Laughing Sherpa by Dr Miriam Korn, MD » Stories

ICU story

Mia Korn — Sun, 14 Dec 2014 21:19:00 +0000

Rites of Passage

ID: 50 year old man with hairy cell leukemia
transferred to ICU for treatment of pneumonia.

Lives with wife and two daughters. Works as CEO of bank.

Mr. Goshen is wheeled into the Intensive Care Unit. His skeletal body is encased in thin yellowish skin, draped with white sheets. With him is a balding white-coated man and his bearded colleague, wearing a white shirt, blue tie, jeans and pointy cowboy boots. As the nurse moves the stretcher to a corner, they approach our white-coated entourage during our morning rounds. The resident’s recitation of numbers describing bed number two’s bodily functions is aborted, “We need to talk about Andrew Goshen.”

Our little circle breaks as we turn to exit single file, into a dingy space of pink vinyl sofas. “Family Room” says the sign outside.

So far, working at the ICU has been okay. Each day, I visit my assigned patient, an eighty year old, white haired woman who is having a hard time weaning off a respirator. She still needs a tube down her throat and taped to her lips, to help her breath. I do my head-to-toe medical student exam each day, then record digits in various tables. I ask her questions. She nods her head or blinks her eyes.

Before her, I’ve monitored less interactive patients. A jaundiced man in his fifties, withering away and swelling up due to hepatitis; a twenty year old,
HIV positive, heroine addict rescued from a house fire, his body mottled with
“cherry red” lesions of carbon monoxide poisoning.

Each morning I arrive at the ICU to see what type of cookies the nurses have left in the staff room and which beds are surrounded by a curtain. Soon uniformed men show up, go behind the curtain, emerging to wheel away a gurney transporting a long white zippered plastic bag, like a tarp-covered log.

* *

“How was your day?” asks my father at dinner. My parents are visiting from Toronto this week.

“Okay,” I reply. “Interesting.”

“What did you do?” inquires my mother.

* *

In the Family Room, we take our places around two fatigued-looking women on the sofa. One has her hand on the other’s shoulder, face turned to whisper to her couch-mate’s bowed head. Dr. Lindsey, the balding one, sits in a chair next to her, with a worried frown.

My attending, Dr. Hardy, is next to him, The young “team”, is scattered about the room, standing beside and behind furniture. I am leaning against the doorpost. The bearded cowboy, Dr. Jones, paces across the room, stops and puts a foot on one of the sofa’s chrome arm-rails.

“We’ve won against the odds. The cancer is licked. He got through the hard part and he’s cured,” he caresses his tie. “Just have to get through this pneumonia.”

“He’s so frail. The chemo took a toll on his defenses,” the older Dr. Lindsey shakes his head.
“He’s still very sick.”

“True, but he’s very young,” says Dr. Jones, the cancer doctor. “He has some fight left in him. I say we push to keep him going. Do whatever we need to do to get him over this last hump. What do you think,
Mrs. Goshen?”

“The woman on the couch looks up, her eyes heavy as she glances at the “players” around her, “I guess you’re right.”

Dr. Hardy, our “team leader”, turns to her, “We’ll do our best to save your husband, ma’am. That’s our job.”

We file out of the room and resume the morning rounds. Back to bed number two’s vital statistics. There are various white-coated doctor people wandering through, asking about Mr. Goshen’s PO2 and BP as they glance a look at his skull-like face. Occasionally, one would go over to his bedside to ask, “How are you doing, Mr. Goshen?”, add “good, good” when he seems to nod in reply, and wander away.

A long piercing shrill shoots through the steady orchestral melody of ICU beeps. Suddenly, the resident is by Mr. Goshen’s bed waving me away to make room for the crash cart being wheeled toward the bedside.

“CODE!”, someone calls out, as nurses load syringes. The resident slaps two orange squares on Mr. Goshen’s chest, grabs paddles from the cart, places them on the bright pads and yells “clear” as Mr. Goshen’s body jolts.

“Sorry Andy!” cries the nurse at the head of his bed.

This scene continues, full of jolts, beeps, injections, apologies to Andy, people pushing down on his bony chest in the bobbing of CPR. Dr. Hardy and I stand in the corner, at Mr. Goshen’s foot – he, watching the heart monitor and barking out names and doses of drugs in response to blood pressure announcements, me, trying to stay out of the way.

Until a nurse points at me, “Take over.”

I am now out of the audience, onto the stage. I push up my sleeves, place two fingers at the junction of his ribs and lay my palm above this, scolding myself for cringing as I feel slime between his chest hairs.

“Get up on the bed!” someone yells. I scramble onto the mattress, straddle the bones under me, and repeat
my landmarking routine.
Looking down, I count, “One and two and three and four and five and. . . “, pushing rhythmically, trying to ignore the crackles of ribs breaking under my efforts and filing away the fear that I will crush the heart below this sternum. Just don’t look at his face. Just count. Just push. Don’t think. Breathe. Don’t screw up. Count. Push. Go. Keep going. Don’t stop. Don’t look.

“Okay, get off,” I comply and stepped away. More jolts. More “Sorry Andy!” ‘s. More blood pressures. More injections. Nothing seems to be helping.

Murmurs about fluid in his lung escalate. A green package is placed in front of the resident. He rips it open, takes out a long plastic tube and pierces Mr. Goshen’s side, triggering a gush of fluid all over the floor.

“Do the other side!” Chest tube number two. (“Sorry, Andy!”) Another geiser.

