It's Valentine's Day, my first year of residency at Mount Sinai Hospital.
I work all day and then stay the night as well; I am on call tonight. I roam the hallways alone. I have been a doctor out of medical school for all of eight months. Mostly, I lay low in the call-room and pray that no one needs me, living in constant fear of a medical emergency. A psych emergency I can handle; it's the 'code blues' that terrify me. I just did four months of medicine rotation at the Veteran's hospital, where I lived in mortal fear of anyone's heart stopping. When I had to stay on call overnight, I would cower in my bed under the thin blanket. I couldn't sleep due to the pounding of my heartbeat, reverberating in my chest and in my head. I was sure that I'd be called to someone's bedside and fumble impotently with the medications and machinery as they lay dying.
My Mount Sinai call is passing by uneventfully. I have eaten some chocolates out of heart-shaped boxes on this ward and that, making my rounds one last time before I head to the call-room to get some sleep. Schmoozing the nurses as best I can, I ask them to think of any last-minute orders that I can write before I turn in, so they'll be merciful and not call me unless it's urgent.
A nurse on one of the wards asks me to see a new admission, a 24 year old guy named Calvo who is quite literally bouncing off the walls. He came up from the ER earlier in the evening, and the nurses are having a hard time containing him. I walk into his room; he has no roommates, thankfully. He is extremely fearful and agitated, climbing onto his bed then jumping off of it and pacing around his room, ending up on his bed again. He is fixated on the fact that he will not live through the night. He is convinced a curse has been put on him, through the Cuban Voodoo called Santeria. I had never heard of Santeria until I moved to New York City, but the nurses here believe in its power.
"You're not going to die," I keep reassuring him. I ask the nurses to give him an injection of Ativan, the most commonly used sedative used on the inpatient wards, and I go to the call-room and try to get some sleep.
At 2:30 in the morning, I get a call. "We're having trouble getting Mr. Calvo's vital signs," explains one of the nurses, in a heavy accent. I figure she just needs help with the blood pressure machine or something, so I lace up my sneakers and go to the bathroom down the hall before heading to the ward. I walk into the patient's room, assuming there'll be a nurse in there struggling with a BP cuff, but he is alone. Immediately it becomes clear why the nurses are having trouble getting his vital signs. Mr. Calvo is lying in his bed, staring straight up at the ceiling, a look of terror on his face. His eyes are wide open, his pupils fixed and dilated, and he is cool to the touch.
"Oh my fucking God! Please tell me this guy is a DNR!" I'm begging as I run into the nurses' station. At the VA, if a patient was a Do Not Resuscitate, we wouldn't have to run a code. Many of the older, sicker patients had orders not to revive them. I grab his chart, but of course, there's no big orange sticker on the front; he's a young guy—as far as I know, a young, healthy guy.
"Jesus! Call a Code!" I yell to the nurses.
I sprint back into his room and start CPR. Or what I can remember of CPR. I am adrenalized, swearing, scared, angry. "What happened? Why is this happening?" I am talking to myself, soothing me with mindless chatter. "Just do the compressions and the breaths, don't panic, breathe."
Oher doctors start to arrive at the code, thankfully, and I continue doing chest compressions while they start IV's, give him oxygen, and inject multiple medicines to get his heart started again. "Clear!" the code team doctor shouts, as they attempt to shock his heart back into a rhythm.
But it's no use. The man has clearly been dead for a while. I knew he was dead when I got there. No one can say with any certainty when he died, or why in God's name he died, but every doctor in that room knows that he is now dead. My patient. My mess to clean up. The code is over, and all the other doctors leave. Like a wild party I have thrown, the keg is dry and the guests have moved on. The room is a mess. There are IV packages and tubing on the floor; there are EKG leads, face masks, and gloves littering the bed.
He is still staring at the ceiling, impervious.
I go to the nurses' station and start to make the calls: the on-call attending, the ward attending, the inpatient director, Dr. Fanques. I am on the phone for what seems like hours as the adrenaline slowly diffuses out of my brain. When I am calmer, I take a deep breath and call the family. I have to tell them in my broken Spanish that I am incredibly sorry, and there is no logical reason, but he is dead.
"El murio!" his sister screams. "El murió!" She sobs into the phone and hands it over to her husband. They want to come into the hospital to see him, and I tell them where to park. We're going to need an autopsy to figure out what the hell happened, but I save that for when I can talk to them in person.
