“I don’t want to screw you.”
Meghan’s words slapped me across the face at 10:00 P.M., several weeks after Dre had gone AWOL. Our pod had moved from the infectious diseases service to the general medicine floor, and tonight it was my turn to work the thirty-hour shift. The floor housed patients with rather mundane illnesses—blood clots, alcohol withdrawal, bellyaches—as well as patients with mysterious illnesses who couldn’t be assigned to a specialized floor because no one could figure out what was wrong with them. It was unclear why Meghan was still bouncing around the nurses’ station. She should have gone home hours ago. And what the hell was she talking about?
“I’m sorry?” I mumbled, stoop-shouldered and pondering a tray of leftover donuts as she blew past me. I waved my hand to get her attention, but her focus was elsewhere. In search of a nurse, Meghan held up a finger in my direction and mouthed, “One sec.”
I sat down at a computer and began reviewing a brain MRI. Lalitha and Ariel had handed me their scut lists and signed over their pagers hours ago and in doing so transferred a potential maelstrom of unfinished business. The idea was to keep the to-do list as short as possible because the evening’s transition of care was inherently fraught with complications. I’d never met their patients and had my own new admissions to distract me through the sleepless night, so situationally I was much more likely to misinterpret a symptom or concern. But these handoffs were an inevitable and increasingly prevalent part of medicine. I’d heard some hospitals even taught the art of the transition during orientation. They may have done it at Columbia, but if so I’d missed it.
“Sorry, I didn’t want to screw you.” Meghan pulled up a chair ten minutes later. “I got fucked,” she said, pointing at her scut list, “last time I was on call. Totally destroyed.” She pulled out a scrunchie from the back pocket of her scrubs and slipped it around her blond hair.
“Oh?” I glanced with some relief at the sparse list she was about to hand me.
“Today’s been a nightmare.”
“What happened?”
She tilted her head toward the step-down unit—an enclosed room for patients who were seriously ill but just missed the cut for an ICU. “Drug mule,” she said.
“Like an actual drug mule?” I asked, looking over at the unit. “Maria Full of Grace drug mule?”
“Nineteen-year-old swallowed sixteen bags of heroin in the Dominican and hopped on a flight to JFK.”
“Holy shit.” It was never Groundhog Day at Columbia.
“Then jumped in a cab and came straight to our emergency room and confessed. DR to the ER.”
“Whoa.”
“She’s just been pooping them out one at a time, handcuffed to the hospital bed. Cop sitting right next to her.”
“And this has to be done in step-down?”
“If one of those bags rips she’s dead.”
“Yikes.”
She handed me her scut list. “Only thing I need you to do tonight is a poop check.”
“Poop check?”
“Make sure she keeps crapping out those heroin bags. Constipation could kill her. If she stops pooping, get a CAT scan. And if there’s an obstruction, call surgery.”
“I believe I can handle that.”
Like most of us, Meghan had a hard time letting go. Every day felt like an unfinished, complicated work in progress with a jumble of loose ends, and there was always a reason to stay another hour in the hospital. Doctors were fond of saying that the later you stay, the later you stay. This meant that friendships and romantic relationships took a backseat and in many cases, began to fade. I had a hard time imagining what I would talk about with my college buddies who lived in Manhattan and worked in finance.
“I must’ve sifted through a hundred thousand dollars’ worth of her shit today,” Meghan said. “Unbelievable.”
I tried to imagine the life circumstances that would lead a teenager to swallow expensive narcotics and hop on an airplane. As I scribbled down poop check, our pagers blared simultaneously.
FREE MUSTACHE RIDES IN THE CCU!
Meghan shook her head. “You guys are having way too much fun with this.”
The page reminded me of Benny. I had continued to check in on him after the breathing tube had been removed from his throat. They weren’t long visits, just enough to peek in and confirm he was improving. Once he regained the ability to speak, we talked football and watched the Yankees. It was remarkable how close he could get to dying and how little beaten down or fazed by the experience he seemed a few weeks later. I wished I had his resilience.
Sometimes I tried to convince myself that his mild progress mirrored my own. As I gradually became more capable, more confident, more efficient, his heart would become stronger and his lungs drier. But deep down, I knew that wasn’t fair. We were two random people thrown together, and our challenges were wildly unrelated. My success or failure as a doctor had nothing to do with his quest to get a heart. But I liked telling myself it did. I liked thinking that when I had finally mastered all of the skills it took to be a doctor, Benny would finally get his transplant.
Meghan stood up and grabbed her purse.
“CCU?” I asked with a smile.
“Bed,” she said. “Good luck tonight.”
