July 1. My first day as a family medicine intern, assigned to Labor and Delivery, and my first night on call, 6 pm sharp. Enviously, I watched the other interns smartly packing up to go home.
“See you in the morning–maybe!” they joked.
I glanced at the status board: eight patients in labor. And now I was “in charge,” at least in name, till 7 am report tomorrow.
Several chaotic hours later, I finished helping a Guatemalan mother of five to deliver her sixth son. My hands were trembling.
Toweling the plucky little newborn dry, I admitted the truth: Despite my University Hospital’s proud reputation as a maternity center, this woman would probably have done as well or better in her own warm, clean, cilantro-scented kitchen. At best, I was superfluous; at worst, a comical hindrance.
In shaky Spanish, I told her, “Su hijo es muy guapo y tiene salud!” (Your son is very handsome and healthy.)
“Lo sé,” she replied, smiling. “Tranquila, doctorita. Todo estará bien.” (I know, little doctor. Be calm, all will be well.)
Washing my hands after the next “case” (a stoic Asian woman who gave birth silently and quickly), I glimpsed my face in the mirror–cheeks drawn, lips pale and chapped. A far cry from how I’d looked at my wedding, just seventeen days earlier. I was already changing.
A page came from the postpartum floor, one flight down. I hurried downstairs to meet the charge nurse who’d paged me.
An Army-trained veteran, she sized me up, clearly recognizing a newbie, then gave me my orders: “YOU, get into room 8. The woman is sixteen years old, C-section this morning for breech twins, one died. She’s hysterical and grieving. YOU go in there and calm her down.”
An imposing Valkyrie, about my mother’s age and twice her mass, she pointed imperiously at a door. Meekly, I went in.
I found my patient sitting in bed, braced bolt upright on her thin arms, and panting.
Something’s off, my nascent doctor’s brain muttered. She might be devastated, but something was off. That was a painful position for someone with a new abdominal incision….
And her face held a hint of gray. Well, she’d just had surgery–surely that was it?
She looked at me.
“Can’t breathe,” she puffed faintly.
Sticking to orders, I said, “I’m Dr. Lyons. This must be so terrible for you. Why don’t you lie back, so we can talk?”
She let me ease her down into a reclining position, then snapped upright again.
“No! Can’t breathe!”
I stared in horror. Everything came together in a rush: This wasn’t hysteria, this was fluid! She was in pulmonary edema! Her lungs were full of fluid!
Panicked as I was, I never thought to confirm my diagnosis by listening to her heart or lungs, and I also forgot to start her on oxygen.
I ran to the nursing station.
“I need a syringe, a butterfly needle and heparin,” I told the Valkyrie. “Where are they?”
She sighed, shook her head and showed me, gazing at me as if I were a new species of toad. The other nurses snickered.
As I drew the blood gas–a test to measure oxygen levels in the blood–from my patient’s wrist, she never protested, just kept grimly panting. This frightened me even more, as arterial sticks really hurt.
The lab technician ran the specimen and handed me the paper strip with the oxygen reading: PO2= 54. Roughly half the right amount.
I emergency-paged the supervising resident. She yawned her reply over the phone: “You hit the vein.” (Venous blood contains less oxygen than arterial blood.)
“Why didn’t you call the Arterial Stick Team?” she continued. “Have them re-draw her blood.”
Chastened, I hung up. But I was certain I’d been in the artery: I’d seen the blood pump, pump, pump its way up the tubing. (Arterial blood pumps; venous blood doesn’t.)
The Art Stick Team appeared, repeated the procedure and took the specimen to the lab.
Waiting for the test results, I sat on the bed with my patient and gently rubbed her straining back. As her thin torso welled and sank painfully, I told her, “Don’t worry, it’s okay, you’re going to be fine.”
I tried to sound resolute, but my cheeks blazed with fear, uncertainty and humiliation. Maybe I was wrong–maybe this was grief after all. Or maybe my patient was in real trouble. What a way to begin my internship! What the hell ever made me think I could do this job?
Suddenly the room filled with people–nurses, residents, techs, medical assistants, even the attending physician! I was shoved out of the way, and they administered oxygen, inserted IVs and converted my “crashing” patient (likely to die without fast help) into an ICU case.
As they whisked my patient away in a stretcher, the second-year resident flung back at me: “Postpartum cardiomyopathy, or maybe a PE.” (Postpartum heart failure, or maybe a blood clot to the lungs).
My patient’s glassy eyes met mine fleetingly. I had just enough time to feel how I’d failed her. Then she was gone.
Shaken and drained, I walked back to the nurses’ station and flopped down heavily into a chair.
Mentally I reviewed my performance. Christ! I’d done so many things wrong! Didn’t examine my patient thoroughly, didn’t start oxygen, drew the art stick myself….
Worst of all, I’d come this close to treating this young woman as “just” a grieving teenage mother. If she died, would it be my fault?
I thought of her surviving baby, curled up in the NICU. I thought of my brand-new husband, sleeping peacefully in our tiny home, and wrenched back confused tears.
I noted the time: 4:27 am. Twelve more hours of call to go. Letting my head fall into my hands, I tried to brace myself.
Suddenly there was a figure at my elbow, and a booming voice.
“Here, Doctor, I thought you might like this.”
A steaming, fragrant cup of coffee appeared beside me. Startled, I looked up into the Valkyrie’s eyes–now guardedly approving.
“Huh? Oh! Wow, thank you very much,” I said. “This smells great.”
She smiled briefly and turned away. As I sipped the life-giving elixir, I realized that I’d passed some kind of test. She clearly held no grudge. In a scant, terrifying half-hour, I had gone from being “YOU” to being “Doctor.”
My pager buzzed: Labor and Delivery. God only knew what was happening up there. I grabbed another quick sip of my scalding coffee and bolted for the stairs.
Paula Lyons, MD
Story editor:
Diane Guernsey
First published in Pulse-voices from the heart of medicine
16 April 2010