“It’s been coming on all morning,” Mrs. Jefferson explains to me. “And I feel like it’s a bit hard to breathe, you know?”

Mrs. Jefferson’s EKG is normal. I’m waiting for the chest X-ray to show up online, but she doesn’t look that bad. She just looks worried. Thomas Jefferson is sitting at her bedside, holding her hand, looking equally worried.

“You’re going to be okay,” I promise her. “You get angina, right?” “Not like this,” she says.

I nod. “Okay, well, we’re going to do a bunch of tests, wait for your labs to come back, but I don’t really think anything bad is going on.”

“I believe you, Dr. Jane,” she says. “I know you always do a really good job. I know you’re looking out for me.”

I feel a stab of guilt about missing that elevated white blood count the other day. But she doesn’t need to know about that.

I make it out of the room and as far as the nurses’ station before Thomas Jefferson catches up with me. He’s got a crease between his eyebrows. “Dr. Jane, I’m worried about my Markie.”

“I understand,” I say in my most understanding voice. “She’s going to be okay. We’re going to get to the bottom of this.”

“You don’t get it,” he says. “Through this whole ordeal, no matter how bad things got, she always told me everything was going to be fine. But today she didn’t say that. She said to me that she thought she was never gonna leave this hospital.”

“I’m sure that’s just because she was so close to going home,” I say. “And I promise you, she will go home.”

Thomas Jefferson looks skeptical. “I promise you,” I say again.

“Okay,” he finally says. “I believe you, Dr. Jane.”

I watch him walk back into his wife’s room. I feel good about the fact that I reassured him. One thing I’ve been realizing lately is that people bounce back pretty easily if you give them a chance. Mrs. Jefferson is sick today, but I feel certain she’ll be going home soon. Thomas Jefferson isn’t a doctor (he’s a Founding Father), so he just doesn’t know that.

I locate Alyssa in the radiology reading room. She’s flipping through X-rays done on our patients from the last few days. “Hey,” I say. “Is Mrs. Jefferson’s chest X-ray up yet?”

Alyssa nods. “Yeah, I just looked at it. It’s negative.”

“Oh,” I say, disappointed. A pneumonia would have given us an explanation for her fevers. “Can I see it?”

Alyssa whirls around with her classic “why are you wasting my time” expression.

“Never mind,” I quickly say. It’s far too early in the call to be pissing off Alyssa.

For the first time all month, the call is going smoothly. It’s a miracle.

I’ve got all my admissions tucked away by midnight, and I manage to retire to my call room before 1 a.m. I might even get a full night of sleep while on call. I actually seem to be getting the hang of this whole doctor thing.

At 1:45 a.m., things start to fall apart.

My pager goes off and I know before I even answer it that it’s about Mr. Thurman. He’s been tottering on the brink of something awful all day, and it makes sense that he waited for the very moment I fell asleep to start crumping. “Hello, this is Dr. McGill,” I say.

“Hi, Doctor,” the nurse says. “I’m calling about Mr. Thurman.” Naturally.

“His blood pressure is low,” the nurse says. “It’s 81 over 53.” “And what are the rest of his vitals?” I ask.

The nurse hesitates. “Um, hang on.”

I sigh, but then get freaked out by how much I sounded like Alyssa just now. I start getting my shoes on because no matter what the nurse tells me, I’m going to be heading over to see Mr. Thurman. I expect he’s going to make a journey to the ICU tonight.

After the nurse reports back to me, I tell her I’m on my way, then I page Alyssa to let her know. “Mr. Thurman’s really sick,” Alyssa says. No kidding. “I’m going to call the ICU and see if they’re willing to take him. He’s probably going to need some pressure support. Does he have a central line?”

“No,” I say.

Alyssa swears under her breath, then hangs up the phone.

By the time I get to Mr. Thurman’s bedside, he isn’t looking good. His oxygen levels are dropping and his blood pressure is still low. I

check the chart and confirm that he’s Full Code. Meaning we have to do everything possible to save the guy’s life, even though it’s not clear he’ll ever have any real quality of life ever again. It seems, in all honesty, like a bit of a waste. But I’m not going to argue the point right now.