At 2:00 A.M., after every task but one had been scratched off the scut list, I grabbed a pair of disposable gloves and headed to the step-down unit to perform the poop check. When I entered the dimly lit room, I could vaguely make out the face of a teenage Hispanic woman—a girl, really—handcuffed to a bed, quietly sobbing. Next to her was a police officer seated in an orange plastic chair with the New York Post in his lap. The officer put down the paper and waved me in.
“Dr. McCarthy,” I said, approaching them. “Covering for the day team.”
A muted television in the corner of the dark room illuminated their faces. The patient was short and thin with long black hair, and I could see tears trickling down her cheeks. Thin red bruises spanned the circumference of each wrist, and the top of her light blue hospital gown was a damp reservoir of tears. Between the cop and her distraught condition, I immediately felt uncomfortable. What was I participating in? What would happen to this woman after she finally pooped out all the bags? Was it a straight trip with the cop from here to jail, and then back to whatever awful situation had compelled her to do this in the first place? I slipped on the gloves and placed a hand on her shoulder.
“Ayúdame,” she said as I stood over her. Help me.
I placed the stethoscope into my ears and looked at the cop. “Just here to get her through the night.” He nodded, and I dropped the instrument onto the woman’s thin abdomen. Her soft belly gently swayed up and down as I tried to listen for bowel sounds, but all I could hear were muffled sobs. My neck stiffened in response to her outpouring of emotion. Dre flashed in my mind.
“Ayúdame,” she said again.
I looked at her midsection and imagined the tiny bags of narcotics lying just beneath the surface, swimming through her intestines. I gently pressed the tips of my fingers into her belly, trying to elicit a subtle sign of pain or tenderness, something that might indicate that a bag had burst, but there was nothing. I removed the stethoscope and examined her face, wondering again what life circumstances had brought this woman to this moment.
But just as quickly as I began to wonder, I felt my mind closing, and a kind of self-protective numbness set in. There was certainly a part of me that wanted to know more about her—her life, her family, why she swallowed drugs for money—but even the thought of reaching out produced a small burst of shame, and brought back the anger I’d felt at seeing Dre’s empty bed. Sure, I still wanted to be like Jim O’Connell, but the reality of connecting with patients was far more difficult than I’d ever imagined. It was messy, and had the potential to make me messy, too, something I desperately wanted to avoid. Emotionally investing in patients was important, but it was going to take a backseat to all of the other tasks I had on my scut list.
I tapped her handcuffed wrist. “Lo siento,” I said. I’m sorry.
Ignoring this woman’s tears made me feel like a machine. Was this what the Badass felt like when he saw patients? I looked at the officer. “I need to sift through her feces.”
He pointed to a plastic blue bin about the size of a top hat in the corner of the room that was filled with a frothy brown liquid. I stepped away from the woman, brought the bin over to a sink, and dipped my gloved index finger into it, fishing around for a plastic bag. I breathed through my mouth to avoid the odor and was careful not to splash any of the refuse onto the floor.
“No drugs,” I said a moment later. “Nada.” I looked back at the woman and removed my gloves. Her large dark eyes continued to emit a stream of tears. The officer shrugged and returned to the newspaper.
“Ayúdame,” she said once more.
I shook my head. “I’ll be back in a few hours,” I said flatly, “to do this again.” Then I walked out of the room and shut the door.
I was headed, as had become all too common, to the bathroom for another urgent death match with my bowels. Several weeks into taking the HIV pills, I now had a clear understanding of why patients sometimes refused them. Ritonavir, the pill that looked like an astronaut meal, seemed to get stuck in my throat every time I tried to swallow it, and the first wave of side effects included an ever-present feeling of fullness that shrank my appetite to subdiet levels. Then I started experiencing gnawing pains and cramps that would manifest unpredictably in various parts of my belly. Pain came during meals or not, and before long I was having phantom stomach pains that began the moment I put the pill in my mouth.
What being a doctor gave me in perspective it took away through overeducation. I knew what tenofovir could do to my kidneys, and the damage ritonavir might wreak on my liver, and soon these organs started hurting, too, even though tests showed no problems. Walking around the hospital feeling light-headed, I wondered if it was kidney dehydration or just a mindfuck. Clearly not phantom was the diarrhea. I had taken up Dr. Chanel on her offer of Zofran for nausea, further increasing my pill burden.
