Written By: Nathaniel Morsches
Before the start of the shift, before I could even make it to the doc box, the police met me at the entrance to the Emergency Department. But if I was already thinking of quitting, what did it mean that this made me want to stay? Out of spite, possibly. Or duty. Or some bruised, unnameable thing.
“Are you Dr. Ross Magdasal?” the tall, brown-haired officer asked me. He pronounced it like, “Maggot sail”.
“Yes. Am I in some kind of trouble, officer?”
“No legal trouble, but we need to make sure you and your family are safe.”
“I’m sorry?”
“At 1816 hours, your secretary received a phone call from an unidentified male-sounding voice who stated that his intention was to murder you and your family.”
The idiot had called from his home phone, so the police had arrested him within an hour after this conversation. Barely remembering when I actually saw the patient 2 weeks ago, I had apparently instructedthe nurse that two turkey sandwiches was enough and that we needed to save the last one for a patient who had not yet had one. Well, Neil didn’t like that, so he sent this death threat to ensure that his point was made.
I had to drive home, bring my family across town to stay with my sister, and tell my crying wife that everything was going to be okay.
I was an hour and a half late getting started seeing patients, but my colleagues didn’t give me a hard time. It wasn’t a death threat for them today, but maybe it was getting punched. Maybe it was getting spit on. Maybe it was getting sued for telling an obese patient that losing weight would help their health.
I didn’t bother asking my supervisor if I could stay home. There were no replacements for me, so I just started my work. I thought of my family scared at my sister’s place and hoped I’d be able to focus at all that shift.
“No, you don’t understand, sir,” I said to the patient. His hands were balled into fists, so I took a step backward. “I can’t give you anything to drink. You’re going to surgery. If –”
“I am literally dying of thirst, man. If I discharge myself AMA, would you give me a drink?”
“You can’t leave Against Medical Advice. You don’t seem to hear me, sir. This is serious. If you leave, I’ll tell you what will happen: Your oxygen levels will drop so much that you will eventually pass out. Hopefullybefore you die, someone on the street will see you and call 911. Then the ambulance will bring you back here, and then we will go through all of this again, except this time it will be under implied consent, since you won’tbe conscious, and you’ll be almost dead. And all this for a sip of water?”
“If I leave AMA, will you give me a drink?” His hospital gown had slipped off of his left shoulder and I could see the impeccable implanted pacemaker scar on his chest.
“Yeah. Fine. But please don’t–”
“Okay, I’m leaving AMA,” he said. He removed the gown and began putting on his shirt. “Go get me some water.”
I brought it to him while the nurse discharged him from the board. The man gulped it down and smiled.
“Okay,” he said. “I’d like to check back in now, please.”
“Really?” I muttered to myself. I stood outside the room for a second and screamed without sound intomy hands.
Next patient, I guess. I rushed over to my desk as my colleague transcribed her note with the microphone AI software.
“You alright, Ross?” Dr. Jennifer Glass asked me. She sipped lukewarm coffee and looked like she hadn’t slept in days.
“Yeah. All good. Guys like that last guy make me wanna quit healthcare. I just hate it when they interrupt me, you know?”
“Yeah, I know. But I’m talking about everything with Neil and his nice little phone call for your family.”
“Oh, yeah. I’m alright, Jen. There’s not much to do about it. You know they’ve already got him in custody?”
“Oh good. Is there anything I can do for you or your wife?”
“Nah. We’re good. Thanks for the offer, Jen.”
“You sure?”
“Yeah.”
“You can tell me if you’re having a hard time, you know,” she said.
“Jen. I’m fine.”
An alarm on the monitors chimed. I used to hear them go off, but now, they’re more like elevator music.
“Hey, are you gonna get the flank pain or the migraine?” she asked.
“My daughter gets pediatric migraines,” I said. “I’ll take that one.”
Heading into the room, a man laid in bed laughing at a TikTok video of a body builder in neon tie-dye running through the streets of Baltimore.
“Hey there. My name is Dr. Ross Magdasal. What brings you in tonight?”
He held up a finger indicating that I should wait a few more seconds until the video was done. Once that business was complete, he finally looked me in the face. The patient was here for a headache which had lasted for six days. He told me about his history and the medicine his primary care had prescribed, Sumatriptan. It hadn’t worked.
“What’s your pain on a scale of 0 to 10?” I asked.
He chuckled like I asked him a stupid question. “20,” he said, “And I know you might be tempted to just type in 10, but I’m telling you it’s off the charts. Type in 20.”
“Sir, I don’t have the ability to type in anything. It’s an electronic form. I have to click one of the numbers. If I put 10, it shows that it’s the maximum. And besides—”
“My pain is more than a 10.”
“I understand, sir. May I finish what I was saying?”
“Fine.”
“The number doesn’t actually mean anything. Its only importance is its relative change later. If you say eight later, then that tells us your pain has improved, but your initial pain rating doesn’t actually matterotherwise.”
“Now my pain’s a 25, asshole.”
