Excerpt from Internal Medicine by Terrence Holt, plus links to reviews, author biography & more

An uncomfortable sensation stirred in my chest.

"I got report on her," the new nurse said. "Do you still want frequent vital signs?"

"How's she doing?"

"I don't know. Do you want me to check?"

"Please," I said, and settled my head on my folded arms.


A HAND SHAKING MY SHOULDER. "Doctor?"

I stirred unpleasantly. My face was stiff. My sleeve was wet.

"I'm sorry to bother you, but that lady in twenty-six, she's not looking so good."

I sat upright.

"Her O2 sat?" the nurse went on. "It's only eighty-two. And her rate is over thirty."

"Is she wearing her mask?"

"No."

"Christ." I was out of the room, stalking down the hall. She lay in the bed, looking expectantly toward the door, the mask gripped in her hand. Her other hand went up as I approached, waving me away.

"Mrs. B," I called to her, pitching my voice as if into the distance.

The head bobbled for a moment, turned my way. The eyebrows were lifted slightly, but the skin above them was unfurrowed. The mouth was a hole air moved through.

"Mrs. B," I said again, willing her to look at me.

She did.

"You have to keep your mask on." It did not sound so idiotic when I said it as it does now.

She shook her head.

"If you don't do it," I said, reaching out to take the mask from her hand, "you're going to die." She made an ineffectual motion as I placed the mask over her face, looping the cord behind her head. Her hair was greasy with sweat. She reached up and placed a hand on the mask. My hand and her hand held it there. Did her breathing start to slow? I held the mask through one long minute, another. The nurse was a silhouette at the doorway. Another minute more, and I was sure the rate had fallen, the laboring of her shoulders lessened. To the nurse: "Let's check a sat."

Ninety-two percent. To Mrs. B: "There. That feels better, doesn't it?" She nodded, faintly, and seemed to settle into the bed. I let my hand fall away from the mask, crooning, "there, there." After five minutes pressing the mask to her face, my outstretched arm felt like wood. I reached behind her head to snug the cord.

She pulled the mask away. "I can't breathe. I don't want it," she gasped. "It's too tight."

And pulled harder until she snapped the cord in two. I grabbed the mask and held it on her face. She reached up and clutched my wrist, and for a moment I thought we were about to struggle over it, but then she stopped and her hand fell away. Her eyes were fixed on mine.

The nurse was still at the doorway.

"Ativan," I said. "Two milligrams IV. And two of morphine." Mrs. B still stared at me, her face remote and motiveless behind the mask. My arm was aching. Was I pressing the mask too hard? I eased up, fumbled with the broken cord, but the ends were too short to make a new one. Mrs. B didn't take her eyes off mine as the nurse reached for the port in the IV tubing. Just as the nurse's fingers caught it she snatched her arm away.

"No." The voice was a whisper.

The nurse turned to me, her expression stricken. "I can't, Doctor."

"What do you mean?"

"I can't force a patient. It would mean my license."

"She's going to die if she doesn't keep that mask on."

"Then get Psychiatry to declare her. But until then it's her decision. We can't make it for her."

Psych wasn't going to declare her. I knew that. It was her decision. I knew that. But I couldn't let it end this way. Surely I could make her see.

"Mrs. B," I said finally, "is there any way we can make this easier for you?"

"How about a bucket?" said the nurse.

My expression must have requested explanation.

"A face tent, they call them. It's open at the top. It works for claustrophobia. Do you want me to call Respiratory?"

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.