BY: JOHN S. DANIELS
When Jason Green begins his internship at Sinai Medical Center, there seems to be no limit to what he can achieve. Brilliant, hardworking, and driven by an intense desire to ease people’s suffering, Jason has a knack for asking the questions that will lead to correct diagnoses. His efforts earn him the respect of his superiors—and the attention of Philip Olsen, a devastatingly attractive orthopedic surgeon.
But none of Jason’s abilities can prepare him for the challenges he faces outside the hospital. Philip, with whom Jason has a seemingly perfect relationship, betrays him with another man. Dr. Fang, his dedicated but aloof research partner, guards a secret that might compromise their research. Can the problem-solving techniques that serve Jason so well in the medical world help him to repair the rifts in his relationships?
TAYLOR JONES SAYS: In The Intern by John S. Daniels, Jason Green is a new doctor just starting his internship at a prestigious hospital in New York. Extremely bright, Jason is more concerned with patient health than protocol and he soon makes a name for himself as a diagnostician of the highest order. Jason is also gay, and he quickly falls in love with a gay surgeon at the hospital. In addition to his hospital work, Jason convinces one of the head doctors to let him work at his research lab where Jason solves several complicated problems for the team. But even though he should be on top of the world, trouble lurks just below the surface, and it isn’t long before Jason suffers some severe betrayals that shake his faith in both himself and his fellow man.
Even though the book is quite technical with medical issues and terms, Daniels make it easy for lay people to understand, It’s a complex love story woven through subplots of espionage and attempted murder. A great read.
REGAN MURPHY SAYS: The Intern by John S. Daniels is a young gay man away from home and family and embarking on a new phase in his life. Highly intelligent and a dedicated new doctor, Jason knows how things should be. Young and idealistic, he struggles with striking an acceptable balance between caring for his patients and obeying hospital protocol and regulations as he does his internship at the hospital. Even though he is somewhat awkward and doesn’t like to draw attention to himself, he won’t back down when a patient is at risk. Originally from Louisiana, he is out of his element in New York. He is learning quickly that things are far from perfect and rarely done the “right” way. Then he falls in love with a gay doctor at the hospital and his world is bright—until he discovers that relationships aren’t perfect either.
The intern is a heartwarming love story blended with mystery and intrigue for a compelling and thought-provoking book.
It was six in the morning on a hot and muggy first day of July in New York City, 2005. Jason Green sat chilled and alone at the ninth-floor nursing station, the hub of one of the general medicine units of the prestigious Sinai Medical Center, his heart pounding in anticipation. He was reading the tenth of fourteen patient charts he planned to review before the official start of his internship, which was in sixty minutes. Jason had just graduated from medical school the prior month, and his anxiety stemmed from knowing that he was entering one of the most sought-after internal medicine internships in the country.
He would be training and competing with some of the brightest young physicians coming out of the most prestigious medical schools, and he wondered how he would measure up to his fellow interns.
At seven o’clock, his resident, who had already been through a year of internal medicine internship and a second year of internal medicine residency, would arrive with two third-year medical students. They would work together as a team for the next eight weeks, and he was determined to be familiar with the patients assigned to his team before their arrival.
Jason’s intense concentration was abruptly interrupted as a strikingly beautiful nurse bolted out of a patient room directly across from where he sat and yelled, “Doctor, come here now! I need your help!”
The nurse was frantic, and the pleading in her voice startled him. In addition this was first time he had been called “doctor” by anyone except for his father, and he was taken aback at the title.
Jason ran into the room to find the nurse breathing into the mouth of a pretty, middle-aged woman. The nurse looked up at Jason, wide-eyed, and shouted, “Call a Code Blue now, Doctor!”
Jason concluded that a Code Blue must be the same as a Code 9 at the University of Mississippi, the medical school from which he had graduated, but he had no idea how to initiate a Code Blue at his new hospital. He wasn’t even officially an intern yet. He gently pulled the nurse away and told her to call the Code Blue. He got on top of the lady and started chest compressions. Five compressions and then one breath from his lungs into her lungs, repeated over and over. Jason could smell the Chanel No. 5 the woman must have recently applied. It had been his mother’s favorite perfume.
After what seemed an eternity, Jason finally heard “Code Blue, room ninety-two zero four. Code Blue, room ninety-two zero four” echoing in the hallway. He was relieved. Help would soon arrive. Jason had practiced cardiopulmonary resuscitation on plastic dummies in medical school, but he had never participated in a real Code Blue and had certainly not expected to begin his internship under such difficult circumstances.
Within thirty seconds, the room was jammed with doctors in white coats; a nurse with a cardioversion device to deliver an electric shock; another nurse with a large cart on rollers filled with bags of fluid, medications, syringes, and tubing; and a respiratory therapist with a respirator. One of the doctors in a white laboratory coat seemed to take over. Jason noticed that he looked very young and was short and stocky, with curly brown hair. His nametag read Seth Goldberg, MD.