“Okay. So what I’ll do is write for the migraine cocktail. It’s very effecti—”
“You’re not listening to me. There’s only one medicine that ever seems to help. I can’t remember its name. Hmm… I think it starts with a D…”
“Please stop interrupting me.”
“Are you going to help me or not?”
“I’ll need to look through your chart.” I got up from the stool and walked out. When no one was looking, I slammed my fist into the wall. No security guards came running, so I looked back at the wall and gave it a solid headbutt.
“What’s the matter, Ross?” Dr. Glass asked back at the doc station, while I rubbed my knuckles. The peeled back skin was gray and translucent.
“Nothing,” I said.
“Oh yeah? Nothing? Why do you look like shit then?”
“I… look who’s talking. There’s yogurt on your chest.”
“Not good enough, Ross,” she said as she wiped her scrub top with a napkin.
“Fine. You wanna know why I’m mad?”
“Yeah.”
“He asked for the medicine that he can’t remember the name of, but it starts with a D.”
Jen paused, processed, and then started laughing. I didn’t join her. The medicine was Dilaudid, and the patient knew exactly what it was. Was it possible that the guy wasn’t trying to abuse the system? Yeah, of course. But his chart showed that he’d filled prescriptions for narcotics at 17 different pharmacies all over the state in the last three months, and I’m just trying to get through this damn shift.
For a moment, I imagined Neil and the starts-with-a-D guy recognizing each other. A small nod. A shared language. The kind of men who know the system better than we do.
“I don’t know how much longer I can do this,” I said to my computer.
“Code blue, trauma room 2, emergency department,” the overhead speaker said, “Code blue, trauma room 2, emergency department.”
“I got it.” I said to Jen.
“Come on, Ross. You’ve had a rough one today. Why don’t you let me—”
“Jen. Drop it. I already have my gloves on.”
The patient was a seven month old child. Goddamnit. There was cyanosis around his lips, and his mother who had carried him in from triage was screaming in the corner while staff piled into the room. My favorite tech, Yvonne, had already begun chest compressions because the baby’s heart had stopped.
I looked at this little boy who had the same size and shape as my own son. Everything around me was quiet. I heard the dull shuffling of Hoka shoe soles across the floor, but no one shouted over each other. They just pumped his chest, started an IV, and looked at me for orders. It was actually this serene silence that livedin my nightmares. It was like the sound of getting caught under the surface of a frozen lake.
“He’s in asystole. 1 milligram epinephrine,” I said. After intubating him, we went through the Advanced Cardiac Life Support algorithm over and over until I knew where things stood.
The mother sat at the very edge of her chair, with her back straight, hands on her lap, and eyes boring into me. Her left leg was bouncing up and down.
“Ma’am,” I said, “we’ve been resuscitating Mano for 35 minutes now, and we haven’t seen any indication that his heart will begin beating on its own again. You told the triage nurse that you had found him like this and he was down for an unknown amount of time?”
The mother wriggled in the chair and then just stood up to meet me.
“Yes, doctor.” She grabbed my forearm and squeezed. “Oh God.”
“I’m so very sorry, ma’am, but I believe it’s time to stop.”
The sterile lights reflected off her glasses, hindering my ability to view her eyes, but I could still see the tears sneaking down her cheeks.
“No, no, no, no. Isn’t there anything more you can do? Please. He’s my son.” She wasn’t angry. She was begging.
“Mano has the same eyes as my own boy. I would not tell you it’s time to stop if I had any doubt in the world. I am so sorry.”
She nodded at me and walked out of the room like a woman waddling out of a movie theatre after the rolling credits. Eyes glazed over, wide and careless gait ready to knock over the trash cans on her way out.
She stopped and turned to face me in the hallway. Everyone around me hustled about, but she was still. I wasn’t sure if she said it to me or not: “How can we ever come back from this?”
“Stop compressions,” I told Yvonne. “Time of death 23:47.”
The mother spent time alone in the room with Mano. I imagined her talking to him about what it would have been like to take his first steps. Ride his first bike. Take his first date to the prom. After his first dance with his bride, take mama’s sweet wrinkly hands and sway to the music together in front of many witnesses and God.
When she was done and had gone home, I saw Yvonne gathering the supplies for the plaster mold. Sothe parents could remember. As if they’d ever forget.
“Wait, Yvonne. I’ll do the mold this time.” I said.
“You sure? Docs don’t usually have to do this.”
“I know, but I want to.” I noticed her badge holder was an image of a lotus flower.
“Okay. Well, I gotta go do a blood draw in room 18 anyway. Thanks. Here’s the stuff.”
I snuck through the curtain and looked at Mano. He was too small for such worldly violence. There was no sound. Just that serene silence that would keep me awake that night and every night, which I didn’t dare break.
His milky palm naturally spread its fingers apart in the latex, but his arm wasn’t quite long enough to reach over the side without spilling the liquid. I had been too stupid and overfilled the container. I’d cling to this earth as a wandering wraith before I would make this mold imperfect, so I dumped out the latex and started over.
