Code Blues Page 3

  "Sure, sure. Why not? We could bring sleeping bags."

  "It's like camping!" crowed Kevin.

  "Uh." I held my head. It felt like the beginning of a headache. I massaged my temples.

  "You think about it," Mom insisted.

  "She should go to bed," Dad said.

  Kevin piped up. "You're going to bed earlier than me!"

  "Good for you." After some more last-minute news, I hung up. I had to smile. There was only one more thing to do tonight.

  With an Exacto-knife that had been lying by the front door, I slit open a box labeled "Misc." Right at the top, wrapped in tissue paper, lay my faceless, jointed wooden man. I'd bought him for a long-ago art class, but didn't really have any drawing talent. I just liked this guy. Some of my friends called him my imaginary boyfriend. I called him Henry.

  The previous tenants had left behind a black veneer desk, topped by a bench-shaped piece of wood that made a second level. Carefully, I placed Henry on top of the bench. I made him sit with his legs dangling down and his right arm bent, hand to his head. Not sad, but pensive.

  Beep!

  I definitely heard something that time. I tracked the noise to my backpack in the front hall. My little black pager read DUPLICATE. I pressed the button to read the number. Alex's cell phone.

  Hot dog! I picked up my phone and heard the rapid beeps that meant someone had left a voice mail message.

  "Hope. It's me. I'm so sorry." Alex's voice, a bit muffled.

  I bit my lip.

  "Listen. Something...came up. Something important. I know this sucks. I'll make it up to you. Maybe tomorrow." A noise, like he covered the mouthpiece, and he said, his voice far away but irritated, "In a minute." His voice got loud again. "Hope, I'll call you." And then he hung up.

  I tried the cell phone number he'd left on my pager. Still out of service. He must have turned it off before and after calling me at home and on my pager. But why?

  I bent Henry's other arm, so now both hands were pressed against his face, like in The Scream.

  I slept fitfully that night.

  Alex never called back.

  Chapter 3

  At 7:25 a.m., I stepped through the ER's automatic doors on the east side of the hospital, near the bike racks. I promptly spotted ten people on lime-green plastic chairs, dozing or watching the TV in the waiting room on my right.

  Ten people already. Happy Canada Day to me.

  On my left stood one black-uniformed security guard in a cubicle. Beside him sat two women behind desks with computers, supposedly registering patients, but really chatting with each other. Triage was a little Plexiglas alcove straight ahead, empty except for an examining table and a stray BP cuff machine, but even so, I didn't feel right cutting through the triage room.

  I turned left, down a little hallway, hoping it would lead to an alternate entrance.

  "Excuse me, miss," called one of the receptionists. "You're not supposed to go in there. That's for stretcher patients."

  People never thought I worked here. I turned and smiled. "Hi, I'm one of the new residents."

  "Oh. Sorry," trilled the middle-aged receptionist. Her mascara had smudged under her eyes, giving her a Goth look.

  "It's July first," the older one muttered. "All the new residents."

  "Oh." They giggled together. Way to make me feel welcome.

  At the end of the hallway, I saw the ambulance bay, and took a right, pushing open the teal emerg doors. Made it.

  Two people bent over charts at an extra-long desk on my right. On my left was an examining room with an eye chart and then two empty resuscitation rooms, their monitors off, oxygen masks and tanks hanging unused on the wall, and the stretchers covered in clean white sheets.

  Nurses in pink uniforms chatted at the large, octagonal nursing station in the middle of the room. Along three walls surrounding the nursing station, blue-gowned patients sat in beds or rooms clearly labeled from one to 14, and more patients lay stretched out on beds beside the station and along the wall.

  I took a cautious sniff. People often complain about the smell of hospitals, but unless it's bloody stool, pus, or a newly-disinfected room, I don't notice much anymore. St. Joe's smelled fine to me.

  I walked up to a nurse with snapping brown eyes and a big smile. She looked to be about my age, and although she was wearing pink scrub pants, she had a blue and brown striped top. I said, "Hi, I'm Hope. This is my first day here."

  She shook my hand. She had quick, bird-like movements. "I'm Roxanne. Let me show you the residents' room." From the windowsill, she plucked a two-foot long yellow stick with a key dangling from the end of it. It looked like a potential weapon. I stared. She laughed. "That's so we don't lose it."

