The first time I stuck a needle in Miriam Lewitsky, I thought she seemed ancient. She had a puffy face, straw-like hair, and bruised, fragile skin. Long-term steroids had caused those changes.
Mrs. Lewitsky was every intern’s nightmare—chronically ill, suffering, and, worst of all, the wife of a board member and therefore a VIP.
She’d been admitted three weeks earlier. Her medical attending was Dr. Cruzario, a highly regarded pulmonologist, her husband a weird but wealthy financier. She carried a diagnosis of idiopathic pulmonary fibrosis.
Rona, the resident, had told me on morning rounds to draw an arterial blood gas from Mrs. Lewitsky. So I gathered up the necessary equipment and headed in to meet her.
“Who are you?” she wheezed from dried, purplish lips. Her nasal oxygen cannula sat high on her forehead, sending oxygen to her hairline.
I introduced myself.
“Hullo then, young doctor.” She closed her eyes and lay her head back against the pillow. “Fix the pillows for me, would ya?”
I came around to the far side of the bed. She couldn’t lean forward on her own; I had to hold her shoulder forward with my right arm while fluffing and repositioning the pillow with my left. She wasn’t as light as she looked.
“It’s gotta be higher. I don’t like it so low.”
I pushed her forward again. The hospital gown stuck to her spine and I felt her damp skin through the thin cotton. The back of her stylish red hair was flat from the combination of lying too long in one position, infrequent washing, and accumulated hairspray.
“I suppose you’re gonna stick me for something,” she rasped. I lowered her back. She hadn’t done any work but seemed more out of breath. I put the nasal oxygen back in her nose.
“Well, actually, yes I am. We need to check a blood gas.” After nine months of internship, I’d learned to invoke the royal we whenever possible. I had no authority and little experience. Calling myself we was a semantic attempt at validation, and a surprisingly effective one.
“Don’t bother with my right wrist. It’s still sore from the last one.”
I turned her left hand over and examined the inside of the wrist. Bruises ran halfway to her elbow. I felt for the radial pulse and she flinched.
“It’s so sore,” she said.
“This is the good arm?” I asked, not feeling any pulse whatsoever.
“The other one’s worse.”
“There’s not much here,” I said. “I’m going to take a feel of the other arm. I’ll make sure to give you some local."
“A lot of good that does,” she said. She was right. The local anesthesia stung and may not have helped, but it made me feel better.
Her right wrist had a weak but detectable pulse. I set up my equipment and prepped her skin.
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