Syracuse, NY 13210
Volume 9, 2009
And Then Something Familiar
Adam Philip Stern
The alarm blared, but the student refused to open his eyes. It was four thirty in the morning. It had been light when he had gone to sleep last night, and it was most certainly dark upon being awakened by that abhorrent siren. He simply could not do it. His eyelids were sealed. His bones were heavy, and his bedding felt as though it had been sent from God. At that moment, he preferred to abandon his decade-long quest of pursuing a medical degree to the agony of having to start his morning. He could not possibly do it all again that day.
And then something familiar happened without his conscious consent: The student rose up out of bed and began his routine. He stumbled to the bathroom and cleansed himself of the remnants of an interrupted night's rest. He fought back the germs in his mouth with antiseptic and scrubbed away the ones on his body. By the end of his shower he began to feel almost human again and resented the fact that with each passing moment, the idea of not getting out of bed seemed increasingly ridiculous.
He turned on the television to drown out the silence in his apartment while he scarfed down an unhealthy breakfast of packaged pastries in an unhealthy amount of time. The television was set to the financial news station, and it made him smile sarcastically at the idea that they were covering the stock market in Asia. The student felt sorry for the American news anchor, because he had obviously been awake for some number of hours already, yet some part of him hated the man talking to him through his television. He despised the fact that this man was being paid to do a job, one that permitted him to be on television no less, while the student had no such reward. With each passing year, it had become more difficult for the student to justify his academic efforts as an investment toward his future. How could it be an investment when the value of his time seemed to diminish with each educational milestone?
The student's walk to the hospital felt surreal; it always did. The stark calm of the streets made him feel as though he were sleepwalking. He never made it from his apartment building to the hospital without questioning whether or not he was actually meant to be out of bed at all. The foot of snow on the ground made matters more complicated as well. Each step came with the disgusting sensation of slush saturating his socks. His dress pants had long since been stained by salt and mud, but it didn't matter since his formal attire was a farce anyway. As soon as he reached the hospital he would change into scrubs. He never managed to get on a pair without wondering how many times before they had been soiled in blood and guts. He'd never forget the time he went straight from assisting in a surgical procedure to his lecture; it was only at the end of the session that one of the student's classmates turned to him and asked what was on his leg. Looking down, it was clear that a piece of subcutaneous fascia had dropped from the operating table and managed to cling to his scrub bottoms for the better part of two hours. A part of someone was hanging on for dear life as the student went about his day completely oblivious.
The student made his way up to the residents' lounge where he discovered the Tiny Ruski. It was hard not to miss him, at well under 5 1/2 feet tall and less than 120 pounds. The Tiny Ruski had been an attending physician in his home country but needed to do an American residency program in order to practice in the United States. He was well into his forties and knew much more about clinical care than the average resident, but his English skills were severely limited. He always woke up the patients with a tug on their ear lobe and the comment, "I check you now."
The Tiny Ruski and the student had an hour to see seventeen patients and write medical progress notes on all of them. They approached the task by a divide-and-conquer strategy in which the student took on a handful of his own patients to examine without supervision. The experience never lasted more than a few minutes; if it did, they would never finish pre-rounding on time. On that particular day, one of the student's patients put a wrench in his flow.
It was Mrs. Charlene Wigginton, an elderly woman being treated for persistent diverticulitis. When the student perused her chart, there was a hand-written note stuck on at the end. The note said, "Please call Mrs. Wigginton’s son to discuss care." It seemed fair enough to the student, yet he wasn't quite sure who the note was intended for. Certainly, he wasn’t meant to call this patient's son. What would he say? If the Tiny Ruski attempted the call, disaster might ensue because of the communication gap. It would have to be the attending physician, whoever that was.
The student knocked on the door and entered in a single motion. The room stank like rotten bananas and three day-old gym clothes. In the center laid a woman who looked much older than her stated age of seventy. The woman was supine and couldn’t quite see the student approaching from the doorway.
"Who's there? Are you my doctor?!?"
