What was it my father said to me
when I forgot to latch the gate
and we spent the night in the woods
searching for eyes among shadows
of tree trunks cast by flashlight?
I began practicing as an internist/nephrologist in the early 1960s. Having rented an office in Los Angeles, I introduced myself to the local medical community and set out to build a practice.
With a growing family, a mortgage and an office to support, I was hungry for patients. Hospital emergency rooms were good referral sources, so I took ER call at three different hospitals.
Late one Friday night, I got a call from one of these hospitals: A middle-aged engineer was in the ER complaining of chest pain. His electrocardiogram showed minor abnormalities, and he needed to be admitted for observation to rule out a heart attack. Back then, this meant several days of blood tests and repeated electrocardiograms. Uncomplicated
I was midway through my internal medicine internship when elderly Mrs. Armstrong was transferred to our service for treatment of a pulmonary embolus (aka PE–a blood clot in the lungs) after a knee fracture repair. I remember thinking, disparagingly, “Surgeons should be able to treat a PE!”
The following morning, our team rounded on our patients and hurriedly wrote orders and notes because Susan, my senior resident, and I would be in clinic all afternoon. As we worked, another resident, Greg, stopped by and invited us to a party that evening. “I hope I can come,” I said. “If I finish early enough.”
Tired from the long drive, I thought back on my years of marriage. Back pain was the first problem, I think. Then GERD, then migraines, dizziness, TMJ, panic attacks, fibromyalgia. They were all tough, serious problems. But all together?
The patient was too confused to follow any instructions, and the loud noises of the ICU machines didn’t make things any easier. I tried to communicate: “I’m from anesthesia and I’m going to put in a tube to help you with your breathing.” A nod. I positioned myself at the head of the
It was a grim night. A man had stumbled, drunk, into the street and been hit by a car. The car drove off, but bystanders called 911. The man was strapped to a bright yellow gurney and brought to the emergency department in an immaculately clean ambulance. He himself, however, was disheveled, soiled and violently combative. He fought. He yelled. He spat. He smelled. He was disgusting.
Everyone deserves good care, thought I. My evaluation found him to be merely drunk. I considered imaging studies, but they would have required general anesthesia, which didn’t seem advisable given the man’s condition. Instead, I admitted him for observation. I got to sleep about midnight.
Despair tastes sour and rotten on my quivering lips. Dishonor feels heavy and tight on my heaving chest. Dejection means hearing only my own sobs through my covered ears. Disgrace sees only my mistakes, and with blurry, red eyes. Depression smells like sweat and fear, even through a clogged nose.
I was lying in the preop area, waiting to be taken in for abdominal surgery, when a nurse came along with a bag of liquid and hung it from my IV pole.
“What’s that?” I asked.
“It’s an antibiotic,” she replied.
“I’m not scheduled to get an antibiotic,” I said.
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