The White Coat Diaries, page 21
“And how many of those have you been in? One?”
I bristle. “Meryl really needs to stop talking about me behind my back.”
“I figured that last bit out for myself,” he says. “Look, this guy is on the rebound, and you’re just one of several available basketballs on the court. A naïve, sexy-librarian basketball.”
I massage my temples. “Does the gift shop sell Tylenol? Why does talking to you always give me a headache?”
He shrugs. “The truth hurts.”
A nurse hands me a chart. “Patient up,” she says, pointing toward an examination room.
Happy to escape my conversation with Gabe, I jump up and knock on the door, not waiting for a reply before I enter the room. “Hi, I’m Dr. Kapadia,” I say.
A woman pacing back and forth glances at her watch. “Are you always this late?”
“Um . . . it’s my first day in this clinic, so . . . no.”
She hands me a thick stack of manila envelopes and a piece of notebook paper with a cartoon drawing of a woman with overly long limbs and flames emanating from the crown of her head. Arrows point to different body parts and are neatly labeled with corresponding symptoms written in capital letters in red ink.
“I had an eight thirty appointment. Fortunately, I’ve brought all my old records and drawn a diagram of my complaints to save time. This has all been going on since about 1987. My left elbow aches and tingles. My index finger, that feels like there’s a hot poker in it. My right leg feels like there’s cold water running down it, but there’s not. I mean, I look at my leg, and there’s no water on it. None. But that’s what it feels like. I get cramps in my pancreas and in my thorasis. My neck itches, and so do both of my breasts. My scalp literally feels like it’s on fire about three to seven times a week. And also, sometimes my right eye feels like there’s pressure in it, like it might explode.”
I look at the diagram. An arrow points from the cartoon woman’s right eye to the words “EXPLOSION EYE!”
I sigh. “Tell me more about that.”
* * *
* * *
I make it to the conference room on the first floor ten minutes after the lunchtime lecture is scheduled to start. I quietly nudge the door open. The room is full of residents and interns sitting in the dark while the lecturer clicks through a PowerPoint presentation on the causes of infectious endocarditis. Imani is asleep at her desk, her head resting on her folded arms. I slide into the seat Bianca has saved for me in the back row.
“Welcome back,” she whispers, smiling. “We missed you.”
I’m awash in a flurry of warm feelings. It’s good to be among friends again.
Clark leans over from the seat in front of me. “Yeah, while you were out playing with mice, we had to cover all your call shifts.”
The warm feelings fade.
Bianca shoots Clark a harsh look, then turns to me. “Are you okay? We were worried about you. Portnoy is such a jerk for having you suspended over nothing.”
I wave my hand. “I’m fine. I’m just happy I wasn’t fired.”
“Do you think it’ll affect your record? Being suspended?” Bianca asks.
I cringe. It’s like I have a rap sheet now. “Probably,” I say. “My evaluation from Portnoy for that rotation is going to be pretty dismal, to say the least.”
Bianca shakes her head in disgust. “Ugh, bunch of jerks. You should sue for workplace harassment.”
Clark smirks at her. “Oh, look who’s suddenly a fan of lawsuits. Very American of you, Bee.”
Someone up front turns around to shush them, and they fall silent. A moment later, I whisper, “Where’s Stuart?” It’s unlike him to miss one of these mandatory lectures. It’d be unlike him to miss an optional lecture.
“I haven’t seen him since early this morning,” Bianca replies. “He was on call last night. Maybe he’s asleep somewhere.”
“No way. Dude never sleeps,” Clark says. “He’s probably at the coffee cart getting his ninth cup of coffee.”
My pager sounds. I recognize the number as one of the ICU extensions. I step out of the room and return the call from a phone in the hallway.
“Norah?” Stuart’s voice is thin.
“Hey, Stu. We were just talking about you. You’re missing the lecture,” I say.
There is a long pause. Then he says, “I have a patient.”
