Being a doctor’s shadow ain’t easy 22Sep2002

My preceptor has MS that is flaring right now so she has not been around. In the small amount of time that I have managed to be with her she not only revealed that she is married to a farmer but has instructed me to find myself one too. Coincidence? Apparently, I am learning on my rotations that a pharmacist plus a farmer equals a match made in heaven.

Anyway, in her absence, she has arranged for me to follow a hospitalist around all day.  This is the first time I have ever heard this term. Our day started early Thursday morning in the ICU. He is tall and welcoming and on the first day of his seven-day shift. We visit patients and read their charts and discuss his past and my “game plan” for the future. I am observing for the most part and don’t have much to contribute. As he tells every single patient we see that they absolutely have to quit smoking, I vigorously shake my head in agreement next to him. He teaches me and I listen and smile. He is a good teacher, and he isn’t arrogant which feels rare. He doesn’t go out of his way to make me feel dumb. I thought isn’t he is fabulous as we are sitting looking at charts and its hard because he doesn’t know the patients but somehow, we are moving right along. Then he gets paged “be there in 10”. Then he gets paged “be there in five”. It is the ER paging him and apparently this isn’t good.

We finish with the chart in front of him and then he tells me to see the sales representative and then to meet him in the ER. I thought he was trying to get rid of me but then I see the sales representative is a cute young man in his early 30s just wanting to talk about Plavix. I am doing my AHEC presentation on Plavix, so he is the man I had been trying to contact all week. What luck! I am very happy to talk to him so we talked for a while and I got all my questions answered and he agreed to walk me to the ER and says “good luck” when he drops me off. There is no one in the ER when we arrive except two security guards and a secretary. Then I see a woman come in who works at the hospital crying and then other nurses come out of nowhere and start consoling her by the wall. I cannot ask them where my doctor is. Then I see another nurse walk by and ask her and she says he is right over there behind the curtain. She tells me to “go on sugar” as she pulls the curtain aside. I look and stop. I can’t walk in. It was a full code and the man in front of me is struggling for his life. I’d never seen a man struggle for his life before. The nurse then gave me a slight shove as she closed the curtain behind me. I looked up to see my doctor pointing for me to stand behind him. When I was safely behind my doctor I looked around and count seven nurses and one EMS lady all running around trying to save this man. My doctor looked calm and was firmly yelling out questions to the women in the room as he was watching the monitors. Suddenly I meet the eyes of a nurse who says “honey, you look pale are you alright? Do you need to step out?”  As she is talking to me all eyes in the room suddenly shift to my face and then name tag. I insist that I am just naturally pale. I normally use the line that when I went to Clinique to find my makeup shade the woman told me I was transparently neutral which is sounds like I am so pale you can see right through me but I don’t because this is not the time for amusing anecdote. My doctor looks over at me and determines that I must be ok, so he lets me stay.  I do my best to stay out of the way and not pass out.

After a while the patient needs to be transported but before he moves, we have to tell his family what is up. I am following my doctor and suddenly the chaplain is walking with us.  I end up standing next to the chaplain as my doctor is telling four hysterical women that this man who they must love is not doing well. All eyes turn to me after the doctor speaks but I have nothing to contribute. I can feel the tears start to well up in my eyes. I can’t cry. There is no time. We are moving again. Back to the ICU we go and this time we have the patient with us and we all somehow travel together in the elevator. In the ICU we are met by more people and I just try to remain out of everyone’s way.  After a while we have to leave the patient in the hands of the ICU and talk to his family again because we have to move on and still get to the other 20 patients that we have to see that day. The doctor yells “page us” as we leave the ICU to find the patient’s family. They have moved and dried their eyes, so four swollen red eyed women anxiously approach us when we enter the room. The doctor says, “nothing has changed”.  We venture down the hall to where we left off before and we are in another patient’s room not more than 2 minutes when the doctor gets paged again. It’s the ICU. His face changes. After a quick call to confirm his suspicions, we take off running down the hall. God, I hate running and now I am running in public after a 6-foot-tall doctor without my albuterol inhaler. I of course have no idea what will happen next, but the doctor seems to already know what is in store for us. The patient has coded again. I know this isn’t good. This time his family was in the room. They are hysterical again and have to be escorted out as more and more drugs are going into every available line. A second pump needs to be brought in. Someone in the room sees that I am from pharmacy and asks me a question that I have no idea what the answer is. Pharmacy school did not prepare me for this. The doctor is now banging his head against the wall. This isn’t good. As more and more bags are hung the doctor asks me with a smile, “now all of these drugs don’t interact right?” Fuck. I am definitely not thinking like a pharmacist right now. I don’t know. So, I say, “do we really worry about drug interactions at a time like this”? He continues to smile. Then when they have done all, they can do, things calm down. The patient looks horrible and I keep looking at the monitors because they say he is alive, but he doesn’t look like he is. As if he is reading my thoughts the doctor says only to me, “this guy is not going to make it”.  Per usual he already knew the outcome. So, this guy is only 50 something with a family which means there is no giving up so Xigris is used at a staggeringly obscene price of $900 a vial as a last-ditch effort. It doesn’t work.

As I watched the patient I thought about his condition and how he got to this point. I do not know what this guy has survived until today, but what I do know is that his blood alcohol level at 8:20 am on a Thursday was 0.4 mg/dL. He had pneumonia that he left untreated for weeks. He has four women who were very upset by his condition and were right there by his side. He did this to himself and I find myself angry at this stranger. How could he be so careless about his body? I am not there for the death and for that I am grateful. Now he is gone forever so he cannot fix the damage that his drinking and smoking did to his body. I guess I just hope for his sake that he had love. I hope he loved those four hysterical women. By the end of our day, I was both physically and emotionally drained. I can’t remember a time when a day in the life had affected me that way. Then again, I have never followed a hospitalist around before. My doctor shook my hand for a while when we parted while he looked me in the eyes and said good luck. It is rare for a person to really see me or try to see me and I don’t know how to handle it. I have only been seen like this in the past by Peter.  And so far, both times have been so overwhelming that I have really had to try hard not to cry. Why am I such a crybaby? And sure, we know now that a farmer can love a pharmacist, but could an American farmer ever love a crybaby? That doesn’t seem likely.