  Behind the nursing station, she showed me a small hallway with a kitchen, a bathroom, a conference room, and two little call rooms, one for the residents and one for the staff doctors. "The staff one has a shower. Yours is the one on the left. Have fun."

  I shed my bag in the residents' room, which was a basic white box with a bed, a desk, and a few hooks for jackets. I wound my stethoscope around my neck and jammed a pen, a pharmacopoeia, and my trusty navy notebook into my pockets. It was just past 7:30.

  Dr. Callendar turned out to be one of the guys I'd passed at the desk when I came in. I now knew that this was the ambulatory side of the emerg. Dr. Callendar looked fifty-something, with a black crew cut, beat-up Nikes, and a white coat over his greens. When I plopped into a chair beside him, he kept on writing a note on a brown clipboard.

  After a full minute, without looking up or putting down his Bic pen, he grunted, "Who are you."

  "Hi, my name is Hope Sze, I'm a first-year resident, and this is my first emergency shift—"

  He glanced up, wearing extra wrinkles across his forehead. His nose was too blunt-tipped and his lips too thin for him to be handsome "You got oriented?"

  Not really. "Well, we walked through the ER yesterday—"

  He handed me a clipboard. "Start seeing patients."

  Automatically, I took the clipboard, but my brain had stalled out. As a medical student, they took pains to orient me and make sure I was comfortable before I worked. As a first year resident, a.k.a. an R1, it was obviously sink or swim. Not to mention the fact that Alex told me my shift didn't really start until 8 a.m., so I was here voluntarily early.

  Dr. Callendar had already turned back to his chart. I took meager comfort in his stereotypically atrocious handwriting. While I watched, he grabbed a giant rubber stamp, pressed it in a blue inkpad, and stamped his chart with headings for a complete history and physical, from "ID" to "Extremities" on his chart. At least that was legible.

  I glanced at my own chart. A twenty-year-old woman, six years younger than me, who'd complained of burning, frequent urination. It sounded pretty straightforward. The triage nurse had even written, "Feels like UTI," or urinary tract infection. Still, it was cool to knock on the door of room 2 and introduce myself as Dr. Hope Sze for the first time.

  By the time I returned, Dr. Callendar had disappeared. All that remained of him was his rubber stamp. I found him in the nursing station, rifling through green slips of paper. He scowled at me, and shoved them in the pocket of his lab coat, but not before I saw the patient names and numbers printed on the slips. He was doing his billing for the night shift.

  I pretended not to notice. "Dr. Callendar, did you want to review the UTI before I send her home?"

  "Of course!" he snapped. "All your patients have to be reviewed. You're a resident!"

  Thanks for sharing. And then he went on to share some more. Did I ask about risk factors? Was she sexually active? Had she had UTI's in the past? How recently? Did she wipe from back to front or front to back?

  I had asked some of these questions, but not others, so I felt stupid but also annoyed; I doubted he was this thorough when he was the one on the line. If pressed, he'd probably just say it was a UTI for reasons NYD, not yet diagnosed.

  At last he wave
d me away. "Go back and do it right. You can follow up with Dr. Dupuis afterward. He's the one coming on at eight."

  Good news: Dr. Hardass was leaving. Bad news: maybe Dr. Dupuis was Dr. Hardass II.

  Granted, I was here to learn as well as serve, but some doctors really like to put you in your place at the beginning. I didn't look forward to playing Who's the Boss for the next two years. Good doctors, secure doctors, don't need to belittle you.

  Sometimes I feel sorry for the patients at a tertiary teaching hospital. You may have to battle your way through multiple layers: med student, junior resident, senior resident, staff. But it's all learning, and as a community hospital, St. Joe's had a thinner hierarchy than most. I headed back to the twenty-year-old to play another twenty questions.

  When I came back, Dr. Callendar was doing "sign out" with a thin, blond, stork-like man in glasses and greens. They strode around the room, talking about patients' results and what needed to be done.

  When I got within a five foot radius of them, Dr. Callendar flicked his fingers at me like he had water on them. "Go see more patients."

  The blond doctor laughed and shook his head. "Wait a minute. You're a new resident?"

  I nodded and held out my hand. "Hope Sze. R1."