“Oh. Okay. Do you need help with anything? I can come up to the ICU.”
“No, just . . . when you were suspended, did Dr. Forks say anything about it going on your record? Like, how did that work? I just wanted . . . to know.” He sounds scattered and breathless.
“What do you mean? What’s going on?”
“Nothing. It’s . . . never mind. Just tell Francesca, if she’s looking for me, that I’m busy with a patient, okay?”
“Sure, okay.”
He hangs up.
I stand there for a moment, staring at the phone. Whatever’s going on, I’m not sure I want to get involved. But it’s Stuart.
I run for the elevator.
* * *
* * *
Stuart is hunched over a computer in a narrow work cubby at the back of the ICU, his hand on the mouse, his expression distant.
“Stuart?”
He squints at me, a deep crease between his eyebrows. His eyes are red and sunken, and he has what I estimate is a week’s worth of stubble. “Norah,” he says. “Norah, I fucked up.”
I lower my voice. “What happened?”
Stuart explains, his head in his hands, that early this morning, he was paged to reinsert a nasogastric tube that had slipped out of a comatose patient on a ventilator. He followed the usual protocol: he covered the end of the tube in viscous jelly and threaded it through the patient’s nose until he was confident it had reached the stomach. Then he ordered an X-ray of the chest and abdomen to make sure the tube was not accidentally lodged in the patient’s lung.
“And? Was it in the lung?” I say. “That’s not a big deal. We’ve all done that before.”
He sighs and points to the computer screen. On it is an X-ray—a front view of the chest and the abdomen—but no NG tube.
“Where is it? Curled up in the back of the throat?”
He shakes his head. “The patient . . . had a head trauma,” he says, avoiding my gaze. “Motorcycle accident. He has a basilar skull fracture.”
I brace myself against the wall. “Please tell me it’s not—”
“It took me a while to figure it out,” he says. “Most of the morning, actually. I ordered a stat CT scan. The radiologist called me. It’s fascinating, really.”
“Whom have you told?”
“No one, yet. But it should be about ninety minutes before the CT report hits the chart and the nurses page the attending. I should quit, right? Before they fire me, I should quit. Or do you think they’ll put me on leave and give me a second chance, like they did for you?”
I have no idea what to say. Wordlessly, I do the only helpful thing I can think of: I page Ethan.
* * *
* * *
“So, let me get this straight,” Ethan says, staring over Stuart’s shoulder at the computer screen. A CT scan image shows a bright white line the width of a pencil cutting straight through a field of scalloped gray and white. “You just inserted a nasogastric tube into this patient’s nose, through the fracture in the base of his skull, and into his brain. Is that correct?”
Francesca appears behind him and peers at the screen. “Ethan, I got your page. What’s going—ohholyshit. . . .”
Ten minutes later, the Neurosurgery resident—an unusually tall fellow with a serene expression and a monotone voice—is seated at the computer, the four of us huddled behind him.
“Well, this is a fucktastrophe,” he says. “It went straight through the left temporal lobe. Hope this guy isn’t right-handed.” He stands. “The attending’s gonna shit his pants. Congratulations. This is definitely a first. We’ll take him to surgery within the hour.”
He leaves, and Francesca turns to Stuart, red-faced. Even in heels, she’s half his height. She jabs her index finger into his chest. “You should have called ENT to put that tube back in using a scope for visualization. That’s how they got it in the first time. Did you even read the chart beforehand?”
Stuart shakes his head. “I usually do. I know I should have. But it was a simple nasogastric tube. We put in, like, ten a day. I had so many other patients to see, I thought . . . I just thought I could do it really fast and . . .” His voice cracks.
“What do I always say about the weakest link?” Francesca demands. “This is the type of shit I’m talking about! You don’t take shortcuts. You check the chart, every time!”
Ethan takes her arm. “Okay, deep breath. Stuart, you’re going to have to talk to hospital Risk Management tomorrow. You also need to tell the family what happened.”
