August 16th, 2004


In London-town...

It was foggy, this morning, as I drove through the pre-dawn darkness from home to this empty and silent apartment where I have nothing to keep me. It was foggy. I left with the usual window of extra time and the usual lack of delays that comes from commuting at 4:45 AM, and I arrived precisely at the time I was slated to arrive. I have thirty minutes before the earliest I could possibly need to leave to be at $hospital. This is precious time, time I could be using to do the dishes I left over the weekend, time I could spend trying to find the e-mail addresses of the doctors I plan to seek out to write the letters of recommendation I should have already asked them to write.

I spent the first five minutes of it sitting on the end of a queen-sized bed, staring into the trifold mirror on the back of the dresser, looking at the face of a stranger.

I am seized by early-morning silence, by the fog and mist that glowed golden and red and swirled around my view at eighty miles an hour down the highway at five-thirty AM. I am wiped clean, empty of emotion, and my cup is filling slowly with loneliness. I stayed the night. I said over and over again, last night, as the hour at which I could have returned here to sleep approached and passed, that I should have come back here. The truth, O Best Beloved, was that I was afraid to come back for just this reason: there was silence around me, as I turned off my book-on-tape and got out of my car and entered my quiet apartment. I had time to think.

I spent most of Saturday and Sunday, almost all of Saturday and Sunday, playing World of Warcraft and I wish I had done something else, but it was good to have time to not-think. I will spend today catching up on yesterday's affaires for my patients, admitting two more (if I get an admission), and trying to keep busy.
Busybusybusy. Because, you see, it is the silence and the aloneness and the emptiness that swallows me whole. And I am alone, here, so terribly alone that at this moment in the post-dawn moments I am contemplating driving back to Fort Wayne in the evening, just to find my Angel and have him hold me.

These days are long, O Best Beloved. So very very long. And we are beginning to discuss in all seriousness how the next three years will proceed.
I have come to realize that the most important thing for me is the ability to go home at night.
  • Current Mood
    lonely lonely
White Coat

Thirty seconds.

Walked into my patient's room this morning. "I want to go home," she says. Then she gives me a Look. "Can I talk to you about something, just between you and me?" Of course you can.
She tells me that if Y, the resident who sees patients with me when S is on call, ever dresses her down for stating her wishes again, that she is going to throw him out a window. Apparently, he told her that she had no right to tell the doctors she wished they would just take her thyroid out if that was what they were going to do, accused her of being too emotional, and told her to just relax while she was in the hospital. I would take it with a grain of salt, but I know Y.

Today: He swept in, introduced himself and me before I could even see the patient around the door, and went through a whirlwind of question-answers, never pausing quite long enough for the patient to think. She has nausea and vomiting and diarrhea, has had for two weeks. That's all that matters to him, despite all his lectures to me about getting a good history and asking questions to sort out the differential.
Today: He interrupted another resident's morning report presentation to take up the topic of the anion gap and how vitally important it was to calculate the delta/delta gap in every patient with an anion gap. The patient in question had an anion gap of 13. Normal is 6-10 or 7-16, depending on which page of the bible Harrison's you read. Someone challenged him. He defended his work by pointing out that the delta/delta showed a hidden metabolic alkalosis. There was a whisper beside me. "Well, yeah, she was vomiting." Not so hidden. And again, a lecture on the urine anion gap. Y loves numbers and mnemonics and steps to go through to make sure you've covered every angle.
Somewhere along the line, he missed one: the bedside manner. He irritates me, abrogates the patient's voice, and sweeps through like some sort of mathematical tornado. He gets the right answer, but leaves everyone bristling. I do not ever want to be Y.

And so help me, if I ever have to have a medical student do what I did today, I may hang up my stethoscope and turn in my license in shame. After S left the room of a mid-seventies lady with chest pain, I looked at her. "They told you you're staying overnight, right?" She nods, with the shell-shocked look of the elderly and terrified and confused. "Do you understand what's going on?" She shakes her head. "Or why you're staying?" This is the second patient, O Best Beloved, for whom I have stopped at the bedside and taken thirty freaking seconds to explain why they are going to be admitted. The first was a lady who asked me, shyly, if she could ask a question. "Am I going to be staying here?" The second was today. Thirty seconds: "In women who have chest pain, especially over the age of 45, we worry about their hearts being the cause of it. Women often don't have the usual presentation for heart attacks. We want to keep you overnight, look at your blood for some markers of heart damage, and do a stress test - look at the way your heart uses blood - in the morning. If all that's normal, then you'll go home tomorrow. If something comes back not-normal, we'll call the heart doctors and have them talk to you. Okay?"
She nodded, managed a bit of a smile. "Okay." I looked into her eyes. "Any questions?" There was a pause, for thought, then she shook her head. "No. Thank you, doctor."

Thirty seconds.
  • Current Mood
    frustrated frustrated