All in a Day

All In a Day

8:00 AM

My job is to not get in people’s way. Only ask the questions on the checklist. Process patients, no decisions of consequence. Each question is a screen to assess symptoms. But what ends up happening is the interview becomes a last grasp for comfort. I hear people tell me stories they wouldn’t bear to tell their husbands or wives. And I have to urge them to answer the medical question directly and move on to the next. Like people on a reverse assembly line, deconstructed to their most minute parts. At the end of the session, people usually shake my hand and leave without saying much. As a fourth year medical student, I can’t legally provide a diagnosis. They look at me waiting for some closure. All I can do is reference them to someone higher on the totem pole. But a patient doesn’t come to the hospital expecting good news anyway.

An announcement pierces the air. “Paging Dr. Sinclair,” the loudspeaker says.

Hospitals have different codes to say over the loudspeaker as to not cause alarm. Code Blue is the most common. It means that a patient is in need of resuscitation. Code Grey means there is a patient with a stroke. We also use doctor codenames as well. “Dr. Stork” means a woman is in labor and needs immediate help. “Dr. Sinclair” means there is a dangerous situation. I’ll have to take the back elevator to get to the cafeteria later.

In the examination room, the chief resident is telling his patient that he should cease chemotherapy treatment. That realistically, he should focus on her quality of life with the little time he has left. He can’t say this out loud, but the doctor wants him to go out with some dignity. Be able to say goodbye to his family without worrying about vomiting everywhere. With some hair left. Able to stand up on his own. I hear his patient warmly say thanks. His voice has a gentle rasp but no waver. I can hear his wife softly sob. She begs him to reconsider. To give it one more shot. He says “I’m tired, and I’m ready.”

Five patients into my day. I look over my lengthy notes. My hands write everything my patient have to say because I don’t know what is actually important for my seniors to know. During my daily reports, what are called “sign-outs,” the chief resident’s eyes always glaze over. When I see his notes on a patient, they’re about a quarter of the length. The bare essentials. I straighten out my pristine white jacket and welcome whoever is up on the queue.

The next patient walks in alone. She looks young but has grown distinct crow’s feet around her eyes. She’s dressed well, but her clothes are unnaturally baggy. I can see her collarbone jut out. She has prominent, attractive cheekbones, but her cheeks have hollowed. I assess her basic information. Age, height, weight, race. She is only thirty-five years old. Five foot five. I try not to avert my eyes when I hear her weight. Usually patients understate their weight out of self-consciousness. She says she’s 150 pounds, and she probably was. I ask her about her family to break the ice.

She says, “I had a son.” The clock ticks loudly, reverberating through my silence. I ask the first question verbatim, and she gives me a short response. After a few questions, her phone goes off with the standard xylophone ring tone. She turns it off without looking.

“You can take that call. I don’t mind.”

She says, “Don’t worry, I don’t need to. It’s just my mom.”

The interview lasts ten minutes. She thanks me and reaches out. Her hand is soft and cold. She holds on and lets the heat of my hand radiate. I have to pull back and usher her out politely.

4:00 AM

I am required to come at five in the morning, but I always come earlier to do my rounds. I check the updated notes, the overnight nurse’s report on each patient in the ward. Most of the patients are still asleep.

This morning, one patient tried to sneak to the bathroom with a cup. His IV bag stand trailed behind. His catheter hung limply between his legs. I had to tell him he couldn’t drink any water or eat anything before surgery.

He kept repeating, “But I’m so thirsty.”

I said, “You can’t drink when the doctors intubate for surgery there is a reduced/no risk for aspiration which could lead to pneumonia, a big complication post surgery.” He stared at me blankly.

“They have to stick a tube down your throat and if you drink, your throat could swell and you could get really sick.”

He said, “But I’m thirsty, can’t you please let me have a cup of water? Just one?” I pressed the call button for the nurse.

She walked in and asked what the problem was.

He said, “I’m so thirsty and the doctor won’t let me drink.”

The nurse said, “Mr. Rodriguez, you have a busy day today and you need your rest. Come back to bed and lie down. Let me get you some candy to suck on. What flavor would you like?”

“Lemon has always been my favorite.”

“You’re in luck. I always carry some candy around, and the last piece is only for you.”

“Thanks, Lisa. You’re my favorite.”

“How about I adjust your bed. Comfortable now?” Lisa asked.