“The only silver lining here,” Francesca says, “is that the man was brain damaged and in a coma to begin with.”
“Except now he needs surgery to take out the tube,” I say.
“What you mean is, he needs a procedure to extract the tube,” Ethan says. “It’s all about how you present the facts, remember?”
Francesca massages her temples. “We have to limit the damage here,” she says. “Make sure you point out that the guy was probably never going to wake up anyway. This won’t change the course of his recovery—or his lack thereof.” Then she adds, under her breath, “You’d just better hope he doesn’t die on the table.”
Stuart nods silently.
“Do you need me to go with you to talk to the family, or do you think you can manage to get that part right?” Francesca asks pointedly.
“I can do it,” Stuart says, meeting her gaze. “I’ll do it.”
“Fine,” Francesca replies. “I’ll stay here and get your patient ready for surgery. And then you and I will take a walk down to Dr. Forks’s office so he can help sort out this disaster.”
We leave Ethan, Francesca, and the Neurosurgery resident at the patient’s bedside. On the walk to the ICU waiting room, Stuart swears under his breath and wipes his forehead with his scrub shirt.
“Stu, it could have happened to anyone,” I say.
He leans against the wall, trembling slightly, then sinks to a crouch. Cradling his head in his hands, he takes several gasping breaths. For a moment I think he might scream. I kneel beside him and put my hand on his shoulder.
“It’s going to be okay.”
“I’m so tired,” he says into his palms.
“I know. Just get through this, and then you can rest in the call room. I’ll cover your pager.”
“What if he’s paralyzed? What if he dies and it’s my fault?”
I can feel the weight of his guilt and shame and fear. It rolls off him like a leaden fog. He adds, in a voice I can barely hear, “How do I live with that?”
“It was an accident, Stu,” I say. “Any of us could have made the same mistake.”
He looks up at me skeptically, then takes a deep breath and stands. His jaw is set, as if he’s refocused on the task at hand and blocked out everything else. I’m reminded of pins at a bowling alley: the toppled ones are cleared away and a perfect, new set appears, at attention, ready to be toppled again.
We walk down the hallway to a glass door marked ICU Family Waiting. A woman in sweat pants and a man holding a cup of coffee with both hands are sitting in an otherwise empty room lined with chairs. I turn to go.
“Wait,” Stuart says, his gaze fixed on the couple. “Do you want to go in with me? Please?”
The woman holds a magazine called Healthy Life!, the cover of which features a man jogging with a dog and the headline “Could it be your prostate? Take our quiz!”
We walk in together. “I’m Dr. Ness,” Stuart says. “This is Dr. Kapadia. Are you . . . ?”
“I’m Craig Perkins.” The man extends his hand without standing up. “This is my wife. How’s my uncle?”
“Thank you for coming in,” Stuart says. “I was on call last night taking care of the patient. Your uncle. I’m sorry to say, there’s been a complication.”
The woman’s eyes flash angrily. “What kind of complication?”
“An NG tube—that’s a tube inserted through the nose and into the stomach—well, it’s supposed to go into the stomach—it passed through his skull fracture and into his brain.”
“His . . . brain?” the woman says. “How is that even possible?”
“It’s a very rare complication of this type of fracture,” Stuart says. “A complication, in fact, that no one in this ICU has ever seen before.”
“But . . .” The man holds his index finger to his nose. “I don’t get how that happened.”
“The fracture is through the cribriform plate,” Stuart says, his tone becoming more relaxed, even confident. “That’s the piece of the skull that separates the back of the nasopharynx from the base of the brain. Usually the tube hits the back of the nasopharyngeal cavity—the back of the throat, essentially—and curves downward to go into the esophagus and then into the stomach. Because of where the fracture is located, there was nothing to stop the tube from going straight through the bone and into the”—his voice catches, and he clears his throat—“brain.”
