Sign of Weakness
A complete short story from the collection, Internal Medicine
MY FIRST CALL NIGHT AS AN INTERN, I RAN into Dr. M, one of the senior attendings, whom I had known for several years. "How's it going?" he asked me. I told him I was on call. "First call?" He smiled. "I remember my first call. About ten o'clock that night, my resident said to me, 'I'm going to be just behind that door. Call me if you need me. But remember—it's a sign of weakness.'"
I don't recall my response: I don't think I even had time to consider the story until evening, when the frantic milling about that makes up an intern's day had started to wind down. That day, we filled up early—three opportunistic pneumonias from the HIV clinic; a prison inmate transferred from Raleigh with hemoptysis, presumably TB, and a fever-of-unknown-origin.
Keith, the resident, whose job it was to direct me in my labors, felt this was a good day—his work was essentially done by five, as together we wrote admission orders starting the workup of the mysterious fever. He said to me, "I'm heading off to read. Call me if you need anything."
"But it's a sign of weakness, right?" I said, remembering Dr. M's story.
Keith laughed. "Right." And sauntered off down the hall.
Later, I was on the eighth floor, getting sign-out from one of the interns on the pulmonary service. It was almost seven— this was early in the residency year, and nobody was getting out before dinner. This intern was post-call, red-eyed, and barely making sense. Her sign-out list was eleven patients long. I don't remember any of it except the one: Mrs. B was listed as a
DNR/DNI 47yo WF w/scleroderma RD. "RD" meant "respiratory distress." The little arrow meant this was one possible effect of her scleroderma. I had never seen scleroderma before, and what it was, exactly, I could recall only hazily.
"She's a whiner," the intern explained. "Don't get too excited about anything she says." She paused. "I mean, if she looks bad, get a gas or something, but basically she's a whiner."
Whiner, I wrote down in the margin of the list.
I sat at the workstation for some time after that, running through lab results on the computer—the scheduled seven P.M. draw was still going on, so there was nothing new on the screen, but it calmed me to go through the exercise.
A nurse stuck her head through the door. "Doctor?"
I was still unused to people calling me that.
"Do you know the lady in twenty-six?"
I fished the sign-out sheets out of my pocket. "What's her name?" There were too many sheets. The nurse gave me the name and my eye fell on it at the same time. Whiner.
"What's her problem?"
"She says she's feeling short of breath."
"Vitals?" I heard myself ask, marveling at my tone of voice as I did.
The nurse pulled a card out of her pocket and read off a series of numbers. When she was done I realized I hadn't heard any of them.
The nurse read them again. This time, I wrote them down. Then I spent a minute studying them. She was afebrile, I noted. That was good. Her heart rate was 96, a high number I had no idea how to interpret. Her blood pressure was 152 over 84, another highish set of numbers that told me nothing. Her respiratory rate was 26—also high, and vaguely disquieting. Her O2 sat—the oxygen content of her blood—was 92 percent: low, and in the context of that high respiratory rate not a good sign. The nurse was still looking at me. "I hear she's a whiner," I said hopefully. The nurse shrugged. "She asked me to call you."
The patient was alone in a double room. The light in the room was golden, the late sun of the July evening slanting through the high window. The face that turned to me as I knelt at the bedside was curiously unwrinkled. Her skin had a stretched and polished look, her features strangely immobile, the entire effect disturbingly like a doll's face. Her chest rose and fell, but her nostrils did not flare. Her mouth was a tight puncture in the center of her face. Only her eyes were mobile, following me as I moved.
Excerpted from Internal Medicine: A Doctor's Stories by Terrence Holt. Copyright © 2014 by Terrence Holt. With permission of the publisher, Liveright. All rights reserved.
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