I had been studying for boards, and my funds and mental reserves were depleted. A friend from residency had told me about this company called Loco Tenens, and I thought I'd give it a shot. I expected to score some quick cash and not work too hard. I told the hiring agent that I wanted a small hospital in a nonurban setting. I figured I'd end up in some quiet place in the boonies, and could get some serious review time in on someone else's nickel.
I scored a one-week hospitalist gig in a dumpy little hospital in the middle of stinking nowhere—just what I wanted. The job came with a moldy hotel room, a food budget sufficient for the few fast-food joints that lined the lame main strip, and little likelihood that I'd be tempted to spend my nights out on the town. The hotel gym was a stairstepper that clicked annoyingly on every stride, a few loose weights, and a too-cold sauna. There was a nice outside pool but it was cold and rainy. I would have to watch my carbs. The location was perfect for studying, but you wouldn't catch me dead living there.
The first night I stayed up very late hitting the books, and finally crashed. The clock radio awoke me with Justin Bieber's “Baby.” That was just how this day was going to be.
I checked my phone—no new messages. It was February 2nd, Groundhog Day. This town was all winter, that was for sure. I shrugged on my trusty lab coat; loaded my pockets with stethoscope, pens, guaiac cards, PDA, and study guide; and ambled into the hospital. So many smiling faces and warm welcomes induced almost as much nausea as a Justin Bieber song. Who were these people? My plan was to learn nobody's name, make no contacts, and enter into no relationships (though a tryst in a broom closet wasn't out of the question if the opportunity arose). I was here for one thing and one thing only—cash-ola. The study time was a bonus.
I finished rounds on 14 patients in less than 90 minutes and headed for the call room. I slipped off my sneakers, flipped on the television and began to drift into sleep...and then the pager went off. It was the emergency room—an admission. Some old GOMER with probable urosepsis and possible aspiration. No family present, no old records. Typical. They had given him some quinolone or other, drawn admit labs and cultures, and sent him up. Oh well, I could still grab a few REMs before he hit the floor.
I jolted awake to the sound of the code beeper. Code called, room 3313. I ran down the hallway, took the stairs down. The door was locked. I ran back upstairs and that door was locked. I ran down all the way to the emergency exit, outside, back around the front of the hospital, to the elevators, up to 3, down the hallway (the wrong way), back the right way and into the patient's room. I checked my own pulse.
3313 was my new admission. He'd been on the floor for an hour and I had not seen him. The look on the nurse's face as she administered chest compressions was a mixture of relief and annoyance. She suggested none too kindly that I get my medical rear in gear.
I leapt into action. He had arrived on the floor hypotensive and tachycardic. The nurse had been tied up with another patient's family that was unhappy with the brevity of my rounds. When she came in to check on this admit, he was unresponsive. She'd been administering CPR for over 10 minutes. He was flatline. We ran the algorithms, but he was as dead as they get. I called it after 45 fruitless minutes. At the end of the shift, I went back to my crappy hotel room—dejected, exhausted, and knowing that there'd be no broom closet action for me this week. I decided to call it a night.
The alarm went off. “Baby, Baby, Baby. Oh…” What kind of radio station was this? Then I looked at my phone, which said it was still February 2nd! Had my phone died? I ambled into the hospital, and found so many smiling faces introducing themselves. What? Suddenly it hit me: This was Groundhog Day. I'd seen that Bill Murray movie. Could it really be happening to me?
I made my rounds, but took more interest in the patients this time, especially one family with many questions. I still was done in less than two hours. I was just going into the call room and slipping off the old shoes when the admit pager went off. This time I did not go to sleep. I started to run for his room, then calmed myself just before I headed into the wrong stairway. I went the right way and was quickly in the patient's room. The nurse was at the bedside. This time she had not been distracted by an angry clan, and was there checking vitals. We hooked up a bag of normal saline and ran it wide open as I pulled up his labs. His white count was high, as was his BUN creatinine ratio. His potassium was low and so was his hemoglobin. He was dehydrated and septic.
I broadened his antibiotic coverage, kept the fluids going, and within an hour he was looking much better. We still had no history on the old dude, but someone in the emergency room said they had left a message for the family. I made a derogatory quip about patients without records. The nurse was not amused. I headed back to the call room feeling better. I was just lying down when the code beeper went off.
I ran without thinking down that same wrong staircase. Not again! When I finally got to room 3313, I found the nurse squatting on the floor by his side. The patient had fallen out of bed. His leg was twisted at an odd angle, and there was copious blood spurting from a head laceration. I would soon discover that I had not looked at his INR which had started at 10, and was only worsened by quinolone. He had an intracranial bleed and a fractured femur. He was dead before the helicopter could come to take him to a tertiary care center.
Another lonely night in the hotel room. The alarm went off. “Baby, Baby, Baby. Oh”…brother. I walked into the hospital. This time I paid a little more attention to the introductions. I was still rounding when the patient hit the floor. I eyed him warily. I had no great love for this old man but knew I had to keep him alive if I ever wanted to see February 3rd. Fluids, antibiotics, check the labs, transfusion. This time I gave him vitamin K. I put the bed alarm on and the guard rails up. I even made eye contact with the nurse. I knew how I'd break this cycle. I'd make sure he was alive when my shift was over.
All the loose ends tied up, I was headed for the cafeteria to have a cup of coffee when the pager went off. I headed back to room 3313. Anaphylactic shock from the antibiotics, cardiac arrest and failure.
“Baby, Baby, Baby.” I knew everyone's name by now, gave the fluids, different antibiotics, transfusion, bed rails, etc. This time I was eating lunch with the nurse when the pager went off. Blood mismatch, acute transfusion reaction. So it would be. Again and again, I tried to steer the old coot through the hospitalization, only to be stymied by medical errors, my own inattention, his undiscovered diseases (diabetes, acute coronary syndrome, contrast-induced acute renal failure). It was a never-ending battle and I was losing. I was getting sick of the patient, but impressed by the tenacity of his will to die. I longed for a no-code status. Where was his family? Didn't they care about him?
“Baby, Baby, Baby.” Here we go. Warm greetings to my new colleagues. Efficient rounds with a helpful nursing staff. Admission, fluids, correct antibiotics, recheck the blood before transfusion, bedside glucose checks, try to call the family. To my surprise, nobody had ever tried to contact them. They had no idea Gramps was in the hospital. His granddaughter came up to the room, several small children in tow. They entered the room. He opened his eyes and smiled at them. His granddaughter hugged him and told him she loved him. The great-grandkids jumped in his bed, delighted to set off the bed alarm.
His granddaughter smiled at the nurse and me, and thanked me for saving his life. “It was nothing, just doing our job, our pleasure.” I walked out of the room; the nurse grabbed my arm and smiled at me. She was off tomorrow and suggested we go see a movie when my shift was over. Sounded like a plan to me.
“Baby, Baby, Baby.” No, it couldn't be! I'd done everything and the patient had survived. I looked at my phone. February 3rd. A new day. I looked forward to going in for my shift, and to my date tonight. Perhaps being a hospitalist in a small town wouldn't be that bad. Still, I was looking forward to payday finally coming.