  He shook it. "Dave Dupuis. Welcome aboard."

  "Thanks." At Western, once you were a resident, and therefore, a fellow M.D., a lot of the staff physicians let you call them by their first names. It sounds like a small thing, but after four years of undergrad and four years of medical school, I was ready for a tap on the shoulder.

  Dr. Dupuis smiled down at me as if he were reading my mind. "Are you interested in working the ambulatory side or the acute side?"

  Runny noses vs. potential heart attacks. No contest. "Acute."

  Of course, Dr. Evil had to step in. "Dave, she's already started on the ambulatory side. She's ready to review a UTI." Dr. Callendar gestured at the chart in my hand.

  I opened my mouth to object, but Dr. Dupuis was already on it. "Good. If you know that case, you can review it. But if a resident wants to work the acute side, she should." He turned to me and added, "Are you interested in emerg?"

  "Yeah. I'm thinking of doing the third year."

  "Good woman," he said.

  We grinned at each other. Dave Dupuis was on my side. There was a hierarchy here, and Dupuis trumped Callendar. Good to know.

  Some people, you just know you're on the same page. Like me and—Alex, I remembered, and my smile dimmed. But for only a second. If he didn't call back and beg my forgiveness, it was his loss. I had a job to do.

  After sign-over, Dr. Callendar glared at me like I needed deodorant and a brain transplant. "So what do you think. Yeah, yeah, yeah. What do you want to give her? Okay." He scribbled his signature after my note, tore out the green slip, and stood up to go.

  A mere 45 minutes after I first saw her, I handed my patient her prescription. It was the first time I'd written a script without getting it co-signed, and it felt good for about 60 seconds. Then Dr. Dupuis handed me a chart for a seventy-five-year-old woman with abdominal pain. "Have fun."

  I drew the dirty pink curtain around bed number 11 before I began the interview. The patient's son helped swish it around his side of the stretcher. My patient turned out to be a tiny, white-haired, half-deaf woman who only spoke Spanish. Her family spoke a little French, but not much. I found myself yelling and playacting a lot. "Do you feel nauseous? Are you vomiting?" Grab stomach, pretend to retch. "Do you have pain in your chest?" Hands to heart, with tormented eyes raised to the acoustic tile ceiling, like I was Saint Hope at the stake. "Do you have diarrhea?" That one was hard. I made shooing motions around my rear end. Even the patient laughed.

  During the physical exam, my hands traversed all over her abdomen, while I asked if it hurt. "Dolor? Dolor?"

  The family enjoyed this demonstration of fifty percent of my Spanish vocabulary (the other word I knew was si, or yes) and praised my excellent command of the language. "Très bien!" The patient beamed at me. She didn't look too pained. I was in the middle of asking her to turn over for a rectal exam when I heard a flat woman's voice from the speakers overhead, "CODE. BLUE. OPERATING ROOM."

  I froze.

  "CODE. BLEU. BLOC OPÉRATOIRE."

  The pink curtain ripped open, revealing Dr. Dupuis' flushed face. "Come on!" he yelled.

  We flew around the nursing station and past the X-ray light boxes. He slammed the side door open with the heel of his hand. We dashed down the narrow back hallway.

  He punched open another teal door. As we sprinted up two flights of stairs, one of my black leather clogs almost went airborne. I jammed my foot back into it. Dr. Dupuis ended up a half-flight ahead of me, but I caught up to him on the landing.

  We dashed left, and then another left past the elevators, and then we were at the T junction of a hallway and Dr. Dupuis was yelling, "Where is it?" at a guy in a white uniform and a blue bonnet-cap.

  The guy pointed back over Dr. Dupuis's shoulder. "Men's change room!"

  Dr. Dupuis doubled-back a few steps and shoved open the door to a small, jaundice-yellow room.

  Should I follow him in a men's room?

  The door nearly swung shut again. I thrust it open.

  Beige lockers lined the four yellow walls and made a row down the middle of the room. A wooden bench stretched lengthwise in each half-room.

  In the far half, wedged between the bench and the lockers, I spotted a pair of men's leather shoes. The feet sprawled away from each other. The scuffed gray soles of the shoes pointing toward me.

