In 1983, the community hospital where I worked did not yet use the acronym AIDS. We used another one--FUO, for fever of unknown origin--which was emblazoned in marker on a red card on the doorjambs of certain private rooms. These rooms each had an anteroom with a sink and a hamper. This is where the donning and removal of protective suits took place. In this 4-foot-by-6-foot space between the hall and the patient's room, the garbage cans bore biohazard symbols, and the red bags inside them were doubled and then encased in a third, clear garbage bag--to protect us, we were told.
I was midway through my internal medicine internship when elderly Mrs. Armstrong was transferred to our service for treatment of a pulmonary embolus (aka PE--a blood clot in the lungs) after a knee fracture repair. I remember thinking, disparagingly, “Surgeons should be able to treat a PE!”
The following morning, our team rounded on our patients and hurriedly wrote orders and notes because Susan, my senior resident, and I would be in clinic all afternoon. As we worked, another resident, Greg, stopped by and invited us to a party that evening. “I hope I can come,” I said. “If I finish early enough.”
The insistent chirp on the phone was a reminder from Fran. “Don’t forget to stop at the compounding pharmacy.” For $58 cash these specialists turned a pill into a cream. GERD made Fran intolerant of most oral medicines.
Tired from the long drive, I thought back on my years of marriage. Back pain was the first problem, I think. Then GERD, then migraines, dizziness, TMJ, panic attacks, fibromyalgia. They were all tough, serious problems. But all together?
During my first year of anesthesia training I was called to open an emergency airway for a patient struggling to breathe in the Medical ICU. When I arrived amid a flurry of activity and billowing yellow isolation gowns, the monitor was crying DING DING DING to alert us that the patient’s oxygen saturation was hovering in the mid-80s--dangerously low. The patient’s small face was obscured by the oxygen mask, his frail body covered by a hospital gown.
The patient was too confused to follow any instructions, and the loud noises of the ICU machines didn't make things any easier. I tried to communicate: “I’m from anesthesia and I’m going to put in a tube to help you with your breathing.” A nod. I positioned myself at the head of the bed and quickly checked to make sure we had everything we needed: suction, laryngoscope, styletted endotracheal tube and a clear view of the monitors. Check.
“We’ll take good care of you, Sir,” I said as my senior resident started pushing the drugs that would render the patient unconscious and immobile.
It was a grim night. A man had stumbled, drunk, into the street and been hit by a car. The car drove off, but bystanders called 911. The man was strapped to a bright yellow gurney and brought to the emergency department in an immaculately clean ambulance. He himself, however, was disheveled, soiled and violently combative. He fought. He yelled. He spat. He smelled. He was disgusting.
Everyone deserves good care, thought I. My evaluation found him to be merely drunk. I considered imaging studies, but they would have required general anesthesia, which didn't seem advisable given the man's condition. Instead, I admitted him for observation. I got to sleep about midnight.
I am in a dark place, and all my senses riot against me.
Despair tastes sour and rotten on my quivering lips. Dishonor feels heavy and tight on my heaving chest. Dejection means hearing only my own sobs through my covered ears. Disgrace sees only my mistakes, and with blurry, red eyes. Depression smells like sweat and fear, even through a clogged nose.
"What's that?" I asked.
"It's an antibiotic," she replied.
"I'm not scheduled to get an antibiotic," I said.