Blood pressure still dropping.

“Paracentesis!”

The resident responds. A narrow tube stabs the centre of Mr. Goshen’s chest.

   “Get an echo!” yells Dr. Hardy. An echo? “If his left ventricle is still working, we still have a chance!”
       We do? He does? I look at the fried, stabbed body before me and the plastic
protruding from it.  We stare at the motionless blobs on the TV monitor. Dr. Hardy rubs his chin, “Okay, that’s it.”

The Team collects in a narrow room, sitting in a row, side by side along the wall, staring at the floor.
The nurses pull the curtains around Mr. Goshen’s bed and open them once some of the tubes had been removed. The woman and her two teenage daughters huddling next to her are escorted into the room. One of the girls sobs the moment she sees the corpse before her. The threesome shuffle to the bedside.

I look down, like my colleagues. There was no way to hide from their wailing.

“Sometimes things can get emotional,” would be Dr. Hardy’s pep talk the next day.

* *

       I go home. I wish Matt was here, not in New York at his conference.
      I sit down to eat supper.
      My mom comes in and asks about my day.
     “Not so good.”
     “W’hat happened?”
      “A lot”.
      She frowns and points to the worn-down soles of my loafers. “A doctor should wear decent shoes.
Can’t you even buy some shoes? How can you walk in those things? Don’t they throw you out of the hospital with shoes like that?”

I don’t reply. I look down at my plate, picking at my spinach, shredding it
into green strips.
She leaves the kitchen.

I slide off the chair and crumple up on the kitchen floor. The coolness of the tile against my cheek soothes me as I bring my knees to my chest and hide my head into the curve I have created.

The next day, Mom insists she drive me to work. She rants about my shoes and my irresponsiblity for not picking up my reading glasses from the optometrist’s office. She is interrupted by my explosion.
“WHAT do you want from my life? You’re nagging me about shoes and glasses while
I go to work everyday and watch people die!”, I sob.

We arrive at our destination. My mother is silent. I fumble for the door-handle, climb out and slam the car door. Dizzy and disoriented by a curtain of tears dripping from my eyes, I stumble toward the nearest hospital door. “Stupid shoes,” I mutter, angered by the accuracy of my mother’s appraisal of them.
My coat clutched in one hand, knapsack slung over my shoulder, I rush down the stark pale-yellow walled, linoleum tiled hallway.

Don’t want to be late for my first autopsy.

The post ICU story appeared first on Laughing Sherpa by Dr Miriam Korn, MD.

GI ward

Mia Korn — Tue, 14 Oct 2014 20:06:00 +0000

A Golden Haze

ID : 63 year-old female. Retired pediatric rheumatologist.

Chronic hepatic cirrhosis associated with long history of alcoholism.

Presents with ascites. Lives alone.

Dr. Reddy is here because her belly is full of fluid. Her liver, fatigued by the wear and tear of decades of whiskey sours, can no longer produce enough albumin, the blood protein which usually keeps water where it belongs. When I first meet her, I see she looks just like she is supposed to look, according to our textbooks : yellow skin and eyes, bloated abdomen.

“Hello, Dr. Reddy. My name is Miriam Korn,” I say as I approach her bedside. “I’m a third-year medical student.” I look down at the geography of her face: wrinkles, pale withered lips, folds of grey skin. “How are you?”

Her eyes look up, squint and smile through a golden haze. “I’m okay,” she replies, glancing at her bulging belly. She knows she is textbook material.

We chat for a while. She worked for 33 years as a pediatric rheumatologist in New York City. She loved it. “Medicine is a great profession,” she says. “You are so lucky.” She answers all of my questions: four to six drinks a night for over forty years. Didn’t “get in the way” until the past five years, after she retired.

She tells me about her travels throughout the United States and Europe. There isn’t much to say about her family, she says. Her only living relative is her sister, who has been her sole visitor during her hospital stay. On the night table between us, there is a photo of two collies surrounding a robust-looking woman, atop a mountain. “That’s Chloe and Sasha, with my sister,” she comments, after noticing my interest, “We were in Yellowstone Park.” Her eyes shut for a moment. The corners of her shriveled mouth turn upward.

* *

Later, I reenter with the team. Dr. Hashem, the liver specialist, clad in a pinstripe suit and silk tie, leads us into the room. I like him. He is proud of the framed Hippocratic Oath that adorns his office wall. “Good morning, Dr. Reddy,” he says as he reaches towards her. “How are you feeling today?” He touches her shoulder. “I’m Dr. Hashem. I think you’ve met Dr. Korn.” Doctor Korn?

The Gastroenterology fellow, Dr. Usala, steps forward with his stethoscope and listens to, taps then pokes her abdomen “We’ll probably have to take some fluid off. It’ll help you breathe more easily,” he says. He steps away from the bedside. “We still need the biopsy results,” he adds. Dr. Reddy nods as our team exits.

We huddle together outside her doorway. I report that the liver biopsy results have not yet returned. This is not acceptable, says Dr. Usala.

Suddenly we are all dashing out of the ward, then racing through secret passageways, with our coats flying behind us, like capes. We slow down as we approach a sign marked “Pathology”, marking our destination. We follow the arrow pointing left, through the glass doors, and proceed towards an open doorway.

As we gather just inside the threshold, a man sitting at his desk swings around and welcomes us. He invites us to sit down. We each find a seat, except Dr. Usala, who remains standing.

There is some chatting about vacation plans until Dr. Usala asks The Question. “Have you taken a look at Reddy’s biopsy?”