  Dr. Dupuis crouched at the man's head, blocking my view of the top, but someone had yanked the man's charcoal T-shirt up to his armpits, exposing his white belly and chest, above his brown leather belt and khaki pants.

  A black woman in a white coat pressed her fingers against the side of the man's throat. "There's no pulse."

  "I'll start CPR!" I yelled, running toward them. I'd only ever seen one code blue, on a sick patient in the emergency room who didn't make it. I'd never heard of a code in a men's room. We didn't even have gloves. Mouth-to-mouth wasn't my first choice.

  I knelt on the cold tile floor, my arms extended, hands laced, and braced to do CPR. Then I finally saw the man's face.

  His features were mottled purple, his filmy eyes fixed half-open, his jaw hanging open under his moustache.

  The man was dead. Long dead. Cause NYD.

  Dr. Dupuis lifted his stethoscope from the man's hairy brown chest, his face grim. "I'm calling it. Eight twenty-four."

  He was calling the time of death. I had only seen that once, after the code. After we had tried intubation, CPR, drugs, and even a pericardiocentesis to try and remove any blood from around the heart. It was too late to try, for this man.

  Dr. Dupuis pressed his fingers against the man's cheekbone. I flinched, but the purple color overriding the face didn't blanch. "Livor mortis," he said.

  I took a deep breath. I remembered that from my forensic pathology course. After someone dies, gravity makes the blood pool and discolors any skin that's not under pressure. I'd just never seen it up close and personal. Now, avoiding the man's staring eyes, I could see that his anterior flanks were also blotched purple. He had died on his stomach.

  I poked my index finger against his mottled flank, indenting the cool skin. As I pulled back, the flesh slowly rebounded, but still didn't change color.

  Dr. Dupuis voice was loud and sudden in my ear. "Let him go."

  I recoiled, wiping my finger against my scrub pants, but he was talking to the black woman who still had her fingers on his throat. "He's too far gone, and this may end up being a crime scene."

  Crime scene?

  Dr. Dupuis's voice shook only a little when he said, "It's Kurt."

  She nodded, dropping her eyes. She withdrew her hand from his throat and crossed her arms, hugging herself tightly.

  Dr. Dupuis stood. "He was one of the doctors here," he said, his head averted.


  Oh, my God. I scanned the face again. The moustache. Was this the guy whose speech I'd interrupted?

  Slowly, I reprogrammed the brown eyes, the broad forehead, the slightly hooked nose, and the moustache in my mind. Yes. It was him. I closed my eyes.

  I heard Dr. Dupuis's steps thumping around the room. He called, "Did you see anything? Evidence of foul play?"

  It sounded like something out of a movie. Maybe it was. I doubt Dr. Dupuis had ever found a colleague dead in the men's change room before, but he didn't let it faze him. He lifted the white plastic lid of the soiled linen cart by the door. "Look for needles," he said, peering inside. "Anything to do with drugs."

  I glanced at the black woman. She lifted one shoulder in a shrug.

  I said, "But wasn't he diabetic? Maybe he'll have his own needles."

  "Even so," Dr. Dupuis replied, his mouth a grim line.

  "You think we should search his pockets?"

  Before he could answer, the door burst open. "Where's the—" Two nurses manhandled a scarlet crash cart into the room. "My God!" exclaimed the plump, blond one.

  The black woman said, "It's not a code now. Dr. Dupuis already called it."

  While she explained, I checked Dr. Radshaw's pockets. His wallet was still in his right pocket. I didn't open it. I found an Accucheck, the machine to check the glucose for diabetics, along with a few test strips, in his left pants pocket. Nothing in his shirt, and he wasn't wearing a jacket.

  I hit the bathroom for evidence. Something was bugging me, but I couldn't put my finger on it. Dr. Dupuis was already in the bathroom, nudging a pile of clothes under the sinks with the toe of his running shoe. The room smelled of urine, mold, and I didn't want to know what else.

  I held my breath and flung open the door of the first toilet stall. The last customer hadn't flushed, and the toilet was balled up with paper and worse, but the floor was clear. I slammed the door and opened the next one.

  An empty white toilet bowl ringed with rust, the black toilet seat pointing toward the sky. Dr. Dupuis materialized over my right shoulder, banging open the stall door. "Don't touch anything!"