seven before they became unduly concerned. I had the foresight to transfuse him with two units of packed red blood cells, and I informed the lab to keep six units ahead. Juan was exsanguinating from eroding blood vessels in his esophagus; vessels that became engorged because his liver was cirrhotic.
Far from enlightening me regarding any new information, I nodded my head and took the stairs up to the ICU. Krakauer was going to be my cross to bear for the month. It was going to be a long night, a night in early July. “Have you checked his hemoglobin lately?” I heard Barry say behind me. I didn’t deign to answer him. He could read the chart. “Have you checked it lately?” he was storming up the stairs after me.
“I had them run one before we went down to dinner,” I said when pressed by Krakauer.
“Like I said, just keep it above seven. And call the gastroenterologist.”
That was about as much support from Krakauer as I had for the rest of the night. I felt like the engineer on a train running out of control that would convey me to the next world.
I had the temerity to ask him a question about another patient in the unit. His name was Tom Baker, an old smoker who had pneumonia in both lungs. He belonged to Dawn Fleming, another internal medicine intern. I was covering for her tonight. Baker happened to be the sickest patient on her medical team’s service. No sooner had she signed out to me, than his blood pressure bottomed out. “What should I do with Baker. He’s still spiking a fever and his oxygen saturation keeps dropping. Baker had me worried during the dinner we never ate, worrying about him while Krakauer was reminisced about Baltimore. Krakauer, of medium height but with long legs, was taking the steps two at a time.
“Should I change his antibiotics. If I do, what should I put him on?” I asked. Though having my medical degree for little more than a month, I doubted that Jenkins was going to make it out of the hospital – at least that was what my intuition was telling me – and I was scared to death that I was going to screw up. That pretty well encapsulated my feelings my first night on call – I was going to screw up and kill somebody.
“Read the resident and intern’s note. Then assess the patient. If you still don’t know what to do, call me. But have all your ducks in a row when you do Don’t waste my time.”
“I already called the ID resident on call. He wasn’t exactly helpful.”
“Look, Covington, if you want to make it through residency learn to read notes and call the appropriate subspecialist. Don’t be the weak sister.”
“Hey, wait a minute, mister. I’m a woman,” said Fairchild, “and I resent that.” She was marching up to the ICU with us, which was on the third floor of the old VA hospital, the cafeteria being in the basement.
“You go see Jenkins first, and I’ll give you a call when I get this admission sorted out. And for God’s sake.…”
“Read my note,” I added. Not since Lincoln addressed those at Gettysburg had a missive conveyed such import. So I headed to the medicine ward. Up on the wards as a brand new intern, it seemed like a trip to the haunted house at the traveling fair, with all the nurses coming up and asking questions on their patients and my beeper going off every few minutes. Trying to do everything that I had to do, I knew that Krakauer was in the emergency room seeing my next admission, another patient to take up a couple hours of my time.
Traditionally, when a patient presents to the emergency room, he is seen by the ER doctor who treats him, or decides he needs to be admitted to the hospital. If the ER physician decides the patient needs to come into the hospital, he notifies the resident of the medical team on call. Presumably, the ER doctor has obtained all the admitting laboratory tests, as well as the attendant EKG and chest X-ray. If the patient needs to be admitted, he beeps the resident on the admitting internal medicine team, who then goes down to see the patient in the emergency room. Once seen and written up by the resident, the resident calls the medical intern who is given the admission. From that point on, the intern owns the patient. Therapeutic measures, orders, and consultations all go through the intern. The intern, in picking up the patient, is responsible for all admission orders, his care on the ward or the intensive care unit, and – if the patient’s stars are still in a favorable alignment – his discharge home. If things don’t go according to plans; well, then – they drop like flies at the VA hospital from the vagaries of their illnesses or the corruption of the system. The scarcely consolable families ship the bodies of their loved ones back to Roswell or Clovis, Hobbs or Socorro, or other settlements scattered throughout New Mexico and the Four Corners region.
How I made it through that first day and night of dire and fright, I’ll never know. It was the most terrifying and taxing job I had ever performed. Admissions swarmed in like the Thoroughbreds at Pimlico. And I was the one standing in the middle of the finish line. I didn’t even touch the bed in the call room that first night. When I’d go down to the ER to meet Barry and see about an admission, I always had a question for him. He’d invariably turn to me and say, “It’s in my note.” But often it wasn’t. Krakauer was in no mood to answer any further questions.
Linda Fairchild, my cohort on the medicine team, was a striking woman, whose beauty was only surpassed by her exemplar knowledge of medicine for an intern, I’d turn to for advice. Then he’d slip out of the chaotic emergency room to go and see how the patients that Fairchild and I had admitted were doing. Linda had a winsome face and a pert body, and it wasn’t hard to figure out just which intern Barry was going to help more that night.
Once, about three in the morning, I passed Laura coming of the ICU as I was going in.
“How you holding up, Bill?”
“Read my note,” I replied. She laughed.
“Only if you read mine,” she retorted. “Where’s our resident extrodinaire? I had a question for him. And It wasn’t in his note.”
“The last I saw, he was flirting with the nurses in the emergency room.”
“I should have known,” she replied laughing again.
“Me, too. I come from a long line of slow learners.”
I took a short break, it was four-thirty in the morning. I still had one patient to finish working up, but I strolled out onto the roof of the hospital. I wanted to count the cobwebs connecting the constellations. I needed a breath of fresh air, cool, fresh air to rejuvenate me and catch my breath. Perhaps looking at them would guide me with some of the patients, help me in a way that Barry didn’t seem disposed to do. A nearly full waning moon was dissolving in the west horizon, but the pole star still shone. It shone where it was supposed to shine. I drank a Dixie cup coffee of coffee while I ate a Three Musketeers Bar. No sooner had I finished the coffee, than my beeper buzzed. The extension seeking me in my tiny universe was one in the emergency room.
But both Laura and I got through that first night on call. And the year proceeded apace, nothing without its miseries or woes: gradually, so gradually, it got easier to do as the long hours wore upon us like an old, broken record. So it must be the same for the thousands of internal medicine residents across the country in teaching hospitals every night of the year. But that month with Krakauer left a bitter taste with me, both for Krakauer and for residencies in general. Still, it was the hardest work I’d ever done. But Krakauer. Of all the residents I worked with, I detested him the most. There were times I be in the emergency room when Krakauer was there, that I’d see him arguing petulantly with the ER doctor on call in the emergency department whether the patient required