“Oh yes!” replies the pathologist, as he motions us toward the microscopes. I look through the eyepiece at some purple blobs. “See the white cells?” he asks. No. “Acute on chronic hepatitis. Doesn’t look good.”

Dr. Hashem leans away from his microscope to allow Dr. Usala to take a look. They nod in unison and look up. Then back we go, through the labyrinth, to Unit Six.

* *

Dr. Reddy is discharged after a week of lactulose, which soaked up the ammonia in her blood, and a peritoneal tap, that sucked out some fluid from her abdomen. I’m glad she is better, for her sake and mine. I’m tired of her talk about the glory of the medical profession, and I feel guilty that I pity her. I wish I liked her.

* *

A month later, during my next rotation, I’m back on Six West to meet a patient who is being transferred to my ward. On the board behind the nurse’s station, I notice Dr. Reddy’s name. “What happened?” I ask one of the nurses.

Her explanation is not unexpected. Dr. Reddy had returned home, started drinking again, and was brought back to the ER in an ambulance a few days ago. Liver failure.

I walk into her room, planning to say hello and bring good wishes, and find a blanket-covered mound of flesh on her bed. Her bloated face has sealed her eyes shut. The rhythmic rise and fall of her giant girth is the only sign of life. A long breath escapes me as I absorb the scene. Was she inside this sleeping elephant? I turn and exit.

“What’s going on?” I ask the intern at the door. “Her ammonia and LFT’s are really high,” she replies. “Pretty bad. Might not make it to the end of the week. Her sister agreed to DNR . ”

Over the next few days, I glance into Dr. Reddy’s room every now and then as my team works on a case nearby. There never seems to be a change in her condition. She looks like a beached whale on a gurney, in a lonely, stark, hospital chamber.

One day, my peek reveals an empty, freshly-made bed. I pause. Had her sister come to hold her hand? Who would take care of her dogs?

I recall Mr. Goshen’s * family sobbing by his bedside and remember the flow of physicians inquiring about his condition both before, and after, his death. And I think about the newspaper article that celebrating his life and lamenting his demise…

Had anyone noticed this soul slip away?

* see ” ICU Story : Rites of Passage ”

The post GI ward appeared first on Laughing Sherpa by Dr Miriam Korn, MD.

GI Ward, ICU, Family Room revisited

Mia Korn — Mon, 15 Oct 2012 06:31:00 +0000

Body Bag

ID: 59 year old woman with no past medical history presents with Budd-Chiarri Syndrome. Lives with husband. Works speech therapist.

“Lea is here,” my Dad greets me, as I walk through the sliding glass doors, spitting me out of Customs. “She’s with Geoff, over there.” He points to a crowd next to the baggage carousel. “They’re back from Honduras.”

I put my purse on the wire baggage cart my father has brought. I wheel it toward the carousel, watching my blue backpack riding by. I chase it, grab the bag and haul it onto the cart. We head to carousel B.

“Lea,” my father exclaims as he stops next to a man I recognize as Geoff. “Miri is here.”

I am confused until I look down, and see a thin, grey-haired wrinkled women, in a wheel chair. Lea? “Lea,” I bend to give her a hug, noticing her bones under my embrace. “How are you feeling?” I ask as I stand up again.

“I’ve felt better,” she smiles. “Just glad to be home.”

“It’s so good to be out of that hospital,” adds Geoff. “They said her shunt should be good for awhile. It was crazy being in the States for all this. Los Angeles was the closest place we could get help.”

Lea frowns and looks down at her lap.

“We have to get going,” Geoff tells us. “She gets worn out easily.” He gets behind the wheelchair and grabs the handles.

“Let’s go.”

Lea smiles again and closes her eyes. Geoff whisks her out the sliding glass doors, into a gray winter day.

“What’s going on?” I ask my father as we watch the doors

close behind them. “Why is she in a wheel chair? She’s so skinny. She looks so old . . .”

“Her liver,” my father replies. “Something wrong with her liver.”

‘What? Hepatitis?” I speculate, wondering if she contracted

it in Honduras. “Don’t know,” he sighs. “They had to fly her to California. Josh and Emily flew there, too. She had two operations. They were worried she would die.”

“Die?”

“She’s very sick,” my Dad nods his head and looks at the floor. I glance at him, then gaze at the linoleum at my feet. My father gets behind the luggage cart, “Let’s go.” He pushes the cart alongside me through the sliding glass doors, stepping into the cold air outside.

* *

A blob of brown clay sits on a wooden table. I have already created a few lop-sided vessels tonight, and am ready to give up on the wheel for now. The fluttering in my throat and under my sternum distracts me, muddling my breathing, scrambling my thinking. I stare at the earthen loaf in front of me. My fingers finally grasp the mud dough. I start kneading, pulling with my fingers, pushing with my palms against the hard surface underneath, gathering, rolling, turning. . . . I take the bundle off the tabletop in both hands, pat it into a ball and place it back on the table.

I grab a green wine bottle, and roll it over my sphere to mold a thick pancake. I dive into my knapsack and pull out my pathology textbook, laying it on the table. I flip it open to find a couple sheets of wax paper and extract green birch leaf between them . I place it on the clay and roll the bottle over it. I repeat this a few times. Looks like fossils of leaves.

I cut around the shapes, and lift the clay leaves, pinching their edges before putting them back on the table top. I trace and cut out the Hebrew letters, Chet, Yood : “Chai”. Life. My hands intertwine letters with leaves.

