At that moment, Alyssa pokes her head into the room. “Jane,” she says. “Did you get the consent done yet?”
Screw this. I don’t need a translator to get consent. “Give me a minute,” I say.
I take the consent out of my pocket and put it down in front of Mr. Sanchez. “Es una consenta,” I explain. “Necesita… um, sign. Sign-a.” I make a motion like I’m signing a form. “Necesita put una needle in su estomago. Por la agua in su estomago.” I pantomime fluid gushing out of the stomach. “Um, comprende?”
Mr. Sanchez looks up at me, then down at the paper. I have no idea if he had any clue what I just said, but he signs the consent anyway. Thank you, Mr. Sanchez!
I come out of the room, holding the consent up like a medal. Alyssa seems unimpressed by my ability to obtain a signature. “Did you get the supplies?” she asks.
“Um. No.”
She sighs. “Okay, go get them.”
I stare at her. “What supplies do we need?”
Alyssa raises her eyebrows. “Really, Jane. Come on, you should know this by now.”
I should? I’ve been an intern less than two weeks. This is my first peritoneal tap. Why should I know this?
When it becomes obvious that I’m not going to magically know what supplies are needed for the tap, Alyssa starts ticking off what I need to get: “We need a red top tube, a purple top tube, a 25 gauge needle, a 20 gauge needle…”
I scramble to write everything down, knowing I’ll get my ass handed to me if I forget a single item. I run to the supply room, and stock up on two of everything, figuring I’m sure to mess up at least once. I return to Mr. Sanchez’s room, my arms brimming with supplies. Alyssa looks over the contents of my arms, probably secretly hoping I’ve forgotten something. I haven’t.
“All right,” Alyssa says. “I guess we can start.” She eyes my face. “If we’re worried about peritonitis, how many PMNs are we looking for in the tap?”
Say what? I have no idea what she’s talking about, and I don’t even know what the order of magnitude should be for the answer. Finally, I take a wild guess: “A hundred thousand?”
Alyssa couldn’t look more shocked. “Are you kidding me?”
I try again: “Ten thousand?”
Alyssa gets these little pink spots on both her cheeks. “How could you do a paracentesis without knowing the number of PMNs diagnostic of peritonitis?”
It’s probably a rhetorical question but I feel compelled to answer: “I figured I’d look it up after?”
Alyssa’s lips become a thin, red line. “Go find out right now. Don’t come back before you can tell me the answer.”
Cursing to myself, I run out of the room to figure out the answer to the question. I don’t want to miss the entire tap, so I’ve got to get an answer fast. Luckily, I see Connie at the other end of the hallway. Connie did a paracentesis a few days ago, so she surely knows the answer. Hopefully, she doesn’t hate me so much that she’ll refuse to tell me.
I race down the hall, yelling, “Connie!” She turns and her face sours considerably when she sees it’s me. “Hey, I have a question.”
“What is it?” Connie asks impatiently, doing an excellent impression of Alyssa.
“You did a paracentesis, right?”
Connie nods warily.
“Okay, so how many PMNs is the cut-off for peritonitis?”
I’m holding my breath. Connie shrugs. “I don’t know. My patient didn’t have peritonitis.”
“But how do you know he didn’t if you don’t know the cut-off?”
Connie gives me a dirty look. It’s becoming clear that she has no idea what the answer to the question is and also that this conversation isn’t going in a positive direction. Luckily, Nina walks by at that moment. Nina, my savior.
“Nina!” I say. “Do you have a second?”
She holds her index finger and thumb about a millimeter apart. “I’ve got this long. What’s up?”
“Have you done a paracentesis?”
Nina nods.
“Great!” I say. “So how many PMNs is the cut-off for peritonitis?”
And guess what? She has no idea. Neither do the next three interns that pass by. Yet somehow nobody but me has been thrown out of the room for not knowing.
Finally, I give in and go to a computer to look it up. The computers have a ridiculously slow internet connection, but I finally find out from Wikipedia that the answer is 250. (I’m embarrassed that I wasn’t even remotely close in my guesses.)