“Yeah, I’m perfect,” Mr. Rodriguez said.

“That’s good. I’ll be here if you need me. All you have to do is press that little call button.”

“I think I’ll be ok. I’m going to try and get some rest.”

“Sleep well Mr. Rodriguez.” Lisa closed the curtain. I took my cue to leave.

People cope in different ways to being sick. Some withdraw. Some latch on. Some lash out. Patients are labeled things like difficult, drug-seeking, depressive, or delusional. But being sick is inherently disempowering.

Cancer becomes the every day norm. We see death all day long, 90 hours a week. You eventually stop thinking about it as individual tragedies and instead as letters on a paper, or numbers on a clipboard. Some doctors think of it as an inconvenience. But to the patient, it’s likely the worst news they’ll hear in their life. Last week, an intern in a different department casually let slip that the patient’s symptoms indicated he likely had cancer. He said it offhandedly. But only the senior staff members give the bad news. After some immediate crisis intervention, the intern’s supervisor pulled the intern into the hallway. I’ve never seen someone get chewed out so badly. The intern looked like he wanted to sink into his shoes.

11:00 PM

I do my second set of rounds before my lunch break. Mr. Rodriguez’s bed is empty. Someone had placed flowers by his bedside. Daffodils. The rest of his belongings are gone. The surgery was supposed to start at nine, and it was a four hour procedure. I found out it had lasted only an hour.

Cancer looks like a bulbous, mutilated mass when you open someone up. It has a hard foreign consistency. But medicine has come a long way. With the advent of robotic laparoscopic surgeries also known as keyhole surgeries, procedures have become very minimally invasive and recovery times are much shorter. But sometimes doctors have to make traditionally large incisions when the cancer becomes too large. Doctors have to caution families not to expect surgery to be a miracle cure. That every time you go under the knife, it’s a big risk. It’s inherently violent, and you make the patient a lot sicker before they can hopefully become healthier. Doctors have to inform families of the financial cost as well. But after the surgery is done, the hardest part is the long walk down the hall to the waiting room.

The cafeteria is like the rest of the hospital, an over air-conditioned, sterile, insulated box. The food objectively tastes decent, but the air makes it feel unsavory in my mouth. I chew to get some nutrients in my body before the latter half of my shift.

“Paging Dr. Stork,” the loudspeaker blares.

I text my girlfriend about my morning. Kerry is an intern at a neighboring hospital. An intern is the most junior member of the team after you first receive your medical license out of school. She works in Cardiology, but she hopes to eventually be a gynecologist. I tell her about my morning. She’ll respond when she wakes up. My girlfriend works the night shift, from five at night to nine in the morning. Since I get home at eight, we haven’t seen each other in a month even though we live together. It’s like a ghost resides in my house. Albeit a friendly ghost who does the dishes and leaves cookies on the counter.

1:00 PM

My pager goes off. It’s time for the differential diagnosis meeting on the new patients. We evaluate what possible diseases or conditions there are based on the symptoms and narrow them down collectively.

I brace myself and walk in the meeting area.

The chief resident, Dr. Han says, “Great, you’re finally here. We’re doing a whip around.” Everyone else in the room stares at me, some with encouraging looks, some with apathy, and some with tired contempt.

Dr. Han asks, “What medication is most viable for a patient exhibiting the following symptoms and why?”

I categorize each piece of information and cycle through hundreds of pages of my reference books. The chief resident crosses his arms and tenses his shoulders.

“Um, um,” I stutter.

“Alright next. Dr. Johnson, what would your recommendation be?” Dr. Johnson is the intern on our team and he can’t come up with an answer. The chief resident moves to the 2^nd Year doctor, Dr. Diaz and asks the same question. His tone is even and unfeeling. She responds promptly. Dr. Johnson shakes his head at me. The Dr. Diaz gives me a weak smile. Sporadically, the chief resident will quiz each member of the staff on a relevant question, and if they can’t answer in thirty seconds, he moves on. I’ve seen him ask six doctors until he gets a valid response in time.

We run our differential and I listen and absorb as much as I can. My cheeks are flush. My hands are still clenched. The session passes in a blur, with each doctor rapid fire eliminating non-answers. By the time I am done evaluating one idea, the group is already three steps ahead. The way they talk to each other, I can’t even begin to fathom reaching that level of critical thinking. Their entire frame of mind is on an entirely different plane than mine. The chief resident can reference every major oncology study for the last fifty years. I can barely remember where my keys are in the morning.

I walk out of the room the same way I walked out of a bar last Saturday. When you are on four hours of sleep consistently, a study showed that it’s the equivalent of being drunk all the time. But there’s so much information a doctor has to learn that 90-100 hour weeks are the only way to get enough experience. I look at my watch. It’s only two o’ clock. Six hours left in my shift.

2:00 PM

I go to the ICU to check in with a few specific patients. The chief resident gave me a list of things to take care of in his absence. He had to give a consultation at the Nephrology Department and would be occupied for a few hours. He told me if I had any questions, to feel free to ask Dr. Diaz for help. All I have to do is check their status.. Nurses check vitals. Most of the patients on the list are stable and everything comes back at predictable levels.

“Code Grey, Incoming,” the loudspeaker says. Means the stroke victim is on his way.

I’ve visited Mrs. Wendy Henderson in her room every day since I started my rotation at the hospital. She has a very poor prognosis, so I have to stop by frequently to check her vitals.

“Good afternoon, Mrs. Henderson.”

“Call me Wendy, please.”

“Good afternoon Wendy. And it’s good to see you too Rita,” I say.

Wendy and her daughter Rita apparently had a falling out a few years ago, but when Wendy got sick, Rita came back. They don’t tell me the details. Rita’s face looks weathered. Her skin is pulled tight against her face. I notice old pockmarked scars around her basilic vein in the bend of her elbow.

I tell them that they  look so much alike. They stifle a giggle.

Wendy tells me that when Rita’s mother was on her deathbed, she told Rita’s father to marry someone nice like Wendy, the family babysitter. So he did. He married Wendy. Wendy was twenty-three years old taking care of three year old child who had her mother’s fire and her father’s lack of fear.

Rita says she just accepted the resemblance, but Wendy always had a long hearty laugh. But it took time for Rita call Wendy, “Mom”, even though they seem so close now.

Rita told us the story when Rita and Wendy were walking around the mall. Rita was begging for some candy and Wendy would have none of it. Rita shouted, “You’re not my mom!” The employees called the cops. They had to call Rita’s father to clear things up.

When Rita was eight, she came down with the chicken pox, and she had to miss a lot of school. Rita called her friends but everyone was busy during the week. Wendy had found Rita’s mom’s old cookbook, so she made some chicken soup. The broth was made from scratch, with chicken bones, veggies, boiled for four hours.

Rita tasted it and cried. Wendy asked her if she was sad, and Rita told her she was sad and happy. Sad her mom wasn’t around, but happy that she could have her soup again. She asked Wendy what her “real” mom was like. And Wendy was good friends with Rita’s mom, so Wendy had quite a few adventures to share. They stayed up all night. Wendy ended up catching a cold. When Rita finally got better, she told her friends about her fun mom who kept her company.

“From that day on, Rita always called me Mom,” Wendy said.

“Because you are,” Rita said. “Hey mom, I have to go, but I’ll be back later tonight?’

“Promise?” Wendy asked.

“I promise,” Rita said. She kissed her mother on the forehead.

With only the two of us in the room, Wendy tells me, “I feel so bad for that poor boy next door. I can hear him calling out for his father at night. But not once have I seen anyone but his mother come around,” Wendy says.

“I’ll check in on him later,” I say.

“Thank you darling. How are you holding up?” Wendy asks.

“I’m hanging in there,” I say.

“You need to eat more. You look too skinny. I wish I could cook for you.”

“Yes, Mrs. Henderson.”

“Call me Wendy, please.”

“Yes, Wendy, I will try and eat more,” I say.

“That’s better,” she says.

Wendy is a Methodist. She doesn’t drink or gamble. She won’t touch playing cards. She never smoked or did any drugs. She always had her music. Wendy tells me stories about how she played the organ at church. The organ was located on the 2^nd floor and she could look down on the congregation from a tiny window used for ventilation. Summers, it would get so hot that she would play with her jacket off and blouse buttons undone. I always poke fun because who else would take her shirt off at church but Wendy.

She asks, “What they do with dead arms?”

“What do you mean?” I reply.

She says her arm is cold. She can’t move her fingers at all. Last week, Rita wheeled Wendy down to the lunch room. She tried to play the piano but her fingers wouldn’t listen to her. Her right hand was clenched in a claw. Today, no feeling except for the freeze she could not warm.

I feel her arm and feel nothing but sharp bone. Where my triceps muscle was, she had skin. The cancer had metastasized all over her body and atrophied her arm muscles.

She pulls out an easy tunes song book. I see her shaking hand trace the notes. She plays an air piano. Looks at each note and misses the invisible piano key. Wendy puts the book back and says that she wants to rest but she can’t find a comfortable position. She hasn’t left her bed since she found out she can’t play piano anymore. Now she’s developing bed sores. I tell her that she needs to keep moving.

“Don’t worry, I won’t give up,” Wendy says.

I walk out and run into a janitor. I ask him to bring an extra blanket for room 306.

4:00 PM

Wendy is sitting up in bed. She motions me over and puts her finger to her lips. “It’s not a good time to talk right now,” she says. “A man I’ve never seen before just walked into the room next door. It doesn’t look like it’s going to end well.”

“What makes you think that?” I ask.

“You’ll see,” Wendy says.

“Get the fuck out!” I hear the woman next door yelling.

“Please Olivia, I haven’t talked to our son in months,” a man says.

“And whose fault is that?”

“It’s mine. I’m sorry. I’m so sorry.”

“It’s a little too late for that,” she says.

“Don’t say that,” he says. “Please don’t say that. Olivia, I’m sorry.”

“Why are you here?” she responds.

“I just wanted to see him and see if he’s ok”

“Well, he’s not. He really isn’t.” Her voice trails off.

“I brought you some coffee. You look like you could use some,” he says.

“Thanks.”

“How are you holding up?” he asks.

“I’m fine,” she says.

“Can I sit down?” he asks. I hear a chair move.

“No, I’d rather you not.”

“I know I fucked up, but please let’s not make it about us. It’s our son we’re talking about. That’s why I’m here.”

“Now what? You show up for the first time in months and you expect me to welcome you?”

“No, I… I didn’t know what to expect.”

“It’s been hard. It’s been really hard.”

“I’m sorry,” he says.

“Look, I can’t do this right now Matt. Let Timmy rest. He hasn’t been sleeping well,” she says.”

“Because of the chemo?”

“He can’t keep anything down. He has to get up in the middle of the night all the time.”

“Is there anything the doctors can do to help?”

“It’s chemo, Matt. It’s not exactly the best thing for your body.”

“But can’t the doctors give him something to help with the nausea?” he asks.

“He’s been taking something called Emend, but it hasn’t really been helping,” she says.

“I can talk to the doctors to see if we can’t switch his prescription.”

“Please don’t.”

“You look tired. I can help. It’s not a problem.”

“No.”

“I’m his father, and I should be part of his medical decisions.”

“Matt, I don’t have the energy for this right now. I don’t have it in me anymore.”

“I should leave,” he says.

“You should,” she says. “We really needed you Matt, and you weren’t there. And now you’re here, when there’s nothing we can do. There’s nothing.” She sniffs, holding back tears.

“Olivia, I missed you,” he says. “Every night I went to sleep thinking about you.”

“Me too.”

“Do you remember when you took me to the hospital on our first date?” he asks.

“Of course I do.”

“Man that car came out of nowhere,” he says. “I’m still hazy on the details.”

“I thought you were an idiot. A brave idiot, but still an idiot.”

“Hey, I wasn’t about to let my date get run down by a car.”

“Like I said, brave idiot.”

“I thought you looked like an angel. But that was probably the concussion talking.”

“Probably.”

“You should drink some of the coffee I got you. It’s getting cold.”

“Yeah.” She takes deep, labored gulps. I hear a chair scrunch as the man sits.

I think about Timmy’s file. It indicates his sedation comes from the Xanax he has to take for his anxiety. It has a supplementary narcotic effect to the morphine. We think he’s in so much pain he can’t process it any more. He had hallucinations during his last round of chemotherapy. He saw his grandmother. Olivia told us that the grandma passed away last year. We called in the psychiatrist. We didn’t know what it meant.

“What’s the doctor’s prognosis?” he asks.

“Not good. He only has a few months left. He wants to see his friends at church for the Christmas service. He’s sad he can’t join in this year. They said he could come anyways, but I don’t think he’s ever going to leave this place.”

“I got him a bunch of new comics for an early Christmas present. I figured he’d be bored having to be here all day,” Matt says.

“That was nice of you.”

“I hope I got all of his favorites. I think I got them all.”

“I’m glad you didn’t wait until his birthday to come. He was asking for some comics for Christmas. He knows his birthday in April is too far away. Look at him. He looks so peaceful,” she says.

“He really does,” he says. The room is quiet, except for regular beeps of the electrocardiogram. “I know it’s not under the best circumstances, but it’s good to see you, Olivia.”

“I wish I could say the same,” Olivia says. The boy stirs in bed.

“Timmy, are you awake?” Matt says.

“Dad, why are you here?” Timmy says, his voice frail and dry.

“You’re awake! It’s so good to see you son,” Matt says.

“Mom, why is Dad here?” Timmy asks Olivia.

“He’s here to see you,” Olivia says.

“And I brought something for you, don’t you want to find out?” Matt says. He places the comics on the bed.

“Please dad, leave,” Timmy says.

“What?”

“Dad, I don’t want to see you.”

“But…”

“Dad, get out.”

“But son…”

“I said get out!” I see a comic book fly out of the room.

“I’m sorry son.”

“I hate you. I never want to see you again.” Matt doesn’t respond. He exits the room with dragging footsteps. It’s always disquieting to see a grown man weep.

The beats from the electrocardiogram accelerate at a worrying pace. Timmy’s breaths become short and labored.

“I’m sorry, but I need to go,” I say.”

“Do what you have to, son,” Wendy says.

The chief resident’s distinct pace clears through the closed curtains. I follow eager to learn from him.

“Dr. Han, please help!” Dr. Han has had Timmy as a patient for a long time.

“Timmy, nod if you can hear me. Everything is going to be ok. Deep breaths now.”

6:00 PM

It’s time for Wendy’s chemotherapy session.  She’ll be on the fourth floor. I’ll go keep her company.

“I’m going to pray for them,” she tells me. Wendy has a prayer notebook. She spoke of God as if He was an old friend who she had become reacquainted with. She says she fell away from God after her husband died. How lost she felt. But she tells me had to find Jesus when she got sick. And Jesus helped her find Rita again.

Wendy has stage four pancreatic cancer. Only a 4% chance to live. People wonder where doctors get these statistics from. We don’t pull them out of a hat. They’re based on exhaustive medical studies averaging mortality rates among a wide population. However, the average person is a late twenties, early thirties male without other exacerbating medical conditions. And that young John Doe only has a four percent chance to survive stage four pancreatic cancer. What am I supposed to say to sixty-five year old woman who’s has a bad heart?

Wendy’s daughter asked me why we couldn’t operate. I could explain that the pancreas is a central organ connected to pretty much everything in some way. I could talk about the different necessary endocrine systems, its physical location, or its multifunctional purposes. I choose to defer.

“Sorry, Dr. Diaz can probably give you a better answer than I can. I’m only a medical student Let me page her,” I say.

Dr. Diaz arrives five minutes later with a psychiatrist. We take Rita to a different, more private room. It’s never really quiet in a hospital. Different machines make a cacophony of noises, a disjointed chorus calling out which patients are alive. Occasionally, a flat note pierces the buzz. A voice calls out the time of death, and the flat line ceases.

The psychiatrist held Rita’s hand. She says we know Wendy is going to die tomorrow. Not eventually. Tomorrow. They try to calm her down and say the psychiatrist was just trying to be nice. She says there has to be something bad you aren’t telling me.

“We never tell anyone they will die tomorrow. because really everybody is different and while you can estimate hours or days of such, we sometimes get surprised,” says Dr. Diaz.

“This is the first time in my life that I didn’t want a surprise,” Rita says.

Dr. Diaz and the daughter walk out of the room. “Can I get you something to drink Rita?” Dr. Diaz asks. She guides Rita to chair, her hand in the small of Rita’s back.

“A bottle of whiskey would be nice,” Rita says.

“Sorry, I can’t help you there. But let me get you a cup of water.”

“That would be great,” Rita says. “I need to sit for a little bit. It’s too much to handle right now.”

“Paging Dr. Diaz,” the loudspeaker says.

“Excuse me, but I have to go,” Dr. Diaz says.

“I understand,” Rita says. Dr. Diaz briskly takes her leave.

Rita finishes her cup of water and places it on the couch. Rummaging through her purse, she takes a small chip out and puts it in the cup. Rita says good-bye to Wendy, but she never meets her mother’s gaze. Wendy calls out, but Rita is gone.

Wendy calls me back in her room.

She asks, “What are doing for Christmas?” Her eyes are red.

I tell her that I’m going home to see my family in D.C.

“That’s a shame. I would have like for you to join me and Rita for dinner. Let me give you my number in case you change your mind,” she scribbles a number on a coaster next to her bed. It’s a different one than the one in her file.

In the cup, Rita had placed her five year Alcohol Anonymous chip.

7:00 PM

Last patient on my agenda before my sign-outs and debriefing session. I step into the bathroom to text Kerry. Shouldn’t have my phone out in public. Inbox is empty. Kerry is in surgery all day.

“Could you send me something to cheer me up? It’s been a day.” I press send.

Timmy is the last patient on my agenda before I do my final sign-outs and head home for the night. I’m shadowing his two RN’s, Lisa and Jen. Since the events in the afternoon with his family, we’ve been closely monitoring his vitals. He’s resting now. His mother hasn’t said anything for a long time.

“Timmy are you ok?” Lisa says. “Timmy?” She gives him a gentle shake. “I can’t get a pulse. Checking respiration. He’s not breathing.”

“Call in the code,” Jen says to me. “Can we get some help in here!” Jen yells out the door.

“Code Blue, Room 404, Code Blue, Room 404,” I relay to the desk. Another nurse rushes into the room. I don’t know her name. She escorts the mother to the side of the room and explains the coming procedure. Olivia hears the nurse but her eyes look unfocused and watery.

Jen lowers the bed. “Engaging in CPR,” she says. She counts off the beats to the rhythm of “Staying Alive,” or more morbidly, “Another One Bites the Dust.”

“Good job with compressions. Make sure you do the whole cycle,” Lisa says. On TV, Code Blue looks like a chaotic storm of haphazard defibrillator shocks and frantic shouts. But in real life, panic is the opposite state of mind you want to be.

The two nurses see the situation.  One says, “I’ll go get the crash cart.” The other nurse takes off his nasal cannula, which delivers oxygen.

Dr. Han and Dr. Diaz arrive. “I’m Dr. Han and I’m going to be running the code,” Dr. Han says, “What’s the situation?”

“He just went into V-Tech,” Lisa says.

“I’ll do the documentation,” Dr. Diaz says. She grabs the Code Blue paperwork from the cart. Everyone communicates their roles clearly. It’s still a whirlwind of activity. The room is always crammed full of different personnel so everyone has to be on the same page.

“Stop the CPR so we can roll him over,” Dr. Han says. “Bring out the respirator.”

“I’ll take care of respiration,” Jen says.

The pharmacist enters. “What IV’s do you have running?” he asks.

Lisa says, “Normal Saline and 20 mg’s of Nitroglycerin.”

Dr. Han says, “Run his fluids wide open, turn off the nitro drip. Continue chest compressions for another two minutes. Dr. Diaz, you’re keeping track of time.”

“Switch out with me,” Lisa says. CPR commences. A lull in the room sets in. While Lisa’s counts under her breath, the squeaks of the bed springs stand out . I hear a rib crack. A common occurrence during CPR. Beads of sweat accumulate on her face. Jen switches in and out to respirate the patient. Everyone in the room watches for any sign of response.

“Two minutes CPR completed,” Dr. Diaz says. During a Code Blue, everything has to be carefully documented.

“Let’s do a pulse and rhythm check,” Dr. Han says. Lisa takes a step back and takes deep belly breaths.

“No pulse. I have flat line on the monitor,” Jen says.

“Deliver 1 mg of epinephrine and resume CPR, for two minutes. Keep on that respirator,” Dr. Han says.

The new nurse says, “I’ll switch in.” She counts off. “1,2,3,4,5,6,7…” Jen respirates.

“1 mg of epinephrine ready to be delivered,” the pharmacist says. Lisa tells him he has a central line. Lisa sets up the IV.

“1 milli epinephrine delivered,” Lisa says. 

“Is he still bagging ok?” Dr. Han asks.

“It’s becoming more difficult,” Jen says.

“Let’s set up for intubation,” Dr. Han says. “Get out the Code Blue panel from the crash cart,”

“1,2,3,4,5,6,7…” Another rib cracks.

“Good Job,” Lisa says. She pats the other nurse on the shoulder.  “We’ll get a chest x-ray when this is all done.”

“Two minutes CPR completed,” Dr. Diaz says.

“I’m going to go ahead and intubate,” Dr. Han says. He completes the procedure with practiced efficiency. “Check for pulse and rhythm,” he says after the patient’s breath stabilizes. “See if there’s color change. He looks around the room. “Lisa, could you listen for blood breath sounds?”

“We have V-Tech on the monitor and no pulse,” Jen says.

“Amiodorone 300 mg, IV,” Dr. Han says.

“Amiodorone 300 mg, ready,” The pharmacist says.

“Amiodorone is in,” Lisa says.

“Two min CPR again.” The new nurse continues on.

“How are you doing?” Lisa asks the nurse. She doesn’t respond. Lisa says, “Change out.” She takes over the CPR procedure.

“Two minutes CPR completed,” Dr. Diaz says.

“Pulse and Rhythm check,” Dr. Han says. His tone remains calm and collected. Timmy still has no response.

“Blood sugar 75 and dropping,” Lisa says.

“Deliver 1 mg of epinephrine,” Dr. Han says. “Resume CPR, two minutes. Call in the EEG and

“Lets brainstorm. Mrs. Tanner, could you describe the lead up to this?” Dr. Han says.

“I don’t know what happened. We were talking, I was just trying to get him to calm down, but he was so angry, so angry. But then he started breathing weird and he wouldn’t say anything, and his heart monitor went crazy and then it just stopped. Please, I don’t know what I’m going to do if he dies.”

“We’re not at that point yet Mrs. Tanner,” Dr. Han says.

“I shouldn’t have let him stay. This is all my fault,” Olivia says to herself. Another nurse comes in.

“Call in the Chaplain on an outside phone,” Dr. Diaz tells the arriving nurse.

“Increase ventilatory rate,” Dr. Han says.

“Increasing respiratory rate,” Jen says. They complete another cycle of CPR. No response. Timmy’s lips take on a blue hue. They do another pulse and rhythm check. No response.

Cease CPR. I’m calling it. Time of death. 7:15 PM. October 16, 2015,” Doctor Han walks out the door without another word. Dr. Diaz guides Olivia to the Chaplain. Olivia stopped crying. She collapses into a chair and begins to hyperventilate. Dr. Diaz attends to her.

“Debrief at nurses station in five minutes,” Lisa says. “Please sign the code blue documentation before you leave.” Lisa lifts the head of the bed up a little. It’s to drain the blood down so they don't look as blue and bloated and to make Timmy presentable for his family.

I excuse myself so I do not lose composure in front of Timmy’s mother. I see Dr. Han go into the staff room.

I open the door. Dr. Han is crumpled against the couch. His body shakes as he gasps for air. I reach out my hand to console him, hesitate, and close the door behind me.

8:00 PM

I’m changed back into my street clothes. Dr. Han has cleaned himself up since I last saw him. He’s waiting by the exit.

“I will see you tomorrow,” Dr. Han says. “Good work today.”

“Thank you Dr. Han.” All the tension in my body dissipates.

“Keep it up,” he says.

“I’ll try,” I say.

“Code Blue, Room 306,” the loudspeaker says. My heart shutters. I turn to race back in the hospital. Dr. Han holds me back.

“Don’t worry, I’ll take care of it. You go home and get some sleep. You’ll need it for tomorrow.”

“Ok, Dr. Han, have a good night.”

“Rest well,” Dr. Han says.

I walk out the automatic doors and do not look back. The winter air bites my face.

8:30 PM

The parking spot across the street from my apartment is available for once. The front door always gives me trouble. I jiggle my keys and work the lock open.

“Hello empty apartment,” I say, kicking off my shoes and letting my white coat fall to the ground. Before I do anything else, I always have to take a shower. Hallway still steamy, I open the fridge and its empty.  My girlfriend and I haven’t gone grocery shopping in weeks.

I pull out my phone to order some food. One new message. It’s a picture of Kerry smiling. She’s wearing my sweatshirt. It’s the first message she sent me when we started dating. I asked her to cheer me up during midterms week and she sent me this picture.

I lie down on her side of the bed and rest on her pillow. It smells like her shampoo. I set my alarm for four hours later and wonder to myself if she still had my sweater. My bedroom is so cold.