A dozen residents and medical students have crowded into the doorway, craning their necks this way and that to peer over one another’s shoulders like a flock of curious, wide-eyed birds. Among them is Clark, holding a steaming cup of coffee.
“What’s happening? What’d you guys do?” he asks.
Stuart turns to stare at him, his mouth still hanging open. “Dude. You stopped for coffee?”
A gangly man with a ponytail wearing a long, tattered white coat, his lips pursed as if he’s just tasted something rancid, squeezes into the room, shouting, “You people need to move, now! I need to get in here.” He is followed by a petite young woman in scrubs who has secured her hair around a pencil. Their name badges identify them as General Surgery residents.
“Terry! Thank goodness!” The nurse seizes the man’s arm.
Terry pushes his wire glasses up the bridge of his nose while drawing in a deep breath, the whistling sound produced hinting that he likely has either a chronic sinus obstruction or really, really tiny nasal passages. “Tell me what’s going on,” he says.
Mr. Leeds clutches the bed rails. “These people are trying to kill me!”
“That intern just defibrillated the patient.” The nurse’s tone is accusatory. “He was wide awake!”
Honestly, I don’t understand what she’s so upset about. The patient was moments away from death, and now he’s alert and talking. Full of vim and vigor, in fact. Yes, technically, you’re supposed to sedate the patient with something like Valium before shocking them, because having your heart electrocuted while you’re awake is probably as unpleasant as being unexpectedly struck by lightning, but—
“The intern did what?” Terry’s voice becomes increasingly shrill, like a teakettle coming to a boil. He turns to me menacingly. “What do you think you’re doing?”
My heart pounds against my ribs as I drop the paddles and cross my arms over my chest. “His heart rhythm was irregular,” I say, unable to quell the tremor in my voice. “And his blood pressure—”
“Are you incompetent?”
“He was unstable—”
“This is my patient!” Terry paces back and forth, seething. “You don’t do anything to my patient! What department are you from?” He grabs my arm and twists it forcefully—not enough to hurt, but enough to knock me slightly off balance—to look at my coat sleeve, where the words Internal Medicine House Staff are embroidered in blue thread near the shoulder. “Internal Medicine? Who’s your senior resident?”
I open my mouth but can’t form any coherent words. Humiliation pricks at the corners of my eyes. Don’t cry in front of the patient.
“That’s me.” A young man in his late twenties with a rakish smile and tousled brown hair saunters past the crowd at the door. Ethan Cantor, a senior resident. I remember him from orientation; he was disarmingly friendly and not nearly as intimidating as the senior residents I’d worked with on clinical rotations in medical school. “What’s the problem, Terrance?” Ethan asks casually.
“You need to supervise your interns, Ethan!” Terry says. “This genius just shocked my patient! Without sedating him!”
Ethan glances at the heart monitor, then nods with the air of a surfer admiring a particularly impressive wave. “Nice. It’s Norah, right? What was it, unstable atrial fibrillation?”
I nod nervously. “His blood pressure was really low, eighty over thirty-five.”
“Sir, sorry we had to do that to you.” Ethan places his hand on Mr. Leeds’s shoulder. “But the young doctor here probably just saved your life.”
I lift my chin righteously but avoid making eye contact with Terry.
Terry snorts. “You don’t shock for an irregular heart rhythm!”
“If the patient’s unstable, yes, you do.” Ethan listens to Mr. Leeds’s chest with his stethoscope.
“Do you two guys know what you’re doing?” Mr. Leeds asks, helplessly scanning the room for reassurance. The residents and students in the doorway adjust their white coats and look away.
Terry glances at Mr. Leeds as if he’s surprised Mr. Leeds is still there. “I’m a chief resident of Surgery!” His face reddens.
“And I’m a chief resident of Internal Medicine and a Visa Gold card member,” Ethan replies dismissively, still listening to Mr. Leeds’s chest. He pulls the stethoscope out of his ears and loops it around his neck. “Sir, I need to get you transferred to the Intensive Care Unit.”
Terry balks. “You’re not transferring him! We’re taking him to surgery in an hour. His gallbladder needs to come out.”
Ethan shrugs. “Sorry, the gallbladder will have to wait. We need to figure out why he got unstable. When’s the last time he had lab work?”
The nurse flips through a chart. “Yesterday.”
“What was the anion gap?” Ethan asks.
She squints at him. “The what?”
He takes the chart from her. “The bicarbonate level plus the chloride level, subtracted from the sodium level plus the potassium level. Quick, what’s ninety plus fifteen, subtracted from one-twenty-six?”
“Twenty-one,” Stuart and I both say immediately. Maybe he says it a fraction of a second before me. Show-off.
“Redraw labs, and let’s get ready for the transfer, please,” Ethan says.
“Ethan, you need to back off.” Terry puts his hands on his hips. “Mr. Leeds, we’re going ahead with your surgery as planned.”
It’s like I’m ringside at a boxing match between two brains. It’s unexpectedly exciting. I silently root for Ethan’s cerebral cortex to beat Terry’s to a bloody, ineffectual pulp.
“Okay, guys, we need one decision here,” the nurse says.
Ethan sighs impatiently. “Terry, let me explain this to you. He has a high anion gap. That means too much acid. Too much acid is bad for the heart. You operate, you cause more acid. More acid, more bad. You follow?”
“I’m calling the attending!” Terry seizes the bedside phone. “You can explain to him why you’re hijacking his patient.”
Ethan shrugs. “You guys can call your mommy from the hallway. We have work to do here.”
Terry glowers at Ethan for a moment, one side of his face making little twitching movements, then slams the phone down and turns to the tiny female Surgery resident with the pencil bun.
“Why are you still standing there?” he thunders. “Get Dr. Brenner on the phone, now! Move, all of you!”