I return to Mr. Sanchez’s room, armed with my answer. “Two-hundred-and-fifty!” I gasp heroically as I burst into the room.
“Right,” Alyssa says.
She places a Band-Aid over the puncture site on Mr. Sanchez’s belly. I can’t even believe it. I missed the whole goddamn thing. She threw me out of the room for nothing, and I missed out on my procedure. This is so, so unfair.
Alyssa is not going to get away with it. Not this time.
Hours Awake: 5
Chance of Alyssa getting what’s coming to her: Like 5%?
Chapter 19
Part of me is hoping Dr. Westin won’t be around when I get to his office. I don’t know exactly what I hope to achieve by coming here, but I feel like Alyssa’s behavior has crossed some sort of line. I need to talk to a “grown up” about it.
The door to Dr. Westin’s office is open in a welcoming way. As he sees me in the entranceway, he immediately waves to me enthusiastically. “Hi, Jill!”
Dr. Westin is nice. Even though he never gets my name right.
I stick my head inside the office. “Hey,” I say. “Is it okay if I talk to you about something?”
“Of course!” He turns away from his computer and places his hands on his desk. Even though he’s too thin and his hairline is receding, at least half a dozen female patients have referred to Dr. Westin as “that handsome doctor.” At first, I couldn’t even figure out who they meant. Recently, I’ve developed a theory that every male doctor who isn’t outright disgusting with a huge hump on their back or something is seen as “handsome” by the general female population. This seems grossly unfair, but it’s the least of my problems right now.
“Please, have a seat,” he invites me.
I gingerly take a seat in front of his desk, like I’m worried Alyssa might suddenly pop out from a hidden corner. I momentarily get distracted by a framed photo on his desk of an athletic-looking brunette with a young boy who is a miniature version of Dr. Westin.
“It’s about Alyssa,” I begin.
Dr. Westin raises his eyebrows. “Yes…?”
“We don’t really…” I take a breath. “Get along.”
“My, my…” Dr. Westin looks very troubled. A deep crease appears in his brow.
“I feel like I can’t ask her any questions,” I say. “She’s always angry at me. She makes me feel like I’m doing an awful job all the time. She never gives me any positive feedback. I just feel like… I can’t function this way.”
“My, my,” he murmurs again. “And have you told this to Alyssa?”
I shake my head.
“Let me tell you a story, Jem,” he says. Jem? He thinks my name is Jem? Wasn’t that a cartoon rocker from the eighties? “Say there’s this professor who notices that one of her students, Stacey, shows up for class ten minutes late one day. The professor thinks to herself that Stacey doesn’t care at all about the class and she doesn’t even have the courtesy to be on time. The professor thinks Stacey’s interrupting the whole lecture, and that Stacey is overall just very inconsiderate.”
“Uh huh,” I say.
“Except here’s what really happened,” he goes on. “Stacey’s grandmother was very ill and she went to see her over the weekend. Because the professor’s class was so very important to her, she caught an early flight back to school in order to be sure to make it in time. Except the flight was delayed. Stacey caught a taxi straight to the school from the airport, all just so she could make it to that lecture.”
“I see,” I say, even though I think that Stacey and the professor both kind of seem like losers.
“Stacey and her professor needed to communicate,” Dr. Westin says. “And that’s what you and Alyssa need to do as well. You need to tell her how you feel.”
I don’t want to tell Alyssa how I feel. I just want to throw something at her.
“Can you do that for me, Jem?” he presses me.
“Okay,” I finally say.
Dr. Westin rubs his hands together. “Good, good.” He grins, showing a row of slightly yellowing teeth. “I predict that by the end of this rotation, you and Alyssa are going to be best friends.”
Best friends. Yeah, maybe if we don’t kill each other first.
_____
As I’m rounding the corner to get to the cafeteria, I hear shouting. Female shouting. Not that yells and screams are an unusual occurrence in the hospital, but this sounds a little different somehow and the voices are oddly familiar. I slow to a stop and start searching for the source of what seems to be a really passionate fight.
