Originally posted in December 2005:
I lingered in the stairwell for a few moments—just a few—today.
The entire stairwell is composed of concrete. The walls are off-white and the floor is now that dingy copper-grey-brown color from years of feet tromping up and down and up and down again on those tired steps. The ceilings are probably close to fourteen feet high and a slim, scratched, rectangular window starts about six feet from the floor. One has to be standing on step two or three from the ground to actually look out the window.
The liquid orange light of the dying sun—and it dies so early these days!—poured through the small gaps between the thick wall of charcoal clouds surrounding the city. A shiny white ribbon of car headlights rippled far below; to its right was a parallel ribbon of shimmering red tail-lights.
It’s cool in that stairwell; the vents that allow the chilly air flow in aren’t visible. Very few people use that stairwell, partially due to its distant location from the rest of the hospital, partially due to the low temperature of the ambient air. It has been completely empty every single time I have set foot in there.
And those few moments of respite are necessary. The ambient noise of the hospital—the malfunctioning IVs, the flushing toilets, the retching or crying or moaning or snoring or yelling patients, the ringing telephones, the beeping pagers, the tapping of keyboards, the thuds of dropped charts, the clatter of dropped silverware, the weird syncopated tonal rhythms of the ventilators, the sobbing of family members, the murmuring of the teams rounding, the sighs of the housestaff and medical students, the uneven rumbling of the cafeteria carts rolling past, the quiet Christmas music floating from the guitar in the performer’s arms—can be too much.
Sometimes it seems like the suffering that surrounds us all never ends. Even though miracles may be happening in every single room—the birth of a baby, the healing of a wound, the deaths of millions of bacteria in the blood, the sealing of fractured bones, the clotting of a wound in the esophagus…
… and for those few moments in the stairwell, everything is quiet and still.
And when my right hand turns the handle and I fling the door open back into the hospital, I am ready to jump right back into the fray.
I am using this stairwell again, now on a regular basis. It’s hard to believe that in a short five months, the dingy grey of winter will smother the city again and what we now take for granted—the cloudless blue skies, the distant snow-capped mountains peeking at us in the distance, the sun that rises before we get out of bed and sets well after we eat dinner—will disappear.
The air in the stairwell is now heavy and warm, reminiscent of the stagnant air on an overcrowded bus stuck in downtown traffic. The whoosh of the air-conditioned breeze upon swinging open the door out of the stairwell is refreshing.
The stairs generally remain unused; usually only my echoing footfalls accompany me as I travel between floors. I haven’t made a point of stopping lately to listen to the resulting silence; my mind has been restless.
People ask me what I am going to do next year—I cannot provide a definitive answer. I share my hope, but hopes are merely thoughts. I’ve done what I can to encourage the fruition of my thoughts and, as a result, am significantly less anxious now. Waiting, though, always takes more time than I’d like.
14 Jul 2007 | 3 comments.
Things I Recently Learned.
>> Post-call residents are sleepy. I did not learn this recently, as I have experienced this myself, but I did learn just how sleepy we can be. When post-call, residents apparently experience daytime sleepiness that rivals that seen in sleep apnea and narcolepsy! I am not certain of the exact citation, but this source supports the assertion. We apparently also don’t realize we are falling asleep when we are falling asleep during our post-call periods.
>> Drinking and dancing may be dangerous for your health. And when I say “dancing”, I don’t mean Da Club two-step—I mean lindy hop. A man—a good, reliable lead—with whom I regularly dance agreed to dance with me.
“How are you?” I asked.
“A little drunk,” he blurted out. I laughed at his blunt response. “I’m just warning you.”
The song was on the fast side and the alcohol clearly had his head spinning—he stepped on me, fell into me, and inadvertently tried to lead me into several other people (follows can become human boomerangs or ninja stars, depending on the lead). Embarrassed, he stopped mid-step, realizing that he failed to catch my hand to stop my travelling. I laughed and made my way back to him in time.
“I’m sorry,” he said, the fragrance of sugary alcohol wafting from his mouth. “You’ve been trying to protect yourself from me during the entire dance.”
This was true. “But at least you warned me,” I said.
Alcohol may be a social lubricant, but it makes people slip up on the dance floor.