“Whoever you are, keep up the chest compressions,” Dr. Goldberg calmly ordered Jason as he grabbed an endotracheal tube and scope. Jason resumed chest compressions as he watched Dr. Goldberg move to the head of the bed, insert the scope into the throat of the unconscious woman, and slide the endotracheal tube into the woman’s trachea. He then took a syringe, inflated the balloon surrounding the tube to keep it in place, and began forcing air into the lungs of the patient with an Ambu bag, the handheld device used to inflate the lungs before a respirator is attached.
Jason continued the chest compressions, and his face flushed as he saw that several of the doctors and nurses were staring at him. He watched as a nurse quickly taped the endotracheal tube to the patient’s face and attached the respirator to the endotracheal tube. Dr. Goldberg gave orders to the respiratory therapist for ventilator settings and at the same time quickly inserted a needle into the internal jugular vein so that medications could be administered. Jason then saw Dr. Goldberg silently motion for him to get off the patient. As Dr. Goldberg picked up the electric shock paddles and placed them on the bare chest of the woman, every eye in the room turned to the monitor. Jason looked over and observed only a flat line–no electrical activity of the heart.
“Stand back, everyone,” Dr. Goldberg calmly ordered in a voice loud enough for everyone to hear.
He pressed the button on the paddle, and eight hundred volts of electricity surged through the woman’s chest wall into the heart, causing the lifeless body to lift in a brief spasm. All eyes turned to the monitor–once again, there was only a flat line. Dr. Goldberg administered another shock, again with no results. Although Dr. Goldberg remained calm, Jason could see that he was distressed at the lack of response. He quietly ordered Jason to get back on the bed and start chest compressions and then asked the nurse for atropine, epinephrine, and sodium bicarbonate, all of which he administered quickly through the jugular line.
Only three minutes had elapsed from the time the Code Blue had been announced over the loudspeaker. The temperature in the room was noticeably warmer from all the people jammed into the small space, and the intense stench of burned skin from the electric shocks startled Jason. But he was most impressed at the efficiency and competency of this lead doctor.
After twenty minutes of repeated sequences of chest compression, electric shock, and administration of several different medications, Dr. Goldberg put down the shock paddles, turned around, and said quietly, “Okay, stop. That’s it.”
Jason noticed Dr. Goldberg’s sad look, sweat dripping from his brow, as he walked out of the dead lady’s room.
Jason crawled off the bed and stood watching everyone silently file out of the room, the nurses and therapists gathering and removing their equipment. The beautiful young nurse who had first asked for his help was standing in the corner, obviously shaken by the events. Jason went over to her and asked her if she was okay. She nodded with a sad smile, and then Jason left the room. He had not even officially begun his internship, and he felt as though he had already lost his first patient.
Jason sat down at the nursing station to continue his chart review and noticed that one of his five remaining charts was missing. He suddenly realized that the dead woman would have been one of his patients and wondered if she had a son who would be as devastated as he had been after losing his mother two years ago. Jason looked briefly at Dr. Goldberg who was sitting a few feet away intently writing a note in the dead woman’s chart. The nursing station was once again quiet as Jason began reviewing the remaining four charts. A few minutes later, he was interrupted when Dr. Goldberg tossed the chart on the desk and looked up at Jason.
“Thanks for your help. Are you one of the new interns?”
“Yes, sir, I’m Jason Green. Y’all were–uh–you were amazing in there.” Jason corrected himself, self-conscious about his deep southern accent.
“I’m Seth Goldberg. I’m your resident for the next eight weeks. Why are you here already? We don’t meet till seven o’clock.”
Jason saw that beads of sweat still covered Dr. Goldberg’s brow, and his shirt was damp with perspiration.
“I wanted to familiarize myself with the patients before y’all arrived,” Jason said, still shaken.
Dr. Goldberg grinned. “Well, you did good in there. But we’re going to have to do something about that accent of yours. You’re going to drive me crazy with it.”
“What happened to that poor lady?” Jason managed to return his smile. “She looked awfully young.”
“She was only fifty, with three children–one a medical student across town. She was going to have her aortic valve replaced today. We tried to get it done last week, but the surgeon said he couldn’t get her on the schedule.”
Jason saw that Dr. Goldberg was distressed and thought that perhaps his eyes had become moist with tears.
“She’d still be alive and probably home already had she been operated on last week. This was the classic nightmare scenario of someone with severe aortic stenosis waiting to have the valve replaced. Goddamn it, and the fix, it’s so simple.” He shook his head and looked down. After a noticeable pause, he looked back up at Jason. “By the way, Sheri, the nurse you were helping before we arrived–she couldn’t take her eyes off you for the entire code.”
