It was approaching 3:00 A.M., the witching hour, when my body temperature inexplicably plummeted and the pace of work finally calmed down. Or exploded. We never knew. On a quiet night, it was the ideal time to throw on a sweatshirt and pick a supervisor’s brain, catch up on paperwork, or prepare for the firing squad of morning rounds. On a disastrous night—one in which there were simultaneous cardiac arrests or a half dozen new admissions—3:00 A.M. was the time when you daydreamed about business school or working as a medical consultant for a hedge fund.
The ER sending Benny to the CCU meant we had dodged a bullet. There would be time to talk, time to check labs and vital signs, time to process the matrix of data and tidy up the unit before the rest of our team arrived at dawn. And maybe, if we were lucky, there would be time for Don to impart some wisdom. I attempted to nudge him in that direction.
“I heard about that diagnosis you made,” I said. “Takayasu’s arteritis. Very impressive.”
Don grinned. “Attention to detail, my friend.”
“There are so many details.”
“Key is figuring out which ones are important. That’s what intern year is about. They call them vital signs for a reason.” I noted a hint of swagger in his voice. “I was just heads-up.”
“I’ll say.”
He ran his hands through his blond hair. “They asked me to give a talk about it to the department. Can you believe that? What the hell do I know?”
I shrugged. Beneath Don’s glimmer of swagger was vulnerability. I’d seen it when Baio had called him out on the phone. It occurred to me that we were all wrestling with some form of impostor syndrome, unable to internalize and appreciate our own accomplishments. There was always someone more impressive, someone who could make you look foolish if they really wanted to. Underneath the glimmering personas, some of us—including me and the women in my pod—secretly worried that we didn’t deserve to be doctors, we didn’t deserve to hold life in our hands, we weren’t the ones who should be leading complex discussions about comfort measures and vegetative states. The key to residency was figuring out ways to ignore those feelings without turning into a monster.
“On second thought,” Don said, “let’s hold off on the vital signs. Get some food and grab a few minutes of sleep if you can. You just know the ED is teeing someone up for us.”
He pulled out his cell phone and showed me several pictures of his son. The kid was crying in every one, but Don was beaming.
“You sure?” I asked. I was wide awake—stress was a remarkable stimulant—but Axel’s axiom wafted into my head: When you can sleep, sleep.
“Couch is all yours.”
In my six months at Columbia, I had observed two types of interns—those who couldn’t sleep on call and those who desperately needed at least a few moments of shut-eye during the thirty-hour shift. I fell into the latter category; just eight minutes of sleep and I felt reasonably refreshed. By contrast, after a sleepless night I looked, as one colleague put it, “like someone vomited on dog shit.”
I had been snoozing for two glorious hours when a brown paper bag dropped on my chest with breakfast. “How was the night?” Lalitha asked, pushing my legs off of the end of the couch. “Lounge is a mess.”
“Not horrible.”
Her appearance meant I’d survived the night. Hallelujah. She patted my thigh with an old Us Weekly and shook her head. “I can’t believe you have a subscription to this.”
I grabbed the magazine from her. “How else am I going to know Candace Cameron just lost twenty-two pounds?”
Lalitha and I made it a point to engage in conversational nonsense for a few minutes every day before the sun rose and the storm of work and morning rounds rolled in. Our lives together were so intense, so structured, so stressful, that it felt good to talk about something other than our critically ill patients.
We all struggled with the weight of our work, but having the occasional dopey conversation was a reminder that we weren’t simply using each other to get through the day. We were normal people who could engage in idle chitchat. But because our personal lives were so limited—the rare off day was often spent catching up on sleep—we rarely had normal things to talk about. Celebrity gossip became linguistic currency, something we could bring up when we needed to disengage from medicine. For me, the levity of the tabloids helped balance out the tragedy of watching people die day after day.
Lalitha scanned Candace Cameron’s new figure and pulled out a compact and brush from her bag.
“Did anyone ever tell you,” I said, as I watched her groom, “that you look like Rudy from The Cosby Show?”
She rolled her eyes. “Did anyone ever tell you that you look like Pat Sajak?”
“Pat’s a national treasure.”
“Sajak crossed with ALF crossed with Chandler from Friends. When he was on drugs.”
Don entered the lounge, and we sat upright. “At ease, Doctors.”
“What’d you do to Matt overnight?” Lalitha asked. “Looks like a truck hit him.”
I parted my hair, held the magazine over my face with my right hand, and flipped her off with my left. These little moments brought us closer.
Don shook his head. “Gotta say I love working with you two. Get along better than anyone I know.”
“It’s because I’m afraid of her,” I deadpanned.
“He is definitely afraid of me.”
“How could I not be?”
The door burst open, and the nurse manager poked her head in and calmly said, “Jones is crashing.”
