A tray slams onto the table, silverware rattling. Clark, an acquaintance of mine from medical school who has the soulful eyes and determined jawline of a young Ernest Hemingway—as well as the tendency to crack each of his ten knuckles one at a time, loudly and repetitively—drops into a chair. Wearing a faded white T-shirt over bloodstained green scrub pants, he looks as if he’s narrowly survived some sort of natural disaster. Sections of his black hair project from his head at varying sharp angles. “Good morning.” His voice is a low growl that reminds me of a lawn mower. “This place should be burned to the ground.”
Stuart puts out his hand, grinning. “Whoa! Another rough first night. Hi! I’m Stuart Ness, Harvard Med.”
Clark glances at Stuart’s hand and takes a slow breath. A vein bulges in his left temple. “Norah,” he says without looking at me, “I’m going to put my head down on the table. I want you to take this fork and jam it into my carotid.”
“Ha! I like this guy!” Stuart laughs, clapping him on the back.
I smile sympathetically at Clark, though I’m fairly sure my night was worse than his.
“Let me ask you,” Clark says. “Is it too late to get off this crazy train? What if we quit now, before it gets any worse?”
I sigh and rub my forehead, the beginnings of a migraine coalescing somewhere deep in the frontal cortex of my brain. “I can’t quit. I’ve put too much time and work into getting on this crazy train. I can’t bail out now. What about student loan debt?”
“Sallie Mae. That heartless bitch,” Clark grumbles, rubbing his eyes with the heels of his hands.
“Easy there, buddy. It’s only the first day,” Stuart says, smiling encouragingly. He’s about to clap Clark on the back again when Clark shoots him a look so menacing that Stuart’s hand freezes in midair.
A moment passes before I realize that a female voice is commenting, dispassionately, from the loudspeaker overhead: “Code blue, room 512. Code blue, room 512.”
A fork clatters to the floor.
We run.
CHAPTER TWO
Sprinting up the stairs would be easier if my white coat didn’t weigh fifteen pounds. Senior residents like to joke that interns carry their lives around in their pockets. Mine are filled with two miniature textbooks, three pens, a stethoscope, a reflex hammer, a hospital ID badge, a penlight, a laminated map of the hospital, and a protein bar. A wearable emergency preparedness kit. Unlike the embarrassingly short medical students’ white coat, which projects nothing but bewilderment and the deflection of responsibility (Me? Oh no, I’m not the doctor. I’m a student. I’m just here to observe. Although once they let me catch a baby as it came shooting out of a woman’s birth canal. It was a beautiful experience.), the long doctor’s coat radiates confidence and capability: Throw anything at me, I’m ready.
In a code blue, the first doctor to arrive at the bedside gets to “run” the code—be the leader and make treatment decisions—at least until the senior resident or attending arrives. I’ve seen codes run before, but this is my first opportunity to be at the helm. This is my chance, finally, to prove my abilities.
The first thing I lose from my coat pockets is a miniature pharmacopeia, a medication reference book. It bounces away down the stairwell, but I keep going, taking the stairs two at a time. I’ll be damned if I can’t beat Stuart Ness from Harvard Medical School to room 512. If I can’t compete with him academically, I’m determined to at least outrun him. I’ve met people like Stuart. There was always one in every class in college and medical school, someone for whom everything seemingly came easy, the curve-breaker, the guy who thought organic chemistry would be great if only it were a little more challenging.
Which is why I’m not entirely surprised when I see a blur of brown, perfectly groomed hair and green scrubs flash past me somewhere between room 485 and room 502. I arrive—perspiring excessively and panting—to see a breathless, ruddy-cheeked nurse standing over an elderly male patient. The nurse chews her lip and adjusts and readjusts her reading glasses, while Stuart, at her elbow, stares at the heart monitor above the bed. The tracing shows a heart rate dangerously fast and erratic, and the words “Critical Value” blink angrily on the screen. The patient, his skin pale and clammy, his eyes wide with panic, speaks in a soft whimper. “What’s happening?”
“Your heart is beating too fast,” the nurse says, fiddling with the wires taped to the man’s chest. Her movements are confident, but worry ripples through her voice.
“He’s in A-fib,” Stuart announces, anxiously clutching his stethoscope with both hands. “Unstable A-fib. Maybe we should try a medication? Maybe diltiazem?”
The patient’s blood pressure is falling due to his heart arrhythmia. If his heart rate isn’t slowed down, right now, he’ll go into cardiac arrest. Every cardiology textbook I’ve read clearly outlines the appropriate next steps for this exact scenario.
Why are they just standing around?
A crash cart with a defibrillator is next to the bed. I grab the electrical paddles as the heart monitor emits an ear-splitting alarm. The patient’s blood pressure reads 80 over 35 and is falling by the second. The nurse, the patient, and Stuart all turn to me and speak at once.
“Maybe let’s wait for the resident,” Stuart says.
“Are you sure that’s what you want to do?” the nurse says.
“What are those for, Doc?” the patient says, his voice barely a whisper. His eyes drift closed.
I shock him. The sound is like a candle being extinguished. “Clear!” I remember to shout, moments too late.
The patient’s limbs jerk and waggle; then he is still, and the heart monitor is silent. No one moves. The nurse clutches her chest, steadying herself against a chair.
Oh my God. What have I done? That should have worked. Why didn’t it work?
The patient’s eyes snap open. “WHHHAAAAAAT THE FUUUUUUCK!!!” He tries to crawl out of the bed.
The nurse struggles to restrain him. “Mr. Leeds, I’m very sorry about that, I—”
“What did you do to me? What in the name of God, you mother—”
It occurs to me that I should have warned him, said something to prepare him, probably, before shocking him. But, with the heart monitor now beeping a jaunty, steady rhythm, I’m giddy with relief. “Look, Mr. Leeds, you’re not in atrial fibrillation anymore!” I smile at him triumphantly. I saved you. I pulled you back from the brink of death.
Mr. Leeds has a wild look in his eyes. “Get away from me! Get her away from me!”
I’m taken aback. Maybe he’s confused. After all, he’s just had a near-death experience. Then I catch Stuart’s eye. He’s gawking at me, his mouth agape.