I Don't Like Mondays

Running late. Monday afternoon. Busiest shift of the busiest - Ow! Banged my shoulder - busiest day of the week. Duck through the waiting room. Standing room only. Slide through the electric doors - quick before they close and automatically kick-groan back open again behind me - and two kids run laughing under my feet into the chaos of swing shift. Alan looks frazzled. Three people waiting for him to get off the phone. We make eye contact and he rolls his while silently mouthing “Shoot me” - then points animatedly toward the trauma room.

Half-jog down the hall, dodging gurneys and whirling around large, smelly, slow-moving land mammals glancing past half-closed curtains at the patients behind them, half of them crying and half of them scowling. The trauma patient was pulled out of a crack house after being attacked with a brick. Her head is a misshapen pumpkin (“Little early for Halloween,” someone says.) and her eyes are blood-caked slits. Her teeth are broken and so is her jaw and the trauma team wants to discharge her home even though she is homeless. “Where is that medical student? Hey, have you had suture class? Yeah? Then get busy on this lady’s face and don’t let the surgeons send her out until I get back.”

Running back down the hall cell phone ringing: “What honey? Can’t hear you. Bad reception. Field hockey cancelled? What? Call your mother! OK.”

Alan is still on the phone, the line waiting for him now six deep. Scan the computer census: pregnant vaginal bleeding; 2-year- old with a fever; chest pain; homeless guy wants a sandwich; guy with a seizure; another chest pain; construction guy not feeling right; old lady feels dizzy; old lady with a fever; bleeding guy in handcuffs after fight with the cops; cancer patient with abdominal pain; HIV patient with abdominal pain; another chest pain?; sore throat; lady coughed up some blood this morning; baby pooped some blood last night; “I think a bug is in my ear. I can hear it moving around in there;” peeing blood for a week; ran out of my pain meds; "Boil on my ass;" "My baby won’t breast feed;" fell down the steps yesterday; "My carbon monoxide detector went off this morning;" "My toe is black;" "I’m depressed;" "My boyfriend has gonorrhea;" headache; toothache; backache; stomachache - run, run, run, run.

Thirty patients in the waiting room - refresh - 36 in the waiting room. “Toni, are we are on divert? No? Better hide us for a couple hours until we clean this place up.”

“Did we ultrasound that pregnant girl? Where is the pile of EKGs? Can we send some of this nonurgent stuff to the fast track? Is there really a live bug in that guy’s ear? Tell the homeless guy that we only have egg salad today. Whoa, that’s a nasty X-ray, does she have a history of lung cancer? Get a chest CT. Is the cancer guy neutropenic? Does he have a fever? What about the AIDS guy? Start antibiotics on both and get them drinking for their CTs. No, I can’t talk to the transport center right now; tell them we are on divert. Block that guy’s tooth and send him to the dental clinic. Is that kid with the fever fully immunized? His parents took him where? Africa? Are you kidding? Pelvicize that girl with the GC and make sure you culture the goo. Call psych for the depressed guy, and make sure security checks him for weapons. What? What do you mean the trauma team sent out the girl with the jaw fracture? Didn’t I tell you not to do that?!”

“Doctor – can you please look at my sister? She’s coughing up blood again.”

Standing in the doorway staring at my patient coughing and spitting up bright red blood. She chokes up a slimy hockey-puck sized clot. The kidney basin is already full and she is reaching for a larger bucket. The telemetry alarms are binging and buzzing. The blood is all over her hands and the bedsheets and is coming out of her mouth and nose. “Oh God. Page pulmonary and anesthesia stat.” Radiology is on the phone. “Initially I thought it was a blood clot in her pulmonary artery but the more I look at it, that’s tumor invading into and eroding into the mediastinum…” I hang up and I’m bumped and jostled by people running through the curtains. My patient can’t stop coughing blood and she can’t speak or breathe. Our eyes meet and a tear slides out from her eye and drops into the blood-filled bucket.

Stop. Stop this. God stop this.

The whole hospital suddenly arrives in this closet-sized room. A nurse slips on blood. More binging, more buzzing. “Get her upstairs! Bronch her! Intubate her first! We need a dual-lumen tube and fiberoptics! Type and cross her for four units! Suction, we need suction! Prep IR and the OR! Who is the next of kin?”

More blood. Another tear.

I sit down on the bed and hold her hand.