Fluttering creeps up my thorax into mthroat. Breath.

Through your nostrils. Breath. Breath again. A few minutes later, my eyes assess the bowl, smooth on the inside, rugged on the outside.

I will glaze it green.

Lea will like this.

I don’t know what else to do.

From across their dining room table, I hand them the info I printed from Medline, about Leidig V clotting factor heritability, and give a quick summary. They thank me. Don’t know if it’s any more than they already know. Hope it helps Emily and Josh figure out whether to go ahead with genetic testing.

We are in their living room. I sit on the beige shag carpet. Geoff is perched on the sofa’s brown velvet cushion. Lea is tucked in her throne, a curved seat covered in white woven wool, hands resting on her lap: a serene, frail, queen in a long white Mexican gown, embroidered with red, orange and green daisies, down her center.

The backdrop is a quilt from Guatemala, hung on the wall.

Her surroundings and colorful dress say “Lea”, reminding me

of countless Thanksgiving meals and multi-cultural cocktail parties hosted in this house. I’d often retreat to help Lea out in the kitchen. We’d chat of travel and art.

“I’m sorry I can’t stay up long,” apologizes Lea. “I get so tired so easily.” She puts a hand on each side of her abdomen, bulging under her dress.

“I have something for you.” I crawl to the mantle behind me to grab a brown paper shopping bag and place it on her lap. She reaches inside, retreiving a flower of pink crepe paper. The blossom opens to reveal a silvery black stone.

“Obsidian,” I explain. “For the blood.”

“Thank you,” Lea smiles as much as she can.

“There’s something else,” I note. Lea looks inside again, and looks at Geoff. “Can you open it? It’s too much for me.”

Geoff leans over toward her and takes the bag off her lap onto the carpet in front of him. He puts both hands into the bag and takes out a white cardboard box, cradling it in his large hands. One hand opens the top, plunges into a nest of white tissue paper and surfaces holding a gleaming moss tinged earthenware vessel.

“I made it in my pottery class,” I point to a green edge. “It’s made of leaves and,” I point to a brown curve, “Chai“.

* *

Two years later, I am back in my hometown, after the first

few months of my psychiatry residency. Relieved to back in familiar territory, I look forward to my month of elective: palliative care.

Although the unit is tucked up on the eight floor, its halls dingy and morale fragile due to repeated budget cuts, I find the staff are friendly and my Buddhist preceptor is like-minded. He brings me articles about opiates, humanistic charting and contemplative psychology. I spend mornings on the unit and afternoons with the team on house calls. Each day, I arrive, noticing which beds are now empty or occupied by a long white plastic bag. I am reminded of the ICU. This is darker and quieter. No beeps to alarm anyone of death drawing close.

“Mr. Parker just passed away,” announces a nurse as she enters the small staff headquarters, where Dr. MacIntosh and I are huddled, writing orders for morphine and Oxy-Contin in patient charts.

He turns to me, “Have you ever pronounced someone dead?”

“No,” I reply. “Let’s go,” he stands, takes the stethescope off the table, wraps it around his neck and strides out of the room.

I follow, stethescope already adorning me. We walk down the hall to Mr. Parker’s room, step over the threshold and head to opposite sides of the bed. Here lies Mr. Parker, glazed eyes and gnarled mouth frozen open.

I am relieved Dr. MacIntosh is here with me, consecrating this moment, knowing that in the future, death certificates will likely be signed alone, in a sleep-deprived haze. Facing me, Dr. MacIntosh puts the ear pieces of his stethescope in place, lifts the white sheet, takes hold of the head of the stethescope and places it on the left side of the motionless chest. I mimic him, placing the head of my stethescope next to his.

I hear waves of air exitting my nostrils.

That’s it.

***

New Year’s Day.

“Lea’s in the hospital,” reports my mother. “Two days after their anniversary. Forty years . . . ” My mother stands at the kitchen sink, staring at a purple jar on the counter. “Can you go visit her? I can’t face it.”

“I’ll go tonight,” I reply.

“Good,” she hands me the jar. I see it is blackberry jam. “Take this.”

I enter Six West and walk down a familiar hallway, entering room 209 of the GI ward. Lea is in the bed on my right. Geoff sits next to her, reading a magazine. He stands up when he sees me, “Miri,” we hug. “Thank you for coming.”

Turning to Lea, I smile and lean over to kiss her cheek.

I hold out the purple jar, “My mom sent this,” and place it on the night stand.

“She’s been so wonderful, driving me around, waiting with me at appointments,” she responds. “She made me a huge jar of matza ball soup. And challah. I just wish I could fully enjoy it.”

“And your dad keeps dropping off supplies at the house,”

adds Geoff. “Your folks have been great. Good people. Really good people.”

“Hearts of gold,” whispers Lea.

“I know,” I agree. I reach into my coat pocket. “This is for you too.” I hand Lea a little bundle made of paper and a fir branch. She reaches her finger into the cardboard tunnel, pulls out the folded paper, opens it and reads my hand-writing.

“I close one eye. I close the other eye. Now, I see. . . . . from the Talmud” Resting the card on her chest, Lea stacks her hands atop of it and closes her eyes.

January 2, 1998. 8:10am

I step past the nurse’s station into the ICU, scanning the beds for my destination. Geoff catches my eye. I stride past gurneys to a bed in the corner, where he stands. There lies Lea, eyes smiling, mouth immobilized by the plastic doughnut between her teeth, attached to the tube that reaches down her throat. I try to hide my wince as I bend to kiss her bony cheek.

