Comfort Zone

Chapter 18

"Lilly Fielding, eighty years young," the ER resident said, "found down in Publix, brought to the ER by paramedics. Patient of Dr. Powell – you're covering, right? Somnolent, hypotensive and bradycardic, with a heart rate of 20 when the paramedics got there. Temporary pacemaker just inserted, and she now has a paced rate of 80. Blood pressure's up. Still unresponsive though. What cardiologist do you want? Would recommend one who also puts in pacemakers." Miriam supplied a name.

"OK. Initial labs unremarkable, head CT negative. Could've had a stroke. What neurologist do you want?" Miriam supplied another name. This was an era of specialists. Lots of cooks were needed for today's broth. Luckily the woman didn't break any bones when she fell or orthopedics would've been involved too.

She grinned for a moment into the mouthpiece, remembering JK shouting urgently at such a time. "Quick! Get a pathology consult in case the guy dies!"

"Dr. Gotlin, you still there? OK, the patient's daughter is on her way to the ER. Are you planning to come in?"

A half hour later, Miriam was heading into the ER in a starched white coat. She never understood doctors who opted out of the traditional garb. It wasn't about power; it was simply the perfect covering, providing pockets and warmth, while hiding weight gain and (as in this case) a complete lack of grooming.

She reviewed the patient's history on the computer, then strode toward cardiac bed seven, catching sight of the attending doctor in the ER. He met her at bedside.

"Thanks for coming in on a Saturday afternoon, Dr. Gotlin. We were expecting some call-in orders and expletives about the interruption."

Lilly Fielding lay on a gurney, frosted blond hair fanned around a pale face, eyes closed. Oxygen hissed through a thin tube in her nostrils. A jumble of wires led from pads on her chest to the overhead monitor, and an already soiled white sheet was twisted around her. Miriam moved to the side for a better view.

The hub of a catheter protruded from the right side of her patient's neck. Through the clear, sterile bandage covering it, she saw the black stitches that secured it to the fragile-appearing skin. A sole drop of blood lay trapped under the bandage.

Jutting out from the hub was a long plastic sheath, protecting a wire that then bifurcated, its two ends plugged into an adapter that was attached by a short cord to a rectangular box bigger than a TV remote, but not as complicated.

"Temporary pacer?"

"Uh huh. Hopefully it'll last until we can get a cardiologist to come in and insert the real thing. Let's see, it's July, on a weekend. That means it'll have to make do until Labor Day, roughly."

He exchanged knowing smiles with Miriam. It wasn't easy to get doctors in on the weekend. Matter of fact, it sometimes felt like the whole hospital was closed for business.

"Odd how so many believe they're entitled to an actual life," Miriam said.

"As opposed to you--"

"The lowly primary care doctor. Oops, health care provider."

The attending launched into the details of the case. Miriam listened, glancing at the overhead monitor. With its irritating beep, it traced a steady rate of eighty, thanks to the pacemaker, and showed a perfect blood pressure of one hundred twenty over eighty. The ER had done a fine job of stabilizing the patient.

"You did good," she said.

"Thank you. Blame and yelling is common, but praise is rare within these walls."

Miriam noted the patient's polished finger and toenails, and gold bracelet. In medical lingo, the woman looked "younger than stated age." Miriam put her hand on the woman's shoulder and gently shook her.

"Ms. Fielding, wake up," she said in her ear, then repeated it louder. No response at all.

"Wonder why she's not waking up," Miriam asked.

"We're not sure how long she was down for. Could've been hypoxic for awhile. We sent the first cardiac enzymes, got blood cultures and so on. Initial head CT is negative but something could bloom. She was found in the produce department you know."

"Are you waiting for me to make some lame joke about hoping she doesn't become a vegetable?"

"I confess I was. We've had a lame joke deficit since JK up and left. God I hope the rumors aren't true."

"Me, too, but sorry, his clown shoes just don't fit me."

"I was hoping for the red nose, actually." The attending gave a sharp laugh, and looked back at his notes. "Wait, this woman lucked out! An off-duty paramedic was bagging tomatoes near her when she fell. She probably wasn't down long; likely she'll have more than a few functioning neurons left when she wakes."

"Score one for shopping the perimeter instead of giving in to a Twinkie fix."

"Exactly. Do Twinkies still exist? Oh yeah, they died and were resurrected. Well good luck. On to the next catastrophe. Good to see you as always, Doc Gotlin."

Left alone with the unresponsive patient, Miriam drew the privacy curtain closed. Impossible task to block out the ER noise; the place hummed with stress, fear, pain and need. Emergency room doctors did shift work, which made it a desirable specialty to many, and Miriam knew the adrenaline-fueled hours satisfied thrill seekers, those with broad capabilities and interests, and those who were easily bored. Sometimes she pictured working frantic days, with true life and death emergencies popping up left and right. "ABG STAT bed 10, heplock bed 6, better make it a large bore," she could hear herself saying.

The truth was she didn't much like the ER. She found it intimidating and full of prickly, impatient people, with low thresholds for snapping if she hesitated in making a decision. Either they were like that before, or else working in an environment of ceaseless urgency and potential terror did that to them.

It's not heroic work I do, she thought, as she often did in the ER. I'm not the romantic figure people think of when I say I'm a doctor and they give me this awed look. I'm one of the worker bees. Most of my day is spent on minutia, toenail fungus and the like. If a true emergency happens in the office, all I can do is wheel the patient stat to the ER or, if there's no wheelchair, yell "Call 911!" and say to the patient "I'll see you later!"

But how often do I pretend that if a lab isn't back in the chart it's a national tragedy? What do you mean the cholesterol isn't back? The patient took the day off to see me. What am I supposed to tell him, eat two potato chips and call me for results in the morning? This is terrible. Truly awful.

Her rumination continued. OK, she thought, sometimes I overreact, let out my inner drama queen. And patients eat it up! They shake their heads and undoubtedly compare the catastrophe with their Haitian relatives dead in the streets, and their Uncle Ramon who tangled with Castro. I guess they need to know someone's willing to head straight for a coronary to stop them from having one.

And sometimes I need it, tripping down the adrenaline highway, because it means what I do matters. It counts. I count.

The curtain was jerked open and one of the nurses stuck her head in.

"Can you hurry up with the orders? We don't want her here all day."

The head disappeared.

Miriam turned back to the patient, calling her in a firm tone and grasping her shoulder. When that failed she flung around some body parts like she was tossing a salad. No response, so she shifted back to a gentler mode and examined her. The exam didn't turn up anything new other than the fact that this eighty year old cared about the way she looked. There were faint scars behind her ears from a facelift, and she wore lace undies. The same brand Miriam used to wear.

She let the sheet fall and looked at Ms. Fielding's Coach bag, which was wedged between her other belongings near the bed.  The ER staff had probably already looked inside.  It would only be good medical care to examine both patient and attachments, privacy concerns aside.  She would ask them.  

Miriam lifted the beautiful bag, wondering if it was a knock-off.

"What are you doing with that bag?" Miriam looked up, startled by the commanding voice. It came from a woman with a similar facial structure to the one lying on the gurney, though thirty years younger. And this one was clearly awake and alert.