"Hi, Mrs. Wigginton. I'mó"
"Are you my doctor? Thank God!"
"No, ma'am. I'm a medical student. Your doctor asked me to take a look at you this morning."
"Who the hell is my doctor? Where is he? Why won't anyone tell me what's going on?"
"You know, I'm actually not sure who your doctor is. I can find out for you though."
The student began his physical exam. Pupils were equally round and reactive to light. Mucous membranes were moist. Oropharynx was not inflamed and showed no exudates. No cervical lymphadenopathy was noted.
"I mean, someone with a God-darn lab coat is in here every five minutes waking me up, and no one tells me a God-darn thing. I don't know what you're doing for me or why you keep sticking me with those little pricks. Why won't you tell me what's going on?"
"I'm going to find out who your doctor is, ma'am. Just be quiet for a second while I listen to your heart and lungs."
The woman continued to mutter, but the student was able to determine that her heart rate was regular and without any discernable murmurs. Her lungs were clear to auscultation bilaterally.
"What kind of hospital is this? I want to be transferred back up to that place on Route 12. They talk to you there at least."
When taking the patient's vital signs, the student couldn't help but notice it was almost six thirty, and he really needed to finish if he were going to get to rounds on time.
"My son is coming, you know."
"Oh, yes. And you won't be able to hide everything from him the way you hide it from me. He went to Cal Tech. So you better tell him everything that's going on. He won't stand for this kind of treatment. You'll see."
The student palpated the woman's abdomen and found she had exquisite tenderness in the left lower quadrant. She winced in pain at the lightest touch and looked at the student. Her pale old eyes seemed to ask why he insisted on repeating a physical exam test that had already been performed days ago.
"Ma'am. You have a problem in your belly, but we're keeping an eye on it. Your doctor will see you later and explain everything we're going to do for you."
"My doctor? I thought you were my doctor!"
"No, ma'am. I'm a student. I'll find out who your doctor is, though."
"This darn place. I swear nobody tells me anything. I want to go home. When can I go home?"
The student's watch now read six thirty and he was officially late for rounds. He walked out of the room without saying another word and came across a nurse.
"Are you assigned to Mrs. Wigginton?"
"There's a note in here that someone needs to talk with her son."
"I know. I wrote that."
"Do you know who her attending is?"
"It was Dr. Phillips, but I think she went on vacation, and someone's going to be covering for her today."
The student's heart began pounding, but there was no time for a panic attack. The Tiny Ruski approached and pinched his ear lobe.
"We late for the roundings."
The student began following the diminutive figure, writing the briefest note of his young career as he walked.
"You know, Mrs. Wigginton's not getting a whole lot of information. She doesn't know who her doctor is, and no one's really communicating with her about her treatment or when she might go home."
"Wigginton. Wiggy, Wiggy, Wiggy. She is demented, no?"
The student felt a rush of relief wash over him. She was demented. He had forgotten that important detail. She couldn’t possibly know about all the minor facets of her care. He felt as though an enormous burden had been lifted off of his shoulders. No longer did he feel as though he needed to save this woman from the intricacies of this place. She would never realize she had been saved after all.
As the day progressed, and the student spent hours on rounds, in lecture, in the operating room, his thoughts and concerns about Mrs. Wigginton faded into the background. There were so many new ideas to learn, techniques to master, and orders with which to comply. Still, even as the student forgot how to spell Mrs. Wigginton's name or that she had a son at all, a slow, sinking, suffocating sensation began to crawl into his throat and on down through his chest. Mrs. Wigginton was demented, yes, but that did not mean she wasn't right; that did not mean she could not be saved. Surely the student could do something for this woman. But what was it? The question unconsciously gnawed at the student, but still, the day marched on. When evening approached, the student's mind was full, and his heart was spent. He needed to get home to study before going to bed. If he did not do this expeditiously, it would soon become impossible to get seven hours of sleep, and then how would he survive the next day?
When the student's alarm rang out the next morning, he knew that he could not possibly get out of bed. And then something familiar happened.
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October 30, 2013
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