“She almost stopped breathing last night, so they had to put in an airway,” Geoff tells my back. “They hope it can come out in the next day or so.” He pauses. “One blink is yes. Two is no.”

My breath sounds loud to me. I lean toward Lea, “Are you in pain?”

Two blinks. “Can I do anything for you?” Two blinks. “My mom and dad send you their best. We’re all praying for you.” She motions with her IV tubed hand toward a folded piece of paper and pen on the table next to her head. I hand it to her and watch her scrawl letters on the corner of white paper not yet filled with similar markings. “Send them my love.”

“I will. Definitely.” Stumped for more words, I stand up.

“I have to go.” I hug Geoff. “I’ll be back.” My knees bend, bringing my lips close to Lea’s ear. “I’m sending you angels.”

Her eyes sparkle as she reaches for my hand. My fingers squeeze her palm and reluctantly release. Legs straighten and propel me out into the hallway, where I hide my contorted face.

****

January 3, 1998. 12:08pm

At lunchtime, I venture a floor above the Palliative Care Unit, to see how they are doing. I enter the Family Room, to find Josh, Emily and Geoff sitting on the pink vinyl furniture, strewn with wrinkled white-cased pillows and brown acrylic blankets. Emily is reading a magazine, as Geoff and Josh, the speech pathologist and veterinarian, hover over drawings on a brown paper bag between them, discussing anatomy. “They have to get the tube into the portal vein…”

I tap Geoff on the shoulder and wave when he turns to face me. Geoff spins around, stands up and hugs me, “Miri!”

Emily looks up, “You look so professional.”

“I’m working downstairs,” I become aware of my white coat. “How is Lea?” “They’re doing more blood tests,” explains Josh. “Hoping she’s strong enough for a transplant. They’ve got a liver. Have to fly it from New Brunswick. Dr. Hashem thinks it could work, if she can just breath on her own.”

Geoff walks to a white board on the wall. He takes a black marker from the ledge at its base and draws a couple of lines. “They have to hook up . . . ”

I turn my attention away from him and sit with Emily. She puts down her magazine and I see the gray crescents under her eyes. “They said Mom is in ‘critical, but stable’ condition.”

I ask if there is anything I can do for them. They offer no suggestions.

I stay with them for the few remaining minutes of my break.

January 4, 1998. 5:50pm

After my workday, I walk up the flight of stairs. My visit a couple of hours ago found Lea sleeping in her corner of the ICU, and the Family Room filled with a a few people I did not recognize. This time, Josh and Geoff are pacing the hallway.

“What’s going on?” I ask.

“They took the airway out,” reports Josh. “She’s breathing on her own. They’re preparing for surgery tonight. It’ll be a lifetime of immunosuppression. Tons of drugs each day. . . . but we’ll help her. Lots of people manage . . .”

“They cut along the portal and hepatic vien,” explains Geoff, leading me into the room, to the white board now covered by more elaborate black-markered diagrams. He points to one of the double lines. “They cut here and –”

“No, Dad,” Josh interjects. “It’s the hepatic vien not –”

I am dizzy, searching my mind’s filing system for the section entitled “liver anatomy”.

Emily rests on the couch, knitting. I join her. “How are your kids?”

“They’re fine,” she replies. “Matt is home with them. They don’t know what’s going on.” She sighs. “I don’t know how to explain why grandma hasn’t visited in so long.” She keeps her gaze on the yarn and needles in her fingers.

I stand up again, hug each of them and wave as I exit the room, buzzing with their new optimism. I glance in the ICU. Lea’s eyes are closed. I do not disturb her.

January 5, 1998. 11:04 pm

The black and white stripes of the fish in the aquarium at the base of my boyfriend’s bed distract me, for awhile. Before we go to sleep under his forest green sheets, I phone my parents for an update.

My father answers. “Lea had to have an operation today. Didn’t go well. Geoff called a few hours ago and said she was bleeding a lot.”

“So, how is she?”

“I don’t know.”

“Is she alive?”

There is a pause. “I don’t know.”

I hang up the phone, and curl into warm arms.

January 6, 1998. 8:30am

I sit in Dr. MacIntosh’s office, fidgeting with my stethescope. We had planned this meeting to wrap up on my final day of the rotation. My eyes dart around the room, my hands interwine, unravel, interwine again . . .

“Are you okay?” asks Dr. MacIntosh as he places a file folder on the table between us.

“No,” I reply. “No, I’m not.”

“Would you like to share what is happening?”

“I think a close friend of my family just died,” Iexplain. “She’s been upstairs in the ICU this week.”

“What would you like to do?” My breathing quickens. “Can we meet in the afternoon?” Dr. MacIntosh agrees and I leave the room.

I call my parents’ home.

“Dad went to the hospital to find out what’s going on,” my mother informs me. “Geoff called at eight and said they were all going there. We haven’t heard anything since.”

“So you don’t know if . . .”

“Can you find out?”

I climb the flight of stairs to the Family Room, and find it empty. On to the next stop.

The ICU is busy with its usual chorus of beeps and blips, monitoring the hearts and lungs occupying the room. I enter, spying the charts lined up on the cart against the wall. “Lea Manser,” says the black marker on one blue binder’s spine. Resisting the temptation to look inside, I walk through the room towards Lea’s bed. As I move closer, I see the curtains are drawn closed.

Are Geoff, Jonah and Emily still with her? I walk to the opening in the curtains, and peak inside. On the bed is a long zippered white plastic bag.

