The first night on call of my rotation in the intensive care unit occurred in mid-January, as a gentle snowfall blanketed Washington Heights. I was lying on a black leather couch in the doctors’ lounge, reviewing a stack of EKGs, when the door flung open.
“Nap time’s over,” a voice said as I pushed a banana peel off my chest and flung myself upright. “Looks like we’ve got some more business.”
The voice belonged to my blond, floppy-haired supervisor, Don, a second-year resident who had taken over for Baio and Ashley as my medical swag coach. Among the many disorienting aspects of intern year was the constant shuffling of supervisors. Just when I became comfortable with one resident’s style, I was pawned off on a new resident with a new system. The carousel of bosses meant I was exposed to all kinds of teaching philosophies, and as the year wore on, I realized just how special Baio had been. Others were excellent in their own ways—some were nimble with needles, others were master negotiators—but no one quite brought the incredible immediacy of medicine to life the way Baio had.
I had heard of Don before I had ever spoken with him. He was a bit of a cornball—a milquetoast midwesterner who loved to show cell phone pictures of his eight-month-old son—but more recently he was known around the hospital as the guy who had picked up a congenital blood vessel abnormality in a young woman after noticing a subtle difference in blood pressure readings in her arms. Word of his careful eye had spread quickly, and Don was now regarded as a master diagnostician. I suspected that he, like Baio, was someone special, and I couldn’t wait to work with him. Don reinforced my belief that professional reputations could be created or destroyed with a single patient.
“New admission from the emergency room,” Don said, gliding across the linoleum. His face was pinched—as if his features were rallying around the scar from his surgically repaired cleft palate—and I wasn’t yet sure if he was one of those guys who would lord his sterling reputation over me. He picked up the black plastic phone and put it on speaker.
“Fellas,” the voice on the other end said. It was Baio.
“My man,” Don replied. “I’m here with Matt McCarthy. What you got for us?”
“Kindly give Dr. McCarthy my regards.”
I moved toward the phone, took a seat in an orange plastic chair, and said, “Hey!”
“Got a young guy down here in the ED,” Baio said quickly. “Nineteen-year-old morbidly obese kid with asthma coming in acutely short of breath. Labs look like shit. Chest X-ray looks like shit. I’m thinking it’s…”
“Influenza?” Don asked.
“Oh, Don,” Baio said, not nearly as impressed with Don’s powers of deduction.
“Sorry, sorry,” Don said, picking up a marker, “I’ll shut up now.”
“We’re thinking viral infection with superimposed bacterial pneumonia. Probably triggered an asthma exacerbation. We might have to tube him.”
“Yikes,” I said softly. I hadn’t heard of someone so young requiring a ventilator.
“Well, send him on up,” Don said. “He’ll take our last bed. ICU’s full.”
The conversation abruptly ended, and Don stood up and moved to a small white marker board. “Stupid mistake,” he said. “Never hone in on a diagnosis so quickly. Let’s make a list of the things this kid could have other than infection. Go.”
Life in the medical intensive care unit was wildly unpredictable. Some nights we admitted up to a half dozen new, exceedingly sick, exceedingly complex patients. Working in the ICU required an advanced grasp of physiology and the ability to remain calm yet assertive while dealing with complex, terrifyingly sick patients. It was the perfect fit for a guy like Baio, but not so much for me. Patients in the ICU are often too sick to describe the events that led up to their admission, and the aim is not to cure a condition but rather to stabilize it. There isn’t much red meat there for doctors who find meaning through personal connection.
Fortunately, tonight was looking relatively quiet. Our unit was nearly full and Don had put out most of the fires earlier in the evening, so we had some time to talk. He and I spent the next half hour creating a preposterously long list of what might be wrong with our new patient, until a nurse knocked on the door, poked her head in, and said, “New admission, Darryl Jenkins, is being wheeled in now.”
Don dropped the marker. “Showtime.”