ICU Surprise!

It was 7:15 on a Tuesday morning. What kind of a Tuesday morning, I could not say. How would I know? There are no windows on 8 North, the adolescent ward at Bellevue Hospital, where I was spending my first month as an intern. There could have been a hurricane outside for all I knew.

What I did know was that in about fifteen minutes a pack of fresh, smiling faces would be arriving, and one of them would bring me breakfast: a toasted bagel with cream cheese and coffee. The long night (or should I say nightmare) was ending, and I could look forward to an easy eight remaining hours of work and then sleep, blissful sleep.

I put my head down on the counter in the doctors’ station and waited.

“Marjie….” A calm, well-modulated voice woke me from a semi-doze. “I want you to run over to the ICU and pick up the new patient who’s transferring to the ward.”

I looked up to see Bob Giusti, the senior resident, standing there in his crisp whites, a red pediatric stethoscope draped around his neck, his shock of thick brown hair freshly washed.

No on-call for him last night, I thought. He’s well rested.

If it had been anyone else, I might have felt resentful. But so great was my respect for the unflappably good-natured and reasonable Dr. Giusti, and so sweetly and nonchalantly had he delivered his request that, tired as I was, I simply picked up my battered clipboard and trotted off to the ICU in search of transfer patient Mark Ortega.

As the automatic glass doors glided closed behind me, a new and surreal world opened.

“Nurse! Nurse! F— you! Asshole!”

A fourteen-year-old man-boy clad only in white diapers was standing up in his bed, clutching the metal pole on the bed frame. His head was half-shaven in Mohawk style, and his torso was tethered to the bedpost with a thick white cord. A steady stream of expletives erupted from his mouth.

Struggling to focus, I turned to the junior resident.

“Hi, I’m here to pick up the transfer patient.”

Agnes Simms, still dressed in the blue scrubs she’d worn all night, her chestnut hair in a state of irretrievable frizz, turned to me and smiled mischievously.

“There he is!” she said, nodding towards the frenetic figure.

I gulped.

“Him?”

“Yup, him.”

Oh, boy.

“What’s wrong with him?” I asked.

Agnes handed me a metal clipboard with his chart. “It’s all here. Have a look.”

Okay. Be cool….This can’t be as bad as it looks.

I sat down at the doctors’ station, trying to concentrate amid my new patient’s screams, and began to read.

“Fourteen-year-old boy hit by bus crossing First Avenue…landed on head…lost consciousness…hole drilled in skull to relieve intracranial pressure…recovering well…loss of behavioral inhibitions….”

So this kid is ready to leave the ICU and come to us? muttered a wry inner voice. And I’m going to take care of him? Okay, whatever you say.

Being an intern, I’d learned, was like being in the army. You got your orders, and you followed them. No questions asked.

Now for the hard part. It was only the first month of my internship, and I was still settling into my new role as a physician. With some effort, I picked myself up and walked over to the patient.

“Hi, Mark! I’m Dr. Ordene. I’m going to be taking care of you.”

“F— off! You asshole!”

Well, so much for the physical exam. I retreated to the doctors’ station. Wearily, I wrote a transfer note copied almost verbatim from the ICU chart, then headed back to the ward. Mark, bed and all, would be wheeled over to us later.

No, I reflected, an intern’s life was not easy. As you rotated through the various wards, month by month, you were like any army private: You got all of the grunt work and none of the privileges. Nurses ordered you around; residents ordered you around. The only ones lowlier than you were the medical students, and they were just that—students. They could always run home to study and sleep.

Of course, I thought, the pediatric ward is a lot more humane than some of the others—say, surgery or ob/gyn. And there’s a certain camaraderie, especially with my fellow privates—I mean, interns. But this thirty-six-hour workday is not my cup of tea….

It was only a few short steps from the ICU back to 8 North. As I walked down the wide white aisle to the doctors’ station, I sensed something different. Everyone was just sitting around—Dr. Giusti, the four medical students, the three interns, the two residents; even the social workers. Why weren’t they bustling about?

As I reached the little glass-enclosed room, they all jumped up and shouted, “Happy birthday!”

Dr. Giusti produced a Carvel ice-cream cake from under the counter.

Wow! This was not what I was expecting. How did anyone even know it was my birthday? What an amazing team I’m a part of!

“I apologize for the new patient,” he said, “but we had to find some way of getting you out of the room.”

“No explanations necessary,” I replied. “This is the best surprise I’ve had in a long time.”

As we dug plastic forks into our slices of cake, I found myself thinking:

Maybe the army isn’t so bad after all.

 *          *          *          *          *

Postscript: The first few weeks, Mark stayed up all night in his bed opposite the nurses’ station, screaming, “Nurse! Nurse! Nurse!” One morning a medical student, performing a mental-status exam, showed him a pen and asked, “What do you do with this?” Not missing a beat, Mark replied, “Stick it up your ass!” then grabbed the poor student’s tie, nearly choking him. But little by little, Mark’s behavioral inhibitions returned, and the real Mark emerged. He turned out to be one of the sweetest, most likable teenagers I’d ever met. He said that his surgical Mohawk hairdo was cool, and returned to visit us after his discharge. Grateful for his miraculous survival, he even volunteered to participate in a study of head-trauma patients.