“How could you possibly make that observation?” Jason asked in surprise. “You were completely immersed in running that code.”
Seth smiled and wiped the sweat off his brow with his hand. “Well, I make a habit of observing people carefully, especially beautiful young women. I’ve been asking her–unsuccessfully, I might add–to go out with me for over a year. So already I don’t like you.”
Jason smiled too. “Don’t worry, sir. She’s not my type. I’m gay.”
Seth laughed. “Well, that’s a relief. Maybe I can set you up with my younger brother. I’ll see you in a few. I have to call the patient’s family and pick up the new students.”
Jason wondered whether the medical team could have insisted on earlier surgery. He felt a mixed sense of sadness and anger at what happened to this lady, and he told himself that he would be aggressive in preventing anything like this from happening to any of his patients. The smell of burned flesh remained on his hands as he sat back down and read the remaining charts. His heart was still pounding, and he didn’t know whether it was from the code or the anticipation of starting his internship.
At seven, Seth returned to the floor with two third-year medical students, just as Jason finished reviewing the last of the charts.
Jason stood up. “I’m Jason Green, your intern.”
He shook both students’ hands. The young woman had blonde hair, blue eyes, a nice smile, and was obviously shy. The other student appeared considerably older, tall and thin, with thick glasses, a rough complexion, and no suggestion that he even had the ability to smile. Jason guessed that because of his age, he was likely among those getting a combined MD and PhD and that he had been doing research for the past four or five years. He did not look happy to be there–perhaps, Jason thought, because he had to take orders from and be evaluated by a resident and intern who were several years his junior, or perhaps because he was more comfortable in a research lab than in a clinical setting.
Dr. Goldberg took the lead again, waving the group into a conference room just off the nursing station.
“Here’s the plan for the next eight weeks.” Dr. Goldberg was all business, looking at Jason and the two students with a serious expression. Jason watched as Dr. Goldberg told the students that they would be performing a history and physical on one new patient each admitting day and that they would be responsible for presenting that patient to Dr. Glassman during attending rounds the following day. “You had better know every detail of your patients’ history and physical examination, every laboratory value, and everything there is to know about their medical problems. If you mess, up that reflects badly on me, and I will not put up with that.”
Jason looked at the students who sat nervously, twitching their hands. Beads of sweat had formed on the PhD’s brow. Jason wanted to say something to comfort the students but held back.
Dr. Goldberg turned to Jason. “Jason, you will work up every admission, including those that are assigned to the students. You had better be thorough but when you present to Dr. Glassman, be concise. We only have two hours with him every day, and we need to make good use of our time–”
Jason interrupted. “I’ll do my best, boss.”
The female student smiled at that remark, although Dr. Goldberg did not seem to be amused.
“I’m serious, Jason,” Dr. Goldberg continued. “I don’t know if you’ve even heard of Dr. Glassman. He’s primarily a researcher and has received a Nobel Prize for his work. He’s brilliant but very demanding, so unless you want to be the object of his wrath, you’d better take what I say seriously. And you’re also expected to be at attending rounds everyday unless you have an emergency you need to tend to.”
Jason nodded. In fact he was well aware of Dr. Glassman. It was Dr. Glassman’s research that had piqued Jason’s interest in Sinai Medical Center. He also knew that Dr. Glassman had the reputation of being very demanding, but he had become elated and excited when he learned during his intern orientation session that Dr. Glassman would be his attending physician for eight weeks. What luck, Jason had thought.
Dr. Goldberg continued his orientation, still addressing Jason. “The students may have two or three required teaching conferences each week with a professor or the chief residents. Otherwise they are here to help you take care of our patients. Don’t be too easy on them. I’ll be off the floor at resident teaching conferences and in the library at least half of every day, hopefully learning things that I can teach you and the students about our patients. But I’ll give you my phone number, and you can call me anytime, twenty-four/seven.” His gaze swept them once more. “If any of you three happen to be religious and have to attend mass or services on Sundays, I’m required to let you do that, although I won’t be happy about it.”
Jason laughed. “I guess you haven’t met too many Jews from Mississippi.”
Dr. Goldberg looked surprised. “I didn’t know they allowed Jews in Mississippi.”
Jason knew that Dr. Goldberg’s comment was meant to be humorous, but it was a stark reminder that in his hometown of fifty thousand, with only sixteen Jewish families, the anti-Semitism was overt. Jason forced a smile.
“Okay, let’s start rounds so we can finish by nine thirty,” Dr. Goldberg continued. “Glassman is coming early since it’s also his first day with us.”
Jason gathered the thirteen charts and stacked them on a rolling cart, and the four went into their first patient’s room. Jason knew that Dr. Goldberg had been on this unit for the prior month and was intimately familiar with all thirteen patients. Dr. Goldberg introduced an ill-appearing middle-aged man to Jason and the medical students.
Jason stