Foreword: This is part of our under-construction compendium of stories, ruminations; The Walls Are Talking is also on Wattpad.
Surgical Ward
I love sweets but there is something about ketchup in pasta that turns me off. But in the middle of a 36-hour shift, my choices of food are unfortunately limited. And I have been stuck in the SICU since the morning endorsements. If it isn’t for the nurse who took pity on me, I would not have peeled myself from a patient’s bedside. So now I have five minutes in the pantry to kill this Filipino spaghetti my mother ordered for me (I love her to death though) and wipe out all evidence of its offensive existence.
Clink. A text message from a colleague asking for more hands in the Operating Room.
There has been a surge of trauma cases at the ER. A good number are already wheeled up for simultaneous life-saving surgeries. They will be needing two assists per case. All the floaters and ward interns are already there. My partner is absent. The OR Chief has scrubbed in. I’m the remaining junior intern who has not ditched the white coat for green scrubs yet. But my senior resident prefers this setting for now.
We have a handful of truly unfortunate morbid cases on the floors (and there are five surgical floors); many more are needing IV reinsertions. An hour to midnight and I have coded four patients so far—none of them made it. In the SICU, Bed 2 is a case of ARDS from hemorrhagic and necrotizing pancreatitis. We just operated on him yesterday, and now his lungs are drowning. I stand over the bed, looking at the imaginary timer. I chart his latest vitals, check the tubes for patency, quickly skip his latest blood gases (they’re not promising anyway), and look at the waveforms on the monitor. Asynchrony. I study his face. Twitch. Pain. I know, I know. The RT has his hands full. This has been a miserable evening for us.
Then an alarm went off. It’s Bed 1. Holy shit. My fingers instinctively palpate a carotid: pulseless VT. I call a Code. The team finds me pumping in an awkward position. The nurses meet my eyes; my senior is on his way, but not the defibrillator. We’re absolutely screwed. The first ten minutes in resuscitation is crucial. Beyond that, the chances of revival after a cardiac arrest are slim. Patients with scarce physiologic reserve fare even worse. And this patient falls exactly in the latter category. Subsequently, he converted into a fine VF, and ultimately, asystole. No amount of epinephrine can get his heart pumping again. The resident has to call it after ten cycles.
Since Bed 2 looks like he can survive the night, I’m being reassigned to the patient I admitted the other night. The unlucky young man lives with his aunt and cousins in the slums. He has been laid off and recently spends his time in the streets. One night, he was sitting by a convenience store drinking with friends when they heard gunshots. It might have been a raid, a buy-bust, or tokhang—who knows? Three bullets found him. He found himself with us.
I find his situation worrisome: his blood pressure resists the double pressors; he is not peeing enough; no family or friends have visited him yet. When the recent SICU mortality will have been transferred to the morgue, this guy can replace that bed. In the meantime, I plopped on a chair at beside and study his gaping midline incision and the puckered red skin around his bilateral chest tubes. A bullet missed his aortic arch by a few inches. Another lacerated his spleen. The third one lodged in his left lung.
Talk about wound healing. After my late dinner, I’m still starving. I am craving for light-hearted company. On a daily basis, we discuss the dead and the dying. And then, there’s death on the floors. Death on the table. Death in our conversations. Death in the charts. Death in the eyes of our exhausted, overworked colleagues. I see my dire spiritual nutrition in the glassy stare of this malnourished young man. When he wakes up—if he does—will his soul shatter at his misfortune? Will he heal from the wounds inflicted by society? My heart weeps for him as much as his wounds weep in pus.
“Nurse,” the middle-aged man on the next bed said. He was referring to me. “My dextrose ran out.”
“Dextrose” is a collective colloquial term for just about any clear intravenous fluid. Yellow dextrose can mean albumin or an antibiotic. White dextrose can mean propofol infusion (rarely practiced though) or some form of parenteral nutrition. But blood is blood; red dextrose is just silly.
His dextrose is just plain lactated ringers. But he neither has a reserve nor an S.O. who can procure for him at the pharmacy. Fortunately, a generous patient from the bed across offers his extra liter of PLR—with a wink and an unsolicited comment about my “pretty face”. For the sake of my patients, I accept everything.
“Nurse,” Dextrose Man speaks to me again.
Winking Man quickly comes to my defense, saying “She’s a doctor, dumbass.”
Dextrose Man does not flinch but accepts his error. “So, Doctor, do you have a boyfriend?”
This is not my idea of a light-hearted conversation, but tonight I may take anything.
“Yes, sir,” I lie.
“He must be rich like yourself. Is he handsome?”
Would I lie about my concept of ideal, optimal, perfect, when it is the only replacement for the missing tangible?
Leave it to his imagination to measure the extent of my privilege: being able to study medicine must make me a hot commodity especially to the upper class. That is far removed from reality, however. Prototypes are misleading as they are dangerous. I’m neither in the affluent circles nor am a hot commodity in the relationship department.
I’m not about to unveil to these strangers my dating life—or the lack of it. Who am I kidding? After this long laborious shift, I sleep. I wake up. Then I restart the same cycle. We do not have holidays or proper weekends for 365 days. It’s a do or die. It’s a protracted ritual, a rite of passage, in this hierarchical professional pathway. Junior internship can feel much like a long-distance relationship—only that this “distance” is metaphysical. Whatever “spare” time one may find in this unforgiving routine is equivocally enough for newfound LDR.
“Ouch,” a familiar voice joins the conversation. It’s my senior surgical resident.
If he has been eavesdropping, this is arguably my worst duty ever. The guy has been hitting on me since I accidently admitted intraoperatively that I’m single. He’s not even my type.
“You’re breaking my heart, doktora,” he adds. “Does the guy have abs?”
Lying is not fun, especially when I have to repeat it. The abrupt turn of his countenance evidently shows his displeasure. He is not enjoying my lying or my lie.
He cuts my monologue and asks about Gunshot Guy. I give him my assessment and interventions. After I adjusted the doses of the pressors by actual dose, not by drip rate, the patient’s MAP steadied at 70 mmHg. And I have been having some urine output since the last hour talking to Dextrose Man and Winking Man. (I skip the CVP because I don’t know how to use the water manometer.)
By sunrise, his mood has completely fermented. We are officially archenemies. To prove just that, during my morbidity endorsement at the close of my 36-hour shift, he has been aiming a machine gun at me, relentlessly firing impossible questions.
I can’t say I did not cry as soon as I hit home. Five mortalities—all mine. A handful more in the death row. Unnecessary workplace drama. I can’t control how people react to my choices. I must have made terrible decisions to be where I am at now. But there’s hope of tomorrow even for ARDS Man, Gunshot Guy, Dextrose Man and Winking Man.
By sunrise, I feel renewed.
See you at the Operating Theater.
Campylobacter Jedi 