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My pager glows a sickly green. It says 0300, 3 a.m. The action on call tonight has been non-stop. I am dog tired, having already crisscrossed the hospital a distance that would rival that trekked by working Sherpas, or pack mules in developing countries. Only four more hours to go.
During my latest foray into the wards, a patient peed on me. A clearly delirious, emaciated East Indian gentleman had unceremoniously lifted his hospital gown, posed á la Manneken Pis, and full-on peed on me. The aftertaste lingers. I think of my wife and tiny daughter asleep at home. Both are cute and warm and all too clearly not here.
My pager screams and I'm moving again. I find my patient, Mr. K, in a resuscitation room in the ER, that wonderful and horrible roiling pot of human soup.
Mr. K is a white tuft of hair and scrawny chicken-legs wearing massively oversized, goggle-like glasses from the 1970s reminiscent of Kareem Abdul-Jabbar. He reclines casually on a stretcher-bed, legs crossed, bare chest attached to a heart monitor, peering at a newspaper. He might as well be in Boca Raton.
His family engages en masse. Admittedly, memory can be fickle, but the following is my best recollection of our actual conversation:
Doctor: Hi, I'm Dr. T from cardiology. How are you feeling, Mr. K? (The monitor shows VTAC, a potentially dangerous heart rhythm.)
First son (vibrating): What are you doing to my father? We need to pack him in ice, I saw it on TV!
Second son: Excuse me, Dr. T, was it? No disrespect, but are you going to kill my father?
Daughter-in-law: My cousin is the chief physician of Chicago. Yes, all of Chicago! I just called him and he told me that you need to …
Mr. K: Hiya, doc! Are you gonna shock me? I've had that before. Go ahead, jump start me like a Buick. For what should I be worried? (ruffles newspaper)
Daughter-in-law: (inspects doctor, notices bare ring finger, eyes granddaughter knowingly)
Granddaughter: (blushes)
First son (loud and hysterical): No shocks, I saw it on TV! Pack him in ice and his heart will slow down! (motions to get ice)
Doctor: Well …
Second son: Enough with the ice already! First things first: Doctor, how do you know you're not going to kill my father?
First son: No shocks! For the last time, do I get some ice or my lawyer? (motions to get ice and/or lawyer)
The most surreal conversation in the history of medicine wears on. I hear myself saying things I never imagined I would need to say in a professional context, such as: "Television nowadays may seem real, but ice won't help," and "Really, it's not you, it's me – I'm married."
Finally, the well-meaning family gets tired. I order intravenous medication in accordance with the Advanced Cardiovascular Life Support guidelines, which I carry, ironically, in the seat pocket of my scrub pants. The medication does nothing. I am going to have to shock Mr. K. I glance at the clock and at Mr. K's family. My mind balks at the inevitability of what I must do.
At this juncture, it may be relevant to mention that I am not training to be a cardiologist. In that vein, did you know that no patient has ever asked for proof of my credentials? These lovely, trusting souls have all allowed me to question, undress, examine, inject, anesthetize, intubate, cut open – and on occasion, when the mood has struck me – electrocute them, simply because I am The Doctor.
Tonight, I happen to be the doctor on call for cardiology. Rest assured, there is a real cardiologist at home asleep (somewhere) whom I can page for advice "if I run into trouble."
I page the real cardiologist. That also does nothing: He confirms what I already know. I need to shock Mr. K.
The moment of truth has arrived. The cardioverter, its electrical charge perhaps augmented by the power of my own anxiety, lets loose its joules of fingers-crossed hope. Mr. K's body bucks and his chicken-legs kick. Still VTAC.
Feet shuffle around the bed. First son mutters.
I ramp up the joules and shock again, singeing Mr. K's chest hair. Still VTAC.
It is hot and I am sweating. I feel the nurses' stares as physical things. More feet shuffle. I wonder exactly how many times I can shock Mr. K before reaching a number that would be deemed unreasonable by my peers in a court of law. I envision the recriminations: "Eighteen? Eighteen times you shocked Mr. K? That was reasonable to you? You didn't think that maybe you should have stopped at 17?" I breathe deeply and shock him again.
By 0700, Mr. K is resting comfortably in the correct heart rhythm, still full of vim and flirting with the nurses. Having previously survived the Second World War, multiple health emergencies and the loving attention of his family, he would have been hard pressed to finally succumb to the likes of me.
My wife calls as I leave the hospital. "You just received your call schedule for your next rotation in the intensive care unit. ICU – that's the complicated one, right?"
Shaul Y. Tarek lives in Toronto.