I dart out of the unit, through the corridor into the first empty room I find. Sitting on the bed, I lean over, head in my hands, taking quick, shallow breaths. I wish I would sob, cry, wail but the waves in my belly and throat are left mercilessly unreleased.

Have to call.

Catching my breath, I reach for the telephone on the table in the room and punch my twenty year-old home phone number.

“Mom?”

“Miri! Where are you?”

“At the hospital.”

“Dad’s back. He couldn’t find them. Do you know what happened?”

“Yeah.”

“What?”

“Lea’s dead.”

Silence.

“How do you know?”

“I just know.”

“Did you see them? Talk to them?”

“No.” “Then how do y–”

“You don’t want to know. I just know.”

The post GI Ward, ICU, Family Room revisited appeared first on Laughing Sherpa by Dr Miriam Korn, MD.

A Night On-Call

Mia Korn — Thu, 14 Jul 2011 20:26:00 +0000

Hiccups

ID : 22 y/o woman, living with parents. History of migraine headaches.

Unemployed. Accompanied by parents.

3:38am says the red LED display of the alarm clock at my head. I have just wandered out of the concrete shower cubicle attached to my room, and am poised to descend into my bed. I slip my legs under the white sheet and the brown acrylic blanket above it. I lay down and rest my head on the white-cased
foam pillow.

“Beep, beeeeeeep. Beep, beeeeeeep.” My pager beckons me. 4:40am notifies my bedside clock. I reach to the phone on my bedside table and punch in numbers displayed on my pager: ER. Not good. I hold the headset to my ear as I lay back down, reclaiming the joys of horizontality, knowing they are soon to be forfeited.

“Dr. Korn speaking”, I mumble into the mouthpiece. “I was paged.”

“I’ll connect you to Dr. Walker,” says the voice on the other end.

I close my eyes, enjoying the brief silence.

“Hi,” the voice rouses me. “You on for Internal Medicine?”

“Yes.”

“Got a consult for you.”

“What is it?”

“Got a girl here with hiccups.”

“Hiccups?”

“Yeah, she says her neurologist told her to come to the ER. She’s been worked up for seizures and found nothing. Neuro won’t see her.”

I am wordless.

“I know it’s a dump, but her parents won’t take her home. So we gotta
admit her.”

I hang up the phone, turn onto my belly and scream into the pillow. Fuck you and your hiccups.

I rise out of bed as my legs swing over, feet hitting the cold linoleum. I pull on my scrubs, hitch the pager at my drawstring waist, slip on my shoes and head out. The hall shocks me with its brightness, as I wander to the elevators.
I stand in front of the doors and press the “down” button. The black arrow lights up and the numbers above illuminate one by one, right to left. “Ding”. The mouth opens, allowing me into the grey chamber. “Ding”. The lips close. And I descend.

The ER is bright, busy and noisy. Beeps dance around me. “I’m from Internal Medicine. Supposed to see someone with hiccups,” I present myself to a nurse.

“Uh,huh,” she rolls her eyes, pointing to an inch thick file folder on the counter. “Bed Nine.”

I pick up the folder, gather some paper, a clipboard and a pen and head to Bed Nine, toward a plump teenage-like woman with short black hair, sitting up on a gurney, propped by pillows and covered by white sheets. Two figures hover nearby, short friendly-faced grey haired man and woman, like two gnomes sitting at her side. I swallow a sigh as I draw closer. The name stenciled in purple in corner of the file is French.

“Bonjour,” I say, though ‘good day’ feels inappropriate. My command of the language is too limited to provide me with an alternative. “Je m’appelle Dr. Korn.”

“Je m’ appelle -” her head bobs with a tiny cough, “Christina”. The two
guardians stand up.

I ask what brought them to the ER and a flow of familiar but indecipherable words, pour from all three, too fast and too altered by Quebecois slang for my comprehension. I shake my head, stare at the lines on the paper in my hand and write at the top: “cc: hiccups”.

“Sorry, do you speak English?”

“Yes, yes . . .” replies the woman. “She –“

“Could Christina tell me the story, first?”

Everyone nods, and her parents sit down again.

Christina tells of her story, punctuated by more bobbing and little coughs. The hiccups start five months ago, on and off for the past five months. She is on medication for a seizure disorder. I flip through the pages of the file. Her neurologist has ordered a CT scan, EEG’s : nothing. This bout of hiccups started three days ago.

“Dr. Wilson said to come here when we called him yesterday,” her mother adds. “We’re waiting to see
Dr. Magee next week.”

“Who’s he?”

“A respirologist.”

My watch beeps, announcing 6am. If I write this up by 6:30, I can get another hour of sleep. “Have to get some paperwork done. I’ll be back.”

Sitting at the counter, I put my head down on the white linoleum. A fellow intern sits next to me, his head propped on his arm, while the other hand scrawls stuff on paper a few inches from his chin .
The beeps of various tones and speeds of monitors around us become a dizzying symphony. After trying to write with my head still on the table, I sit up, flip through the chart, copy the answers to some of the questions I should have asked and write up the orders. 6:42am. I rise, give the pile to a nurse standing at the counter, graze by Bed Nine. “You’ll be on 6A” and head out.

8 am. I walk into the ward’s computer room, pick up my print-out, and jot a list of “to do”‘s under each name. The list is longer now, filled with admissions from the night before. Rifling through a pink pile of lab results, I pull out sheets with familiar names.
Dr. McKim is holding the same two foot-long print-out. “Nine admissions,” I report.