The man leans back in his chair. “Wow. What do we do about this?”
“He’ll need a procedure,” Stuart says, “to extract the tube. That will happen tonight, under the direction of a neurosurgeon.”
“Will there be brain damage because of this? I mean, what are the repercussions of this tube being in his brain?” the woman says.
Stuart clears his throat again. “Well, we don’t really—”
“This is unlikely to change the course of his recovery,” I say.
The man nods and, after a moment, says, “Okay. Well, do what you have to.”
“We’ll have someone bring you the consent forms to sign,” Stuart says.
In the elevator on the way back to the ICU, Stuart is silent. His fists are clenched, and the veins on the backs of his hands stand out, blue and turgid, against his pale skin. I notice he’s lost weight, making him even lankier than when I met him that first day at orientation. He looks brittle, like if you gently pressed your index finger into him in the right spot, he might crack into pieces.
“Hey, why don’t you give me your pager, and you can get some sleep?” I say.
He shakes his head. “No, thanks, Norah. I’m fine. I just need a coffee.”
“Stuart, you need—”
“I need to get back to work,” he snaps, silencing me. “And so do you.”
I stare straight ahead, feeling my stomach lurch into my chest as we descend.
CHAPTER FIFTEEN
In fact, Stuart’s patient makes a remarkable recovery. Two weeks later, he awakens from his coma and is removed from the ventilator. He’s so grateful to be alive that the fact that his right arm is paralyzed is of minimal concern to him.
The hospital gossip machine has been working overtime since the incident, and I’ve overheard some of the upperclassmen bruit about the story, snickering, calling Stuart “Dr. Piths.” The Radiology department presented the case at the monthly hospital-wide Grand Rounds lecture, so that all the residents and attendings from various departments could marvel over the amazing CAT scan pictures of an NG tube spearing someone’s brain. They didn’t use Stuart’s name in their presentation, referring to him only as “a member of the house staff,” but by now everyone knows it was him.
Stuart has been withdrawn and subdued, reading even more than usual, avoiding conversation, sometimes avoiding eye contact. For weeks, even Clark hasn’t been able to get him to crack a smile, and none of us have seen him in the cafeteria.
I’m sitting with Bianca and Imani at breakfast one morning when Stuart appears at our table, half a grapefruit and a cup of coffee on his tray. His white coat is still filthy and he hasn’t shaved, but he looks a little less dejected today.
“Mind if I join?” he asks.
“Shut up, Stu,” Bianca chides, smiling. “Since when are you so formal? Sit down and tell us everything. Are you okay? We’ve been worried about you.”
Stuart sighs as he picks at the grapefruit with a slightly quivering hand. “That patient will never use his right arm again.”
“You don’t know that,” I say, trying to sound buoyant. “He might recover better than you think.”
“I heard they’re not putting you on leave,” Bianca says, trying to stress the positive.
“No, they’re not putting me on leave,” Stuart says, his expression flat. “Lucky for me.”
I shouldn’t be bitter. It’s fortunate for Stuart that his patient’s attending was more forgiving of his mistake than Portnoy was of mine.
I am, I admit to myself, a little bitter.
Stuart goes on to tell us that his meeting with the hospital Risk Management team—a husband and wife, both attorneys, who, apparently, hate each other—lasted seven minutes. The attorneys told him it would be two years before the statute of limitations expired and the patient would no longer be able to sue him or the hospital. They seemed tremendously pleased to learn that the patient is, in fact, left-handed.
“And they told me to stay away from the patient,” he says. “I’m not allowed to set foot in his room. Which I guess I understand. I’m a menace.”
“Stu, it was an accident,” Imani says, while Bianca and I nod in agreement. “You can’t beat yourself up over it.”
He sighs again and taps his fork against the tray. “Yeah, I know. Dr. Forks and Francesca said I should look at this as a learning opportunity. Learn from it and move on, they said.”