>> That may not actually be PCP in the pee you see. (Sorry.) When urine is subjected to toxicology screens (for cocaine, heroin, etc.), false positives may appear. PCP is apparently not a commonly-used substance in the Pacific Northwest and thus, we were advised that if we came across a urine toxicology screen that was positive for PCP, we should ask the patient if s/he had taken other substances. Guess what the substances are?
Diphenhydramine (Benadryl) and dextromethorphan (cough syrup)! People do consume these substances to get high (think high school kids and other people who cannot afford alcohol) and thus, it is possible that we may see these individuals with altered mental statuses (stati?)… though people who are acutely intoxicated with PCP generally behave in highly threatening and scary ways. People high on Benadryl and cough syrup usually appear confused and disoriented.
>> Paraskavedekatriaphobia. It means “fear of Friday the 13th“. The term doesn’t appear to be official (Merriam-Webster does not recognize the word), though one can find treatments for it on the first page of a Google search. (sigh)
12 Jul 2007 | 3 comments.
Literary Medblogging Project: A Picture….
The title of this Literary Medblogging Project is “A Picture is Worth A Thousand Words”.
I solicited medbloggers to participate in this summer’s edition of the Project: Write a medically related story that is less than 1000 words from the following image:
Read the literary creations of the medblogging bards:
(Curtsey to the lovely Barbados Butterfly who so wanted to emerge from her writing cocoon, but the chrysalis of work has foiled her efforts!)
To all the literary medbloggers who continue the tradition of nurses and doctors as storytellers, thank you.
The only reason why she ended up at the hospital was because someone had called an ambulance. She was sitting alone on the bench at a bus stop, cradling her protuberant belly and moaning in pain. It was late—maybe 2:00am or so?—and the medics easily coaxed her into the A-car.
It was an uneventful delivery; her son entered the sterile world of the operating room within the hour she arrived at the hospital. People were surprised to see her. The last time she had visited the hospital was about a year ago, when she had an abortion.
She was displeased with the birthmark. When the nurse placed her newborn son into her arms, she flinched. A black heart covered the right half of his face, as if someone had spilled ink on his head.
She held him, but said nothing. A nurse asked her to say, “Cheese!” and took several photographs of the couple. Mother and baby did not smile.
This was another black heart, another reminder of the hatred from the world. Two days ago, she saw a man with a dark heart tattooed on his neck. Last week, a child clutched two balloons while walking down the street with her parents; the two balloons formed a floating, wobbling heart. The two potholes on 4th Avenue near Park Street were shaped like hearts with ragged edges.
People seemed to speak incessantly about hearts. When the chic young women with Louis Vuitton bags dangling from their slender shoulders walked along 2nd Avenue, they always said, “I love you!” into their shiny cell phones the moment they passed her. She started to shout back at them to halt their taunts: “You do not love me! You hate me! I see your black hearts!”
The police asked her to stop shouting at the pedestrians. She spit at them.
In jail, the stains on the floor resembled watery hearts. She saw chains of hearts in the oatmeal that congealed in the plastic bowls. Holes shaped like hearts appeared only in the slices of white bread she received.
She had the abortions because people told her that she couldn’t take care of babies. Where would the children live? How would she purchase food, clothing, and toys for her kids? If she didn’t feel safe in the world, how could provide safety for them? If she took her medication as directed, they advised her, maybe she could raise a child with some help.
The medication, she knew, would further blacken her raven heart.
She looked at his face again. She removed him from her lap, placed him on the bed, wrapped her gown around her, and walked out of the room.
Her son started to cry.
These days, she skims the crowds with her eyes while smoking cigarettes by the fountain in the concrete park. During the rainy season, people often wear hoods or hats that obscure their faces; sometimes people carry their umbrellas too low over their heads. Occasionally she lurches forward in recognition, only to realize that she merely saw a shadow over the stranger’s face, not a dark birthmark.
Her son would be around twenty years old now. She wonders if he lives in the same city; sometimes she wonders if they had already crossed paths. She isn’t sure if she wants to meet him. She just wants to see him and how he has grown.
Black hearts no longer follow her the way they once did. Now that she is searching for them on the faces of men, they are more difficult to find. Perhaps the world no longer feels as much hate towards her. She’s not sure.
He keeps the black heart in a drawer in his apartment. The photograph of their unsmiling faces is buried between the old tee-shirts he no longer wears. His girlfriend occasionally traces the faint scar on his face with her fingertips; she only sees it when she is cologne close. He doesn’t recognize either person in the picture. It is as if the photograph is a generic paper insert in a low-quality picture frame.
She keeps looking. He keeps looking away.
10 Jul 2007 | 8 comments.
Spam of the Day.
From: Melnora haddonfield
To: Maria
Date: Jul 9, 2007 6:40am
Subject:
Your penis will be big enough to hang your clothes to dry.
(link to “Penis Enlarge Patch Rx”)
9 Jul 2007 | 4 comments.
Bureaucracy.
A patient has a tube that connects her insides with the outside (technical terms). A clog forms within the tube. Multiple people with a variety of letters after their last names try different methods to dislodge the clog; no one succeeds. The surgeons want to visualize the area where the tube is located before pursuing any procedures. This results in the saga of…
How to Get a Radiology Study for a Patient in the Hospital:
1. Tell the patient you have ordered the study and why. (0 hours.)
2. Fax the radiology request to the radiology department.
3. Call the radiology department to confirm receipt of the request. Someone states that the procedure will be done before the day ends.
4. The day ends and the weekend begins. (8 hours.)
5. Ask the nurses of the unit if the study was completed. The nurses say no. One of them proactively calls the radiology department to ask why the study never happened; someone replies, “We never got the request.” (15 hours.)
6. The patient expresses umbrage at the shoddy care.
7. Call the radiology department and ask when the procedure can be done—it’s not exactly urgent, but it’s not routine, either. Someone replies, “It’s not an emergent procedure; it won’t be done until Monday.”
8. Call the radiology resident on call and repeat the request. The radiology resident replies, “It’s not an emergent procedure; it won’t be done until Monday.”
9. Consider climbing the academic hierarchy to coerce the radiology staff to do the procedure, but realize (probably correctly) that the effort is futile.
10. Page the surgery resident to explore other options that may or may not involve a radiological intervention. (16 hours.)
11. The surgery resident calls you back. (17 hours.)
12. The surgery resident kindly offers to brainstorm with the radiology resident so that a study can be obtained within the next few hours.
13. The nurses offer to contact their supervisor to prevent this type of shoddy care from occurring in the future. Say, “Thank you.”
14. The surgery resident pages you. (18 hours.)
15. Call the surgery resident back. (18.016 hours.) The resident offers another radiological study that includes injection of a dye. This procedure can be done over the weekend. The resident asks you to write orders.
16. Call the radiology resident and ask how dye can be injected into a tube that is clogged. The radiology resident stalls, but ultimately states the study is warranted and that perhaps, a small bit of dye will make it through the tube.
17. Call the nurse and politely ask her to take down a verbal order for this study. She politely does so.
18. Your attending pages you. (19 hours.)
19. Call your attending back. He says, “Just wanted to give you a heads up—radiology didn’t do that procedure yesterday.” Nod vigorously in an annoyed fashion, though he can’t see you. Tell him that you’re taking care of it.
20. Someone from radiology pages you. (22 hours.)
21. Return the phone call. The radiology tech reports that he cannot perform the procedure because he is not permitted to inject the dye. “You can, though,” the tech says. “You’ve got an MD.”
22. Look at your growing, disorganized queue of consult requests. Ponder throwing the phone across the room.
23. Say, “Thank you,” and hang up.
24. Call the radiology resident and argue your case: Psychiatry residents don’t routinely inject dye into these tubes, are unfamiliar with this dye (and what adverse reactions can occur from it), and are uncomfortable doing this. “Plus,” you add, “we’re getting slammed today with consults.”
25. The radiology resident agrees and generously states that he will push the dye. “But please re-fax the order and note on there that I’ll push the dye.”
26. Re-fax the radiology request.
27. Confirm that the radiology study has been completed. Call the radiology resident to learn the findings. (24 hours.)
28. “The tube wasn’t clogged,” the radiology resident dryly replies. “The dye went in without a problem.” Smack yourself in the forehead. Twice, for good measure.
29. Thank the radiology resident and hang up.
(sigh)
8 Jul 2007 | 5 comments.