by Michael Zacchilli, UMMS 2007
Grand Prize Winner 2006 Gerald F. Berlin Creative Writing Award
It wasn’t supposed to be like this.
On the wall, the clock’s hands grudgingly surrendered a few more millimeters… it was 3 o’clock in the morning. I looked through the wire-latticed window, banged the hard metal plate next to me, and sighed in accord with the whirring motor as the doors to the Cardiac Catheterization Lab swung outward into the empty corridor. The doors’ hazy reflections passed wearily across the polished hardwood floor and their shadows drifted across the newly painted walls—a failed attempt to shade the tactless reality of the fluorescent lights overhead.
Across the hall, a man faced the wall silently, his hands pressed tightly over his eyes—they dropped suddenly at the sound of the doors. To my left, in a mocking attempt at comfort, a womb-like recess in the wall supported a thin cushion and the huddled form of a second man. His arms were locked around his chest in a pitiless embrace as he rocked slowly back and forth in that somber asylum. Then he looked up, eyes pleading silent prayers.
It was not supposed to be like this.
The corridor was empty.
9 hours earlier…
“Time out of OR: 5:45 PM. Here’s the last patient from Room #2… we’re done for the day.”
The hospital bed drifted slowly to rest in the PACU like a boat to dock, leaving a host of nurses, residents, and myself standing listless in its wake. The heavy-eyed passenger slowly scrubbed his face with his hands, and I found myself doing the same as I stepped out into the lounge. My legs willed me to the nearest seat, unceremoniously abandoning me as I dropped onto the hard plastic. I ripped off my surgical mask, uncaring as the blue straps tore into my skin before snapping free. It had been eight hours, one pelvis, and three femurs since I had first stepped beneath the OR’s hot lights—somehow that last knot just wasn’t worth the effort.
My roommate burst out of the PACU behind me with a smile on his face.
“Hey man… we better hurry home. This is our last Friday night off for the rest of surgery,” he said, clapping me on the back. “Oh wait, I forgot, you’re on-call tonight.” His already broad smile grew wider, and he laughed as he jogged out the door, leaving me alone. Tonight would be my first general surgery call. A chief resident, an intern, and I would be covering more than seventy patients from now until morning rounds. My stomach clenched and spun—I was hungry, not nervous, just hungry. I took a breath, stood up, and began the long trek to surgical sign-out.
As I entered the room I grabbed a copy of The List—the pulse of a hundred lives laid out in stark monochromatic Times New Roman. The chief from each service briefed us, and my spidery scrawls quickly adorned the orderly register: unfinished tasks, recent labs, general concerns, basically everything I needed to worry about. For the next seven hours, I roamed the hospital doing postoperative checks and sinking comfortably into repetition—recording urine outputs, listening to hearts and lungs, asking about pain—I was finally beginning to feel useful. I finished writing my notes, neatly placed the charts back into their racks, and decided to page my intern.
And that is how I found myself sprinting to the nearest stairwell, my short white coat flapping behind me, spilling forgotten index cards and leaving them to flutter helplessly down into the dark void. It was my first night on-call for surgery, and one of my patients—one of those anonymous names on my list—one of my patients was coding. But I was the medical student, and so everyone had justifiably rushed to their responsibilities caring for the patient. They had never thought to page me.
Despite my haste, I paused outside the doors to the catheterization lab. I was safe in the corridor… I knew what was happening in the corridor. I had no idea what was behind the door. I had never met this woman… everything I knew about her life was in an 8 cubic inch block of typed script. I didn’t even know her full name (the computer had decided that Jorgensen, M 67F was sufficient), but she was my patient, and she was dying. Nobody had put that on The List. I decided it was time I tried doing something about it, and banged through the doors.