I need to fill out a death certificate, which I have never done before. I call the medical examiner's office to get some advice. I don't know why he died, or how he died, but I'm supposed to fill out an official form for the city which explains his death. The pathology resident on call at the morgue is very helpful in explaining how I should fill out the form. I can't simply write that his heart stopped. It is the result, not the cause, of his death as far as the pathologist is concerned. Also, he doesn't think my listing a voodoo curse as the proximal cause of death will fly. We are bonding over my predicament at four in the morning, flirting not-so-subtly, and I am tempted to ask him out. Out of respect for the dead, I do not.
I leave the nurses' station when the paperwork is completed, and I ask the nurse to page me when the family shows up, but of course I can't go back to bed. I wander the wards and go to my office. My favorite patient, the toothless old schizophrenic lady with tardive dyskinesia, is wandering the halls. TD is an irreversible side effect from some of the older antipsychotic medicines (the newer antipsychotics are much less likely to cause it, carrying a risk of obesity and irreversible diabetes instead); it manifests as uncontrollable movements, often in the mouth and hands. She sees me and gives me the biggest, sweetest smile while her tongue darts in and out of her wrinkled mouth. I tell her everything, and she nods her head sympathetically. I don't know how much of this she gets, for she is quite possibly demented, but I want to connect with someone, and her loving gaze is almost enough.
In the morning, I have to explain what has happened to the residency director, my father figure at the hospital.
"I heard what happened last night, Julie," he opens. "How are you doing?"
I sit down in his office, in the cushy leather chair across from his desk, and I start to cry. It is the first time I have cried for the dead man. It feels good to finally break down, but I worry that I'm making Dr. Wilson feel uncomfortable. He's a shrink, though; he's probably used to people crying in his office. I look to my right, where, as if to assure me, a box of Kleenex is ready and waiting.
"I feel like I threw a party and now I have to clean up the mess," I choke out between sobs. I blow my nose and continue, "I mean, the code. Whenever I went to codes at the VA, it was always somebody else's patient. When the code was over, I left. This time it's my patient. They left all this trash in the room, and I had a bunch of paperwork I had no clue how to fill out, and they left me with a corpse. Do you know what I mean?" I don't know why this is how I start, as a victim, in trying to explain my failure, but it is what's foremost in my mind, for some reason. I guess it's a symbol of my new responsibility as a physician, which I don't want. I want to go back to being a guest at the party, when I was a medical student watching the action, and not the host of a failed attempt at resuscitation.
Dr. Wilson murmurs something comforting about this being something we all goes through, but then he gets down to business. "Listen, Dr. Fanques is going to need you to write up everything exactly how it happened. There's some confusion about exactly when the code was called. Was it before you got there or after?"
"After," I answer. "I told the nurses to call it."
"Well, that's not exactly how they're portraying it," he tells me. "So why don't you go home and write up the whole story. Try to have it for him tomorrow morning."
"Dr. Wilson, I'm leaving for my week off tomorrow afternoon, so if there's any sort of meeting about this, I'm not going to be there."
"That's all right. I think we'll be able to get through that without you, as long as we have your written statement."
I go home, write up the entire case as best I can remember, and pack for my week with my parents in Palm Springs. I have never needed a vacation more. I can't wait to fall asleep on the plane.
Fast asleep on the plane…
"What?" I startle, looking frantically around the pitch black room. Where am I? Am I hallucinating? I could swear I just heard a voice say my name.
"What do you want me to do with this guy?"
The clock by my bed says 4:12. There is a phone in my hand. "Oh...Uh...I'm sorry. I must've just spaced out. Acid flashback," I joke. "Can you maybe rewind a little? I think I might've missed some of your presentation. I think I fell back to sleep while you were talking. I'm really sorry. Can you just start over?"
I haven't thought about that Valentine's day in years. What made me think of it now?
"Whatever, sure," says the resident. "He's a twenty-seven year old guy, history of bipolar disorder and cocaine abuse. Parents say he's been off his lithium for a few months, at least. Brought in by ambulance from home. He's grandiose, thinks he's got supernatural powers, pretty hyper-religious, hyper-verbal. He keeps going on and on about Santeria. Isn't that some kind of Haitian Voodoo? Or is it Cuban? You ever heard of it?"
"Yeah," I clear my throat. "Yeah, I've heard of it."