It’s probably a blessing at this point that Mr. Thurman doesn’t really appear to know what’s going on. His head is lolling around and he grunts a few times as a sweat breaks out on his forehead. The reading on the monitor tells me his blood pressure is still dropping.

Alyssa materializes at the bedside and I feel nothing but relief. “Should we put in a central line?” I ask her.

She bites her lip. “I can’t. I’m not signed off yet.”

In order for a resident to be allowed to do a procedure independently, they have to be observed a certain number of times by an attending physician. At that point, they are “signed off” to do the procedure. Apparently, Alyssa hasn’t reached that level of skill with placing central lines.

“What about the ICU resident?” I ask.

Alyssa shakes her head. “She’s a junior. She’s done less than I have.”

Well, great. I guess we’re just going to have to let him die then. “Call Surgery,” Alyssa says to me.

“Huh?” I say.

She grits her teeth. “Get the person on call for Surgery. They’ll put in a line. They’re great at it.”

“Okay,” I mumble.

I know before I even speak to the operator that she’s going to tell me that Dr. Reilly is on call for Surgery tonight because that is the kind of luck I’ve been having. I page him and sit by the phone, waiting for the call back. I don’t expect him to return the page. He never does.

So I’m pretty shocked when the phone rings: “This is Dr. Reilly, returning a page.”

“Hi,” I say. “Um, it’s Jane.”

Ryan is quiet for a minute. “Why are you paging me?” “We’ve got a guy who needs a central line… urgently.” He sighs. “Don’t you have a senior resident?”

“She’s not signed off,” I explain.

Ryan snorts. “What do they teach you guys over there, anyway?” “Come on,” I say. “Please… just help us out…” Help me out.

There’s a long pause on the other line while I hold my breath. “Yeah, fine,” he says. “I’ll be there in five.”

I expect him to take his sweet time getting over here, but once again Ryan Reilly manages to surprise me. A few minutes later, he arrives on the ward carrying a central line kit. He doesn’t look me in the eyes, and when he addresses me, it’s in a sharp monotone. Like I’m just some intern he’s never met before. “Where’s the patient?” he asks.

I lead him to Mr. Thurman’s room. He eyes the patient, with his wonky pupils, the drool pooling in the corner of his mouth, and the feeding tube in his belly.

“Jesus,” Ryan says. “What’s wrong with him?” “Brain injury,” I say. “Motorcycle accident.”

Ryan shakes his head. “Maybe this is God telling you something…” I stare at him. “What are you saying?”

His eyes finally meet mine. “You don’t think this is all a huge waste?”

“No, I don’t,” I say angrily. Although to be honest, I really sort of do. But I don’t want him to win this argument. “I mean, if it were you or your family member…”

“If it were me,” Ryan interrupts, “it would be over right now. Hell, way before now.” He glares at Mr. Thurman, as if he is furious at the man for having the gall to be alive. “That will never be me. Never.”

I don’t like what Ryan is saying. I swallow hard. “Look, can you put in the line, please?”

He nods curtly before gowning up to go inside the room. I’ve only seen a handful of central lines placed in my short medical career, but it’s obvious Ryan is very experienced with them. His hands are incredibly steady as he slips the catheter into place and slides out the guidewire. It takes only a few minutes, which is a good thing considering I’m practically holding my breath the whole time.

Ryan pulls his gloves off with a loud snap as he pushes past me out of the room. “Congratulations,” he says. “Your patient lives another day.”

I watch as he grabs the patient’s chart to jot down a quick note about how he swooped in to save the day. I want to say something, to apologize in some way, but I’m convinced that whatever I say will come out wrong. If I praise his work, he might think I’m being insincere. Besides, he’s a surgeon—placing central lines is probably as routine to him as breathing.

As I wrack my brain to think of what I can say, I hear a loud voice booming overhead: “Code Blue in Room 327B. Code Blue in Room

327B.”

I’m not on the code team tonight so my first instinct is to ignore it.

Then I remember: Mrs. Jefferson is in Room 327B. And then I run.

Hours awake: 2O

Chance of Mrs. Jefferson living till morning: ?????????