“Okay,” He drinks in a deep breath. “Let’s go.”

At noon, I am wilting and thirsty to go home. Dr. McKim and I sit across from one another at a white linoleum table after our eighteenth bedside meeting. He looks at the wrinkled paper. “Why do I always get the busy nights?” he asks the air.

His self-pity annoys me. You”re sleeping while I am here dealing with all these people! “Just five more to go,” I reassure him.

Our last bed is Christina.

“What brings you here?” asks Dr. McKim.

“Hic (cough)– cups,” she replies.

He looks at me.

“Her neurologist, Dr. Wilson, told to her to go to the ER.” I elaborate. “He just returned my page. He’s coming to see her this afternoon.”

Dr. McKim pauses, as if to wait for me to tell him the truth. “That’s good.” He flips the pages in the binder I have passed him. “He’ll take care of you.,” and wanders out of the room.

I stay behind for a moment, uncomfortable with the swift entrance and exit, though I didn’t know what else to say, or ask. “So, yes, uhmm, Dr. Wilson said he’d come by today.”
Christina’s head bobs. Her mother smiles.

“Thanks (cough) for everything.”

What everything?

“Thanks for taking care of m — (cough) -ee last night.”

Care? I had been barely polite. Not even nice, really.

“You are the only per – (cough) – son who didn’t treat me like a – (cough) –

piece of shit.”

The post A Night On-Call appeared first on Laughing Sherpa by Dr Miriam Korn, MD.

A Day among Surgeons

Mia Korn — Sun, 19 Jun 2011 07:34:00 +0000

Plastic Man

ID: 53 year old man with no past medical history presents with

large scalp basal cell carcinoma.

Lives alone in apartment. Works as custodian.

My cat’s ginger paw caresses my cheek to rouse me for her breakfast. The red digits of my bedside clock read 4:53.

I reach to the clock, tap a button curtailing the alarm, heave the duvet from my body, swing my legs on the ground, chuck off my nightshirt and put on my running outfit. Sabine squeaks, purrs and makes figure eights between my fleet as I stumble into the bathroom. My eyes close as I brush my teeth, hoping to imbibe more sleep.

I wander into the kitchen, open a cupboard door to find the red bag of kibbles. I fill Sabine’s bowl full of her niblets, put the bag back in the cupboard, walk down the stairs, and out the door, setting out into the darkness.

The clop of running shoes hitting sidewalk pavement echoes through suburban streets lined with lightless houses. A half hour later, at the end of my nervous jaunt , I pause at the threshold and catch a peek of sunrise, the highlight of my day.

I unlock the door, step inside, take off my running gear, jump in and out of the shower, dress, grab my knapsack and head out, as Sabine darts outdoors before I close the door. I walk among the gold, mauve and pink streaks of the dawn sky, enjoying my post-jog state. Ten sweet minutes.

I arrive at the Plastic Surgery ward, swinging my white lab coat around me, as I join the flock of white coats gathered next to the counter. I glimpse at the clock on the grey wall behind us: 26 minutes to 7.

The residents are huddled over the trolley of white binders. We medical students are satellites, awaiting the cue to proceed down the hall, at the tail of the parade.

Haziz looks up from the huddle. “Okay. Let’s go,” he pushes the cart of charts, sparking the procession. I hide at the back, chatting with Jorge, a surgeon completing his fellowship. “Why do they have to round so early? It’s mean waking everyone up. Doesn’t make sense.”

“Have to see everyone before the first OR, at eight.”

“Why don’t they just see the person scheduled for eight and then see the rest after that?” I ask.

“Have to see everyone,” he repeats. During his Plastics residency in the States, he had once told me, the residents arrived at 5 am so they could round, write and then present case summaries to their preceptors at general rounds at 6:30 am.

“Was it useful?” I ask.

“That wasn’t the point,” he replies.

We follow Hazziz and Dave from bed to bed. I cringe as we wake each person lying in the dark by switching on the bed’s flourescent lamp above each head. I lean over Hazziz’s shoulder as he peels back bandages on her belly concealing pink flesh and yellow puss. “Does it hurt?”, I ask the woman under the gauze.

Hazziz turns his head to me, “No wonder you want to be a psychiatrist.” Why did he say that? He turns back the bandage, leaving it lying on her skin, awaiting a nurse to remove it and apply a fresh one.

We turn to the next bed. The man’s ear is patched. Hazziz and Dave grumble. “We’ll be starting the reconstruction today,” says Dave,and turns back to the entourage, shaking his head. “Waste,” he whispers.

“What does he mean?” I ask Jorge.

“He shot himself. Tried to commit suicide and botched it,” he replies. “So now we have to fix it.” I try to catch his eye, smiling meekly as we walk out of his room.

We wander into a private room. Dave ignites the light. A startled round man awakes with a little white stocking on his head. A few seconds after the light is switched on, a couple of white-coated grey-haired, balding men arrive. They approach the bedside, as Dave, Hazziz and we, their white-coated ducklings, step aside.

“It’s pretty big,” says Dr. Tupper as he rolls the stocking off the scalp underneath.

“It’s huge,” Dave exclaims as Dr. Tupper pulls off the white gauze, revealing a giant scab resembling a purple crusted pancake-shaped hat. “It’s like a plate.” The puzzled eyes under this grotesque beret look up at him.

“It’s okay, Mr. McKenzie,” Dr. Tupper puts his hand on the man’s shoulder. Mr. McKenzie’s face softens. “We’ll take care of it.”

