one holding his hand, no one shedding a tear. No one even knows he is gone until an hour later when a nurse finds him. The only notice taken of his passing is when some lowly resident, grousing and resentful, is dragged out of bed to “pronounce” him.

 

I leaned against the counter, resting my cheek on my fist. I had been working almost twenty hours in a row, and still had another sixteen to go. I glanced down at my rumpled lab coat, my faded scrubs with that old farmer’s bloodstains on the cuffs. My mouth felt grimy, my eyes were bleary, and I needed a shave. I knew I should go to bed, but there was something refreshing about being there with Annie.

“Did you come on at eleven?” I asked, knowing full well that all nightshift nurses come on at eleven.

“Why, yes, Doctor, I did,” she said, trying not to laugh.

“What’s it like outside?”

“Dark,” she said, nodding her head thoughtfully. “Mostly dark.”

“God, it never changes around here, does it? Every night it’s the same thing.”

Annie smiled and began putting the charts back in the rack.

I slumped down in a chair next to her. I wanted to stay, but I couldn’t think of anything to say.

“Mike,” she said, a chart in her right hand, “you should get some sleep. You look terrible.”

“Flattery will get you nowhere.”

I sat there dumbly, too lethargic to get up.

When she finished filing the charts she said, “Okay, if you don’t want to go to bed then how about seeing Mr. Flannery in twenty-three? He’s got a fecal impaction. Maybe you could take care of it for him.”

That did it. “All right, fine. I’ll leave. But what if I never make it back to the call room? What if I collapse and die of unnatural causes at the end of some deserted hallway? It won’t be so funny then, will it?” I stood up and waved my hands in the air, proclaiming the headlines:

 

MAYO RESIDENT FOUND DEAD IN STORAGE ROOM. ORTHO NURSE
UNDER INVESTIGATION FOR CRUELTY TO ANIMALS

 

“Will you get out of here? I have work to do.”

“Sure. Fine. Don’t worry about me,” I said as I began walking down the dark hall. “If I don’t see you again, have a nice life.”

“I should be so lucky.”

“It’ll be too late for tears when they pluck my cold, lifeless body from a floor in Central Supply.”

She laughed and waved a hand at me. “Go to bed. You’re nuts.”

“That’s what they said about Vincent van Gogh.”

I trudged down the dark hall toward the elevator. My first year in orthopedic surgery was drawing to a close. I had never learned so much, never seen so much, never suffered so much as I had in this last year; and yet the road ahead seemed so long. I was still a lowly junior resident, with one more year of holding retractors, one more year of making narc rounds at three o’clock in the morning. But a spark had been ignited in me, and it enabled me to see past all the scut work and ignominy that lay ahead. In one year I would be a senior resident. In three I would be an orthopedic surgeon.

At the end of the hall, the janitor was still swishing the floor. I nodded to him, stepped gingerly across the soapy floor, and pressed the button for the elevator. I stood there, looking wrinkled, rumpled, and drained. As Frank Wales liked to say, I looked like I’d been “rode hard and put away wet.” I could almost read the janitor’s mind as he looked at me out of the corner of his eye. “This guy is a doctor?”

I had come so far. I had grown so much, but as I prepared to start my second year, I found myself wondering the same thing.