a typical morning

6:00am
i'm already tearing through the underground hallway connecting the parking lot to the main hospital, weaving between slow walkers left and right. i'm walking so fast that the PDA in my white coat pocket is making a smacking noise against my car keys. by the end of the trek, i'm out of breath and reminded of my lack of endurance. i'm heading towards the lymphoma/leukemia service--my home for the month.

6:30am
with the computer on wheels, the intern and i are in front of the first patient's room (of 14 we need to see this morning). a woman with newly disgnosed leukemia. she's doing fine. labs look great. x-ray...mmm, no change. fevers overnight? nope.
in.
good morning, sorry to wake you. any problems? big deep breaths. good. lie back. breath normally now. does this hurt? any pain? k. thanks. be back to see you later.
out.
that was an easy one. and on to the next.

6:40am
nurse stops us between rooms: "ms. l is very short of breath and has been all night. can you come see her?"
i look at my watch. in the next 40 minutes i have to see all these patients, help the intern with labs, then head over to conference.
"ok, check a sat, put in for a stat portable [chest x-ray], and get her a breathing treatment. i'll get there." the nurse looks sceptical but turns and walks away.

6:42am
my pager goes off, and i head to the nearest phone. after the first ring i hear: "yeah, this is the nurse taking care of ms. l. she's really short of breath and has been all night. i don't know what's wrong with her. i just talked to the fellow and he just wants a breathing treatment sight unseen, and i think something's wrong..."
i pause for a couple seconds before slowly saying, "i am the fellow." nothing on the other end.
the nurse starts talking rapidly, "oh i'm so sorry i thought i paged respiratory therapy...i..uh..i..." i tell him i'll be right there and hang up. why can't one morning--just one--go without complication? i see the patient--she's doing ok, but a bit fluid overloaded. as i'm entering a lasix order in the computer, the nurse approaches me and begins to apologize before i cut him off: "you have been up all night taking care of sick patients. i can't imagine how frustrating it is for you to ask for help and not get it immediately. i'm sorry i didn't get here sooner." [that nurse and i are good friends now]

7:15am
mr. r has lymphoma. his room looms on the horizon. the intern and i look at each other and steel ourselves for the predictable onslaught.

in.

"good morning! you're looking very well today! any prob--" my worst fears are realized as mrs. r interrupts with her daily diatribe of her husband's endless pains, aches and sniffles:
"well he had a stomach ache last night around 11:23 but that went away with some mylanta but i was wondering if you knew what that was and also he has this spot on his leg can you look at that i was wondering if it's an infection or maybe something else and, honey, didn't you say that you were having blurry vision in your left eye around 3am this morning or was it your right eye or was it 4am and he had some diarrhea last night about four times at 7:14, 8:23, 9:00 and when was the last time, honey, cuz it's smudged in my book here but i think it was about the consistency of pudding wouldn't you say, honey, or maybe like pudding that had been in the fridge for a while but that last one sure did a number on..."

by this point, i've stopped listening. i'm standing behind the intern who's really bearing the full onlaught, nothing to protect her from query after complaint after suggestion. i'm in a better place. i'm looking past mr. r, past mrs. r, out the window behind them. the sun is rising, casting a warm pink glow on the changing leaves on the trees. i start to smile as i feel myself floating, drifting on the soft clouds...

i snap back to reality as the intern asks me, "so should we send a sample?"

of what??? i've been off in la-la land for the past few minutes and have no idea what the hell has been going on in front of me. now, all three people in the room are expecting some enlightenment from me. i take the path of least resistence, "so, let's see how things go, and we'll re-evaluate." everyone nods in agreement, in unison. i beeline for the door.

out.

as we walk away from the room, the intern smlies and says, "of stool." she knows where i've been. i knew i liked her for a reason.

7:20am
next patient, one of my favorites. this woman has been suffering for weeks with an inflammation of her bowels caused by her weakened immune state. a tube in her nose, IV's in her arms, and a bandana on her head, she has had nothing to eat for days on end. each morning she looks at me with sad eyes and asks, "when can i have my orange?" she loves oranges. one night, while i sit at the foot of her bed, she describes what it's like to eat an orange, pushing her face into a cut half, squeezing it, sticky juice running down her face. it sounds like heaven.

today, i have nothing new to tell her. her belly is quiet since her bowels stopped their natural rhythmic pulsing. no bowel movements. i don't have to tell her the bad news as my eyes say everything. no food for yet another day. she turns her head to the side, away from me in a sign of exasperation. as she turns her head, the NG tube tugs at her, and she grimaces. i stroke her hand before i leave the room. another no-orange day.