The high pitched howl of a beast readying for the night can be heard behind the thick glass windows of this urban hospital with me peering at the moon blanketing over its grey skeleton. I dive my hand into my pocket and stare at the shrieking electric box in-front of me–no wolves here, just my pager. I turn it off and shoot another glance outside; there’s a highway with many passing headlights much like tiny fireflies, my own personal light show.

It’s been over half a year since I put on the long white coat and those two heavy letters were anchored at the edge of my name. Medicine like so much else is frustrating in that furthering its understanding begets only more complexity. So as I walk on grey carpet through long and shadowy hallways, stale Nutragrain bar in hand, I only briefly consider how much more I’m able to do now than only just a few months ago.

My gigantic Galaxy smartphone begins to vibrate [should have gotten the smaller one…] in the front pocket of my blue scrubs and I drag my finger across it’s screen to reveal a message from my supervisor.

“New admission–room 6, post code”

My right foot pivots 90 degrees and like Derrick Rose weaving through the paint I make my way across meandering hallways and empty conference rooms. “What could it be? Sepsis, MI, anaphylaxis, PE…” I mutter out-loud, a habit I’ve only recently adopted after realizing it helped me think–or at least relax.

If there’s one thing that takes getting used to its the symphony of chaos that plays out when a patient arrives onto the unit– specifically if they’re sick. Nurses orders are carried out, specialists are consulted, lines are placed, vials filled, EKGs done–all in quick succession. My job in all of this is to synthesize it to create a comprehensive plan which can be a challenge when decisions are being made and pondered in a very dynamic environment. Stepping out of the room for just 5 minutes to gather a tube or glove can blind me from seeing a bedside procedure ruling out a particular etiology. The chaos dies as fast as it begins, so if something is missed it might as well have never happened. All that is left in the end is the gentle beeping of telemetry and sounds of ventilators blowing.

I walk into the room to see a middle aged African American man named Bobby Jones. He is intubated and has three pressors running. A brief conversation with the EMS squad reveals that the patient was coded several times. The labs drawn show complete derangement of his electrolytes and an EKG reflects this. He’s a complete mess–across the hall is a patient who just recently was declared brain dead, another across from him is finishing a cup of pudding after being extubated only a few days ago. I wonder how this man will end up.

The air is heavy and sullen; an entire family looks up at me hoping for an explanation as to what started this terrible day. The truth is I don’t really know, I have a few ideas, but no definitive answer. I tell them this and they all nod understandingly. The wife, keeping a strong face for her family, tells me that a prior doctor from the other hospital told them that their was little chance of recovery. She wonders if her brother, who is waiting for their OK to catch a flight should even bother considering his poor prognosis. What a tough question–I look at the floor and envision the scene and what I would do if I were in their shoes.

“Tell him to come–we’ll do everything we can for a recovery but even if he doesn’t, I know I’d want to be here”. The words fall flat as soon as they leave my lips and for a moment I’m scared to see them wither and die in front of me but against all odds it seems to make them happy. They mention their thank you’s while I begin to exit. As soon as I do I sigh with relief and head downstairs to see the next patient. I pass by the window again and catch a glimpse of those bright lights–my own personal light show–and continue on.

Disclaimer: Patient information has been dramatically altered to protect the identity of all those involved.

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