I dropped the magazine and grabbed Lalitha. This was the scenario Don had prepared me for: Mr. Jones, the man with the unusual lungs, had dropped his blood pressure. I felt a surge of adrenaline. “Let’s do this,” I said, feeling momentarily like Baio. The transition from goofball to physician was instantaneous.
“Blebs?” Lalitha asked as we bounded out of the lounge. She was a step quicker than I was. Her ponytail sashayed from side to side like a broom as we blew down the corridor past Ingrid Hansen, who was staring blankly out a window.
As we entered Jones’s room, the first thing I noticed was a large window at the head of the bed. A container ship could be seen in the distance, floating south down the Hudson. The room—with its khaki walls, framed Impressionist artwork, and muted television—was oddly quiet. I was accustomed to a cacophony of alarms blaring whenever I encountered a patient in distress, but this room was silent. I imagined myself as the second-year resident, about to lead Lalitha through a resuscitation.
ABC, ABC
A nurse increased the amount of supplemental oxygen as I turned to Lalitha and announced, “Please assess the patient’s—”
“Tension pneumothorax,” she said quickly. “We need to decompress.” She reached for two butterfly needles as I felt for a pulse. Mr. Jones’s eyes were closed and he was gasping for air.
“Got a pulse,” I said firmly. I stared at the man’s heaving chest, relieved that I didn’t need to start CPR. His ribs would have snapped with the first thrust of my palms. Jones was suffering from end-stage AIDS and pneumonia; he was emaciated, weighing less than one hundred pounds, and his cheeks were sunken in. His arms were like two Wiffle ball bats, flailing as he gasped for air. As I estimated his heart rate—it was well over one hundred beats per minute—I pictured myself doing chest compressions on this frail man, and I imagined one of the shattered ribs piercing through his heart like a warm knife through butter.
Don hung back and watched. Standing next to him, in what momentarily seemed like a mirage, was Baio. Instead of going home after his night shift, he’d come to the ICU to check on Darryl Jenkins. They both folded their arms. Part of being a strong supervisor is knowing when to let your intern take the lead, and this was apparently one of those times. Mr. Jones’s eyes bulged as he squirmed in bed, panting for air. I took a deep breath. Lalitha and I were on our own.
“Have you done one of these before?” she asked as we hovered over the patient. “Needle in the chest?”
“I watched the video last night,” I said, feeling like an actor in a commercial saying, “No, I’m not a doctor, but I did stay in a Holiday Inn Express last night.”
“Good enough.” She felt for the man’s left clavicle. “I’ve done one. Just do what I do.” She tilted her head toward his right clavicle and handed me a needle that had been attached to rubber tubing. Lalitha plunged the needle into Mr. Jones’s chest and turned to me. “Go.”
I felt for the landmark on my side and with my left hand thrust the needle deep into the man’s meager chest. In my right hand I held the rubber tubing that was attached to the needle. Don and Baio sidled up behind us and peered over my shoulder. I waited for a gust of air, but there was nothing. “I thought a rush of air was supposed to come out,” I said, “if a bleb really burst.”
Lalitha and I looked at each other nonplussed as Mr. Jones continued to gasp for oxygen. Don and I hadn’t discussed a Plan B. I readjusted the needle and waited for something to happen, but nothing did. I waited for Baio to say something encouraging—you can do this—but he just stood behind me with his arms folded and his mouth shut.
Beads of sweat gathered above my lip as Mr. Jones writhed in his bed and his blood pressure continued to plummet. Two nurses entered the room; one quickly injected a medication into the man’s arm while another checked vital signs. ABC, I said to myself. He had an airway, he was breathing, and he had circulation. What was next? I was watching a man suffocate and I wasn’t sure what to do. Intubation? I readjusted the needle a third time. Nothing.
I looked at Lalitha and she looked at Don. We would need to intubate him if things didn’t turn around quickly. He’d also need a large IV in his groin if his blood pressure dropped again. After what felt like an eternity but was actually ten or twenty seconds, Baio handed Lalitha and me a small Styrofoam cup filled with water. I was about to take a sip when he grabbed it and said, “No.” I looked at Lalitha, who had placed the tubing into the cup, and I followed her lead. Again, nothing.
I readjusted the needle a fourth time and with Baio’s gentle prompting, dropped the plastic tubing into the cup of water. We both peered into my cup, which was now bubbling vigorously, and smiled. “There it is.”
Air rushed out of Mr. Jones’s thorax and into my cup. It was a moment straight out of MacGyver, not an instructional video. How did Baio come up with this stuff? I felt the muscles in my face relax just slightly. Lalitha nodded and glanced at her watch. Minutes later, Mr. Jones was breathing comfortably.
“Well done, Dr. McCarthy,” Baio said, as he headed toward the exit sign. “Amazing things are indeed happening here.”