Call #2

Today will be different. Today I will not make any mistakes. I have my sticky notes. I will not give Alyssa any cause to yell at me. I will be the best intern who ever was.

Ha.

I have five patients going into my call and we’re meeting Alyssa in the resident lounge at 8a.m. Even though I’m technically not supposed to arrive at the hospital until 7:3O for call to avoid breaking work hour rules, I come in at 7:15 because I am supposed to pre-round prior to our meeting, and I want to make sure I have all the information ready. I am just that dedicated.

I arrive at the lounge at 7:55 a.m., but Alyssa and Connie are both already there and acting like they’ve been waiting for hours. Alyssa looks at her watch and sighs loudly. I’m early, you know!

I plop down on the couch next to Connie. For some reason, Connie only has one patient going into call, while I have five. How did this happen? I have no clue.

Connie is blessed, I think. She’s the sort of person to whom good things always happen, and it’s not clear whether she engineers it that way or she’s just lucky. She has a very innocent look, with her layered black hair always pulled back in a thin pink headband and dimples I could stick my whole pinky inside. It’s hard to imagine any treachery coming from Connie. Then again, she’s a dermatology resident. (More on them later.)

Alyssa crosses her legs and glares at us. Well, she glares at me. She gives Connie a knowing smile.

“I was reviewing the history and physicals you wrote from the last call,” Alyssa says. “And I wanted to give you both some feedback.”

Alyssa whips out of her pocket photocopies of the notes that we’d written during our last call. I see my handwriting scribbled over with red pen, angry lines crossing through my sentences, often with only the commentary, “No!”

In the first paragraph, Alyssa has left only one word untouched. The word is “diabetes.”

I look over at Connie’s note. She received only a handful of red marks. A few times in the margin, Alyssa has written, “Good!” And once, “Great!”

This is not boding well for my call tonight.

“This needs a lot of work, Jane,” Alyssa says to me, shaking her head in utter disappointment.

“Sorry,” I say. I’m only five minutes into my call and I’ve already been forced to say that word.

“Did you pre-round on all your patients?” she asks me. I nod. “Yep.”

She squints at me. “When did you get here this morning?” “At 7:15,” I admit.

“You know,” Alyssa says, “considering you’re still learning your patients, you should be spending thirty minutes pre-rounding on every patient.”

I do the math in my head. I have five patients and we were supposed to meet at 8 a.m.. So that means I’d have to arrive at the hospital at… 5:3O a.m.? But I’m not supposed to show up until 7:3O for call!

I turn this paradox over in my head, knowing that whatever answer Alyssa gives me probably isn’t going to be satisfactory. Before I can say anything, Alyssa says, “Well, what’s going on with your patients?”

Not a whole lot. Mrs. Coughlin’s biopsy is still pending. Everyone is sick enough to be in the hospital, but not that sick. But I’ve got a handful of updates. “Mr. Chang’s magnesium is low,” I begin. “Should I give him some magnesium?”

Alyssa frowns. “Why wouldn’t you give him magnesium? What would be the downside?”

“Nothing, I guess,” I say.

She huffs at me. “Jane, you should know this by now. Replacing electrolytes is your responsibility, not mine.”

“I understand,” I say.

It would be great if she was going to let this go and let me continue talking about my patients, but I can see she isn’t.

“Yesterday, I had to replete Mrs. Coughlin’s calcium for you because you didn’t do it,” she says. “That is not my job.”

“I understand.”

“There’s no harm in giving a patient a little extra calcium,” she says. “Just, as you know, don’t give it at the same time as phosphorus.”

My eyes fly open. And… what do you do if you’ve already done that? Before I can figure out a way to delicately word that question, Alyssa’s pager goes off.

It’s the ER. We’ve got our first admission. “You’re up first, Jane,” Alyssa says.

That means I need to keep track of what she’s writing, so I don’t waste a precious second of time. Except Alyssa has her index card at a weird angle and it’s hard to read her handwriting upside down. Finally, I stand up to get a better look and I’m practically doubled over Alyssa, balanced on the toes of my clogs.

She cups the phone receiver and glares at me. “Jane, could you give me a little breathing room?”

“I can’t see,” I explain lamely.

Alyssa sighs and tilts her index card another five degrees toward me so I could read it.

My admission is Alexander Chandler, a 63-year-old man who is HIV positive and being admitted for shingles with severe pain. He’s currently sitting in the ER, screaming in pain.

Joy.

At least this time I have no problem finding the room. I grab his ER chart outside the door, then gown and glove before I walk into my patient’s room because he’s on isolation precautions. The lights are out, and I see a man lying under a thin layer of sheets. He’s taking slow, careful breaths and is covered in a thick sheen of perspiration.

He is also in fantastic condition for a 63 year old. I check the chart

—he’s 36. Apparently, I am not very good at reading upside-down.

Mr. Chandler’s appearance is a surprise to me. Aside from being much younger than I thought, he’s very clean-cut looking. His hair is clipped short, he doesn’t have any tattoos or piercings, and he seems well-groomed despite his illness. I feel odd saying this but he’s actually fairly attractive. Internally, I click off some of the reasons why he might have contracted HIV:

1. Sex
2. IV drugs
3. Transfusion
4. Needle stick

Mr. Chandler rolls his head in my direction and offers me the smallest hopeful smile. He says in a hoarse voice, “Are you my doctor?”

“Yes,” I confirm. “I’m ’Doctor’ McGill.” Damn it, I still can’t get rid of those scare quotes.

“Thank God,” he says.

I have to say, this is the first time I’ve announced to a patient that I was their doctor and did not get met with some sign of disapproval or horror. I’m flattered.

“How are you feeling, Mr. Chandler?” I ask him. “Alex,” he corrects me.

I nod. “Sorry. Alex. Can you tell me how you’re feeling?”

“Not so hot, Dr. McGill,” he says, taking a shaky breath. “This hurts. A lot. I mean, a lot.”

“Can I take a look?”

He nods his consent. I lift up his standard light blue hospital gown and I look for the lesions on the left side of his chest. Shingles, also known as herpes zoster, is a reactivation of the virus that causes chicken pox, and is not uncommon in patients who have impaired immune systems, such as people who are HIV-positive.

I see the red blisters clumped together in a wedge-shaped pattern over the front and back of his chest. They are arranged in a “dermatomal” distribution, meaning they follow the path of a spinal sensory nerve. I gently graze the blisters with my fingertips and he gasps in pain.

“Sorry,” I say.

“It’s okay,” he says. I can almost hear him swallow and there are tears in his eyes. “It’s just… pretty tender. And the Tylenol isn’t really cutting it.”

I look down at Alex Chandler’s chart and now it’s my turn to gasp.

He’s right—all they’ve given him for pain is extra-strength Tylenol. “That’s completely unacceptable,” I say.

He gives me a crooked smile. “Well, you know how it is. They figure I’m HIV-positive so I must be a drug addict.”

“I’ll get you some morphine,” I promise him.

He nods. “Thank you, Dr. McGill. I really appreciate that.”

Hours awake: 4

Chance of quitting: 12%