The scene that greeted me was unexpected. I had envisioned a team surrounding the bed, someone yelling frantically for a vital piece of equipment, the nurses looking on in horror. That is precisely not what was happening. It seems that in the life of a third-year medical student, reality always finds a way to humble you, a way to bluntly testify to your ignorance… in short, reality explains why nobody remembered to page you. And so, instead of standing at the center of chaos, I found myself observing from the edge of a dead quiet room. The anesthesia team quickly finished the intubation and began oxygen, glancing nervously at each other. My intern anxiously wrote admission orders as the resident spoke with the ICU nurse in hushed tones over the phone. But I didn’t need to hear desperate cries. I didn’t need to see desperation. Looking at their steeled expressions, glancing into their eyes, I saw hesitation, and I knew things were not good.
And then everything happened at once. The phone clicked, the chart closed, and the anesthesiologist unlocked the bed with a snap. Each person grabbed a portion of the bedrail, and they began rolling towards the patient transportation elevator.
“Hey…” My chief resident spoke clearly—a staccato plea suddenly penetrating the dull fog of the surreal nightmare. “Hey, I’m sorry to have to do this to you. We need to get this patient to the ICU now, and she’s going to need everyone here when she gets there… Her sons have already been called. They should be out in the corridor. We need to help her… and that means you need to help them. There are three things they need to know: one, the situation is serious; two, their mother has been intubated and is moving to the ICU; and three, we are doing everything we can for her right now.” He carefully noted each assertion on his fingers, marking my cadence. “Now go, answer the questions that you can, and send them up to the ICU waiting room with the ones that you can’t.” I watched silently as the elevator doors slid shut, swallowed that moment of certainty, and left me alone. And so I stood for a moment, my thoughts accompanied by the irregular beeps and dimmed light of the abandoned catheterization lab…
There is an unspoken lore in most hospitals. It’s a theory unexplained by science, unproven by any systematic review, but people believe it nonetheless. Its almost a sixth sense. In fact, it’s not uncommon for staff to give witness: “patients just know when its time.” And you need only look as far as the Pediatrics ward to learn that, despite all odds, they can sometimes decide to get better. It seems that occasionally this intuition extends beyond personal concern, and loved ones are gifted this terrible knowledge—at times of truth, when thoughts and perceptions are stripped down to raw emotion. And so it was that Mrs. Jorgensen’s sons knew every word I would speak before we ever met.
The doors swung outward in perfect arcs, and swept doubt from the eyes of the two men facing me. And just as swiftly their piercing gazes shattered my trepidations. For a few moments we stood in silent dialogue, frozen in that empty corridor. I remember it distinctly. The words that followed were nothing but formality. Fifteen minutes passed, and then they clasped my hand, thanked me, and disappeared into the vastness of the dark stairwell. Despite all my efforts, I would never see them again.
I walked away down the empty hall, and I soon found myself sinking once again into the sedating repetition of postoperative checks and discharge plans. I wanted to numb my mind, to blanket and smother my doubts beneath mounds of patient education forms and lab printouts… but every checkmark I placed on The List, every completed task, stood in stark contrast to my uncertainty. What happened in the ICU? Had I been realistic in offering my explanations? Hope had a way of rising and the fall was so much longer from the 7th floor ICU…
I finally left the hospital a few hours before dawn. It seemed a singular period of time, a fleeting undefined moment when the world walked wearily between dreams and consciousness. The ground was blanketed in a thick white sheet, and snowflakes danced brightly in the halo of the streetlights. They seemed infinite… a million tiny stars. It was impossible to follow any individual path for more than a moment—they moved a thousand directions at once, up and down, each at their own pace and heading—but watching the ground, as the pure white drifts grew slowly, it was impossible to deny the truth. They all stopped eventually. Regardless of that frantic dance, despite the beauty of their chaotic journey, they all ended finally in quiet repose. I walked on in solitude, a million tiny crystals lighting gently on my wool jacket… they felt heavy.
I walked on through the cold until, slowly, my unquiet mind was tamed by the night’s unbounded silence, by its relentless truth. Eventually the night, this night, seemed somehow natural. The strong wind pushed me, shook me, carried me in its currents… and I walked.
Note: The work above is an account of actual events. The patient name and other details in the story have been altered in order to maintain patient confidentiality.