After a minute, I find Nina and Julia standing in a nook by the staircase, glaring at each other. Julia is pointing a finger menacingly in Nina’s direction. I’m actually a little frightened for Nina, who is half a head shorter.
“You think I don’t know what you’re doing?” Julia hisses.
“I have no idea what you’re talking about,” Nina says, although I can see a crease between her brows.
“You’re sneaking out during your calls,” Julia snaps. “I know it and soon our attending is going to know it.”
“That’s a complete lie,” Nina lies.
My Dansko clogs squeak against the floor and both girls look up. I blush and wave awkwardly. “Hi,” I say as I waggle my fingers. “Um, anyone want to get lunch?”
Julia looks from Nina to me with utter disgust. “Neither of you has any integrity,” she says. She shifts her menacing finger to point in my direction. “I know you had a boy over the night before last,” she says.
“Don’t be silly,” I say. I let out a little strangled laugh.
“He left the toilet seat up,” Julia says.
Damn you, Sexy Surgeon! “I always pee with the toilet seat up,” I lie.
Julia just shakes her head at me. She turns back to Nina. “If you do it again,” she says, “you are going to suffer the consequences.”
On those words, Julia turns on her heel and storms off in the opposite direction, leaving Nina and I with equally stunned expressions on our faces.
“Christ,” Nina says. “How do you live with that crazy person? Aren’t you afraid she’ll murder you in your sleep?”
“A little,” I admit.
“If you do it again, you are going to suffer the consequences,” Nina says in a mockingly high voice. “Who the hell does she think she is? A Super-Villain? I’m just giving shots to my diabetic cat. Sheesh.”
“Yeah, well, wait until you hear what she left on the bathroom door.” I quickly get Nina up to date on Julia’s Bathroom Manifesto, and the fact that I found a Kitchen Manifesto this morning taped to the refrigerator. I fear that I’m going to be spending most of my intern year cleaning the bathroom and kitchen of our apartment.
“Wow,” Nina breathes. “What a nut job.” She links arms with me and starts pulling me in the direction of the cafeteria. “But what I really want to know is, who is this boy you had over the other night, Dr. McGill?”
My cheeks grow hot. I’m not sure if I want to share this with anyone, even Nina, who is quickly becoming my best friend around here.
“You’re blushing!” Nina says joyfully. “You can’t deny it now because you’re blushing. Spill!”
“It’s just a surgery resident I met in the hospital,” I mumble.
Nina stops and examines my face. “Wow, you really like him. You’re in love.”
“Oh my God, I am not in love!” I’m really not. “I hardly know him. Actually, he’s kind of a jerk.”
“No, you’re in love,” Nina insists gleefully. “You luuurve him! You lurve him and you want to have like a million of his babies.”
I cringe. “Don’t mention having babies. Please.”
Nina sighs, suddenly glum. “You’ve got a cute surgeon and all I’ve got is a diabetic cat.”
“I think I would take your cat over the surgeon,” I say. “Really.”
“Well,” Nina says thoughtfully. “He is a very sweet cat.” She brightens. “Do you want to see some new photos?”
I really, really don’t. “Sure,” I say. Apparently, I am physically incapable of refusing to look at photos of cats and children, so I spend the next several minutes indulging Nina by looking at photos of Valsalva scratching at a post or playing with a toy mouse.
“By the way,” I say, trying to end the slide show. “You were right about Connie being evil. She jumped on me yesterday because Dr. Westin said she had to take one extra admission.”
Nina beams. “Say that one more time.”
“Say what?”
“The part about me being right.”
I raise my eyebrows. “Uh, you were right about Connie.”
Nina smiles. “First time I’ve heard I was right all month. I was beginning to forget what it felt like.”
Amen to that.
Hours awake: 7
Chance of quitting: 18%
Chapter 20
I get an easy admission in the afternoon: a young woman with a diagnosis of pyelonephritis (kidney infection). I feel like I’ve had a lot of pyelonephritis cases since I’ve been here, although I’m beginning to notice that 90% of all patients at County Hospital share one of the following ten diagnoses:
1. Chest pain, rule out heart attack
2. Heart failure
3. Cirrhosis (liver failure)
4. Emphysema/asthma
5. Kidney failure
6. Pyelonephritis
7. Stroke
8. Pneumonia
9. GI bleed
10. Alcohol/drug intoxication/overdose
I guess that’s how you get to pretend to know everything: pretty much everyone has the same ten diagnoses.
This patient is named Carla Canady and she’s twenty years old. Her age is good news since young patients don’t stay long in the hospital and my service is gigantic. The other piece of good news is that they put her in a room with Mrs. Jefferson. That saves me at least a little bit of running around. I think I walk the equivalent of a marathon while on call.
From Ms. Canady’s social history in the ER note, I discover she’s the mother of a two-year-old girl. I have to say, the patients at County are making me feel like I ought to have popped out at least three kids by now. By twenty, everyone has a kid, sometimes two. And there’s a tiny voice in the back of my head that wonders if I’m not doing things the wrong way. Wouldn’t I be happier if I were taking care of my baby now instead of pyelonephritis patients? Isn’t procreating what nature wants me to do?
Not that I have anyone to procreate with right now. Not exactly.
Ms. Canady’s other problem is that she’s diabetic. And she’s not taking very good care of her diabetes. Actually, that’s an understatement.
The test we use to measure diabetic control is called a Hemoglobin A1c. An A1c of less than 6 would mean excellent control of the diabetes. An A1c of less than 7 is good control. Ms. Canady’s A1c was 13. That means she’s essentially treating her diabetes with sugar pills. Literally.
I go in to talk to her, and she reminds me a lot of my teenage cousin who is always rolling her eyes and saying, “Whatever.” She has on way too much make-up, especially around the eyes, especially considering she’s sick and in a freaking hospital. I can’t believe this girl is a mother, although she does look much older than twenty.
“You guys are giving me way too much insulin,” she tells me when I come to see her.
I think if she thinks it’s way too much insulin, it’s probably just the right amount. “When y
ou’re sick,” I say, “it’s really important to keep good control of your blood sugars.”
“I just have an infection though,” Ms. Canady says. “Don’t you treat that with, like, antibiotics?”
“Right,” I say. “But if your blood sugar is controlled, your body is in better shape to fight the infection.”
“But doesn’t sugar turn into energy to fight infections?” she says.
I almost start to launch into a big explanation, but instead I decide not to waste my breath. “No,” I say. “It doesn’t.”
“Whatever,” Ms. Canady says and rolls her eyes. But at least she doesn’t protest any further. For now. I have a feeling this battle is only just beginning.
_____
I end up down in the ER with Alyssa for a GI bleeder. The woman has blood coming out both ends, if you know what I mean. We were all set to admit her to our service when her blood pressure took a nosedive and she earned herself a trip to the ICU instead. Unfortunately, by the time we get done in the ER, it’s after 7 p.m., meaning the cafeteria is closed.
I comment on as much while I ride upstairs in the elevator with Alyssa. As I say the words, my stomach growls pointedly.
“You should have stashed some food from lunch,” Alyssa points out. I don’t know where she expects me to store food since we have no fridge. In my cheeks? She whips her phone out of her pocket.
“I’m going to call my husband and ask him to bring over some fast food,” she announces.
For a moment, I actually think Alyssa might offer to have her husband pick up some food for me as well, but that doesn’t happen and I certainly am not going to ask. I think I’m going to have to take my chances on the food cart. I finish up a few notes and head downstairs.
Luckily, the food cart is actually there this time so I can eat something aside from popsicles. As soon as I get out, I can smell meat heating up in a big vat of oil—the stench permeates a 20-foot radius surrounding the food cart. They have a wide selection of red-checked boxes containing the various deep fried options. After quickly surveying the possibilities, I buy a box of something thickly breaded, possibly shrimp, with a side of French fries and a soda. I carry it up to the resident lounge.
The Devil Wears Scrubs Page 13