Before attempting immersion again, I put both of his hands together in a prayer position and I gently placed my forehead against his. Those hands were the same as my own son’s, angelic and lovely. I held both of them in mine and I whispered into his ear, “It could have been so different, little boy.”
The mold came out exactly as his mother would have wanted. It captured every little crease and tiny pore. His wide fingers were both proud and awkward, which made me imagine a stuttering prince. Still gloved, I wished I had made the effort to feel his skin with my hands.
Slipping into the bathroom, I locked the door and watched my reflection frown and then sob into his palms. I waited patiently for him while he cleaned himself up with that rough brown hospital paper towel as it scratched up his cheeks and nose. When the sclerae of his eyes finally went back to pink instead of bloodshot, I left him in the dark and closed the door behind me.
I didn’t look at Jen as I passed the doc station. Everything smelled like latex and warm plastic. Someone yelled, “No! Not yet! I’m not ready!” down the hall away from me, but I just walked to my next room. It was a man with ankle pain after he had stepped in a pothole.
“Where the hell have you been?” he said.
“Excuse me?” I asked.
“I’ve been waiting for three hours.”
“I’m sorry, sir. There was an urgent matter that required all of my attention.”
“I asked for a sandwich an hour ago.”
“I’m very sorry about that, sir. I’m going to do my best to take care of—”
“You keep saying sorry, and there’s still no sandwich in my hand.”
I looked at the tanned, leathery appendages he called hands. He had clubbed fingers from smoking for decades. Could they even hold a sandwich without tearing it to pieces?
“Please don’t interrupt me,” I said.
“Get me a fuckin’ sandwich now.”
There was a patch of red paint that was peeling in the top right corner of the wall I faced. The red flap moved as the air condition blew past it. It was waving at me. Taunting me. The monitor was disconnected from the patient and it beeped. It screamed, actually. It was getting louder, and I felt vomit tickle the back of my throat.
“You know, this isn’t an easy job,” I couldn’t help but say.
“What?”
“People like you do not make this job easy. You wanna know what I was doing before I came in–”
“Well, boo hoo, Doc. Hopefully, your million dollar paycheck will help you sleep–”
“No. God. Stop. You may not interrupt me again. I was resuscitating a baby who had died in his sleep. You think your sandwich is higher on my priority list? Get a life.”
“Oh,” he said. A Stroke Alert went off overhead. Jen would get that one. An alarm beeped in the room over and I stared at the man.
“Yeah.”
“So is the baby okay? Shit. I don’t know why I asked that,” he said, voice caught between guilt and disbelief.
I left him without a word and went into the store room. I found gauze wrap and started repairing my injured knuckles from earlier. Before I left the quiet room, I called my wife. She woke up for me, but was glad to hear my voice. I was glad she was safe.
“Oh, Ross. There you are,” Jen said. She almost bumped right into me as I was coming out of the store room. She put a hand on my shoulder and gently pushed me back in, and closed the door behind her.
“Jen, what’s going on?” I asked.
“You are a great doctor. I’m on your side.”
“Okay.”
“You’ve had a really bad day, and I think it’s affecting you.”
“No, it’s not, Jen. I’m fine.”
“What are those bandages on your knuckles then?”
“Take it easy,” I said.
“Why are your physician notes written like a mad man?”
“You read my notes?”
“Yeah.”
“Why would you do that? I thought we were friends.”
She handed me a printed copy of a few of my notes from the last few hours. “Can you blame me?” sheasked.
The packet of notes had highlighted areas. I had missed an elevated creatinine level in a patient with no prior history of kidney failure or congestive heart failure, and I didn’t give fluids. There was another patient who should have had linezolid for cellulitis, history of MRSA, and allergy to vancomycin. I had given Bactrim like a first-year resident.
“I can’t believe you read my notes, Jen,” I said.
“I’m glad I did. You can fix this now. But tomorrow, administration will be able to look it all over.”
“They’ll be able to see the changes any way. It still records everything you ever sign.”
“Ross,” said Jen, “you know you have to change this stuff.”
Behind Jen, next to the door of the store room hung a poster. “Physician Wellness” it said across the top in yellow letters. It was an advertisement – my friend, Harry, head of the psychiatry department was offering free sessions of counseling to doctors at the hospital.
“I don’t have to change anything,” I said.
“What are you going to tell Sabrina in the morning? That you actually thought your patient was becoming a demon?” She was referring to another note, in which I had clearly meant to say that the patient had a “labile demeanor.”
“I don’t know yet. I’ll come up with something, though.”
“Ross, please. Let’s go sit down, fix your notes, and go over some of these treatment mishaps. I’ll help. I’m here for you.”
“Why do you want to help me?”
“Come on, Ross. You’re gonna get through this,” she said placing her hand on my shoulder. She opened the door and the sounds of chaos from the department came flooding into my sanctuary.
I thought of Mano and whispered, “It could have been so different, little boy.”
“What did you say?” asked Jen.
I grabbed the Physician Wellness poster from the wall and put it into my breast pocket. Jen and I sat down together and got to work.