The other white-coated man, Dr. Calham steps out of the circle to the periphery. He points toward the bed, then leans toward Jorge and me. “He’s a janitor at Parksville School. He’s probably been walking around with this thing growing on his head for years. Went the emergency room a few days ago and took of his cap.”

“Why did he come in now?” I ask.

“He said it was starting to bleed. That worried him.”

7:52am.

We file out of Mr. McKenzie’s suite as Dave and Hazziz rush up the stairs and the rest of us scatter.

I emerge out of MGH, off to the refuge of the Children’s Hospital. I look forward to hanging out in the surgeons’ lounge with Cal, a general surgery resident and my preceptor who just returned from Africa where he had fixed cleft palates for a week.

I appreciate the morning light pouring through the lounge windows, sunny disposition of my preceptors and simplicity of our work.

We do a lot of “ear tucking”. I am allowed to practice my stitching, well-hidden behind auricular cartilage. My handiwork brings it closer to the child’s head. “No more Dumbo jokes,” for this boy, notes Cal as I hook my needle into this young scalp.

1:02pm

After lunch, I head back to the dingy red brick hospital for adults. The glass doors open as I step on the black rubber at its entrance, beaconing me down the fluorescent-lit corridor, up the dim grey elevator and onto the top floor. I walk to the women’s change room, full of lockers of a few dozen nurses and a handful of physicians, put my coat and knapsack in an empty locker marked “STUDENT” and change into green cotton pajamas: “scrubs”.

I exit the locker room, pairs of green-clad women and men pass by me. Hips graze hips. Hands roam along backs. Everyone is giggling. I am bewildered.

Cal meets me at the nurses station and we head to the OR. Together, we approach the stainless steel sinks. After stretching the handles of a mask over our ears, covering mouth and nose, we each reach for a plastic yellow packet from a pile, next to the sink, and rip off the plastic skin to reveal a soft pink block . I turn the tap handles with my elbows, unleashing a stream of water, and enjoy the warm foam bubbling from the pink sponge, as I rub my palms, fingers, wrists and forearms. Three minutes. Minimum, I am told. My elbows tap the long chrome faucet handles to shut off the flow of water. Our elbows bent, keeping damp hands in mid-air, we turn our backs to the swinging doors and push through, into the operating theater

Inside, we are greeted by a masked, green-clad nurse. Her ungloved hand pinches the wire at the top of my mask, molding it to the bridge of my nose. She holds up a wrinkled green cotton gown in front of Cal, as he places each hand through the holes presented to him. Another nurse has a gown ready for me. I follow Cal’s lead. Once his hands are through the cuffs, he spins one hundred eighty degrees. My nurse taps my shoulder, triggering my turn. I watch Cal’s nurse’s (now latex-covered) hands create three bows from the ties along his back, as the woman behind me does the same. She grabs an extra strip along his side, he twirls and then I twirl. The final bow is tied along each of our waists.

“Thank you.”

I follow Cal to the silver trays where paper rectangles, atop a green towel, await us. I pick up the package, rip off the top edge and open it, exposing two flat, hollow, latex hands. I tuck my finger inside one glove, reach my other hand inside and pull the latex over the green gown’s cuff. Cringing in my effort to not touch my skin with my rubber digit, I reach inside the other glove and pull it over my hand, wrist and cuff. My finger grazes the cotton sleeve. Damn. Recalling last OR, when I wasted four pairs of gloves, I decide to let it go.

Our sterile fatigues in place, we join the troops assembled around a hill of cotton fabric the same color as our outfits.

It encompasses a familiar round purple disc, surrounded by a bed of hoses, and illuminated by a spotlight. Mr. McKenzie’s tumor is the afternoon’s center of attention.

I shift to the second row, behind Hazziz and next to Katherine, my classmate. Dave stands across from us, with a woman and man on his side. Together, we form a circle around

Mr. McKenzie’s head. Cal stands somewhere among the other half dozen in the room.

“We’ve been at this for three hours,” says a tall figure. “Could take another three or four. We’ll need a lot of blood.” I recall the voice from this morning’s rounds. Dr. Tupper?

Dave asks for a scalpel. The woman at his side passes him a stainless steel blade. “It’s a big job. I’ll be ready for a beer at the end of this one.” He cuts into the mass before him. Blood seeps around the knife. The nurse sops it up with white gauze at the end of scissor-like stainless steel forceps.

“Are you going to the party tonight?” she asks.

“What party?” asks the man next to her. I recognize his eyes. It’s Dr. Calham.

“The one for the closing of the OR’s at the Civic Hospital,” she replies. “This is the last OR day here.”

“Should be lots of booze,” mumbles Hazziz as he tugs with his forceps.

“Sounds good, where is it?” Dave keeps his eyes on the task at hand.

“On the eighth floor,” she says.

“Sure, I’ll go over when we’re done,” Dave turns to her. “You going?”

“Just doctors are invited.”

“You can be my date.”

“I’ll go, too,” says Dr, Calham. “You can be my date.”

“I can’t be both of your dates,” she giggles.

“Sure you can,” assures Dr. Calham.

“Yeah,” Dave looks up. “You can be the Plastics concubine.”

The nurse turns to Dave,” What’s a concubine?”

I turn, wriggle through this green crowd and head out the swinging doors, gasping for air.

The post A Day among Surgeons appeared first on Laughing Sherpa by Dr Miriam Korn, MD.