As I exited the bathroom once again, feeling shaken and worse for the wear, I tried to think about the crying woman in step-down, but I didn’t have it in me. Between getting burned by Dre and feeling like a shell of myself thanks to the pills, I had very little bandwidth to connect with my patients beyond trying to keep them alive. Every time I thought of my patient’s pain, I thought of my pain, and of the medications that were causing it. Every time I imagined taking the pills for the rest of my life, I wanted to scream.
In the midst of my third and final poop check, a few minutes before 7:00 A.M., my pager went off. The message was just a phone number, and a moment later, I found myself on the phone with an oncologist named Dr. Phillips. One of his patients—a middle-aged Cuban woman with multiple myeloma—had been hospitalized with pneumonia and I was taking care of her on the general medicine service. I had never met Dr. Phillips, but he left notes in the woman’s chart, explaining what he wanted me to do for her on a given day.
“I need you to come to my office,” he said, as I held the phone in one hand and my soiled gloves in another. “As soon as possible.”
I was at the tail end of a thirty-hour shift and my brain was starting to shut down; soon my vision would be blurry and my judgment would be grossly impaired. I didn’t want to meet him. “Is it something we can talk about over the phone?” I asked. “It’s just that I’m post-call and we’ve got rounds that go till noon.”
“I will see you in my office as soon as rounds are over.”
What could this be about? I wondered. What couldn’t be said over the phone? Or via email? Whatever it was, it didn’t sound good, and I wasn’t remotely in the mood for bad news.
Just after noon, I staggered into Dr. Phillips’s wood-paneled office. There was an orchid on his desk and the usual column of diplomas on the wall. He had white hair and a long, broad nose. He offered me a seat in a large brown leather chair as he remained standing behind his desk.
“Dr. McCarthy,” he said, “thank you for meeting me face-to-face.”
“Of course. It’s nice to finally meet you in pers——.”
“You’re taking care of Ms. Barroso,” he said, loudly clasping his hands together. “I’ve known her a long time. A very long time.”
“Yes.” I quickly scanned my brain for the latest details of her case. “Seems to be doing well. Hopefully discharged in a few days.”
“Tell me, Dr. McCarthy, what happens to vital signs when a patient is in pain?”
This was what couldn’t be asked over the phone? My eyes were heavy and my stomach ached; I was due for another round of HIV pills. Why was he doing this to me? “Heart rate and blood pressure increase,” I said. “Although I’m sure there are exceptions.”
He nodded. “Now tell me, do her relatively unremarkable vital signs tell you anything about whether Ms. Barroso is in pain?”
It felt like a trick question. I flashed back on my conversation with Sothscott over Gladstone. My neck started to tingle. “Not necessarily.”
He took a seat and frowned. “Dr. McCarthy, Ms. Barroso has been in agony for several days. She’s suffering.” He shook his head and locked eyes with me. “And it’s because of you.”
I was suddenly very awake; I felt every muscle in my body clench. “What?”
“I asked you to come to my office because I need an explanation. I need to hear from you why this is happening.”
I shook my head and sat up in my chair as words leapt out of my mouth. “Every day I ask her, Tienes dolor? Do you have pain? And she says no. Every single day. This is the first I’m hearing that she’s in pain.”
He put his elbows on his desk and wrinkled his brow. “Do you use a translator?”
“No, I don’t. I ask her in Spanish if she’s in pain and she says no.” He shook his head.
He shook his head. “She’s suffering.”
“I ask her every day,” I added. I could tell my words were coming out too quickly, that I sounded defensive. I tried to slow down, but I couldn’t. “The nurses ask her every shift. If she said yes, they’d page me. But they haven’t paged me.”
Were we talking about the same patient? “I must be missing something.”
“Indeed.”
This wasn’t making sense. “I’m running all over the hospital and no one has ever paged me to—”
“Has it ever occurred to you that you’re not using the right words? That you’re not asking the right questions?”
I paused. “Honestly, no.”
“If you bothered to get a translator, you might understand that she’s in agony.”
Bothered? Was he claiming I’d been negligent? “I feel terrible about this, but I’m not sure what to say.”
“Apologize. And use a translator.”
I stared down at my shoes, trying to make sense of this conversation. I was deliriously sleep-deprived, but this had nothing to do with that. “I’m deeply sorry, but it has never been communicated to anyone that she’s suffering. And I can’t have a translator just following me around.”
He clenched his teeth. “It was communicated to me. And there are phone translators in every room.” He scribbled down a phone number on an index card and handed it to me. “Use it.”
I looked at the numbers and tried to wrap my head around what was happening. I took a deep breath. “Okay.”
He closed his eyes and sighed. “That’s it. That’s all I have to say. I’ll give you one more chance to get this right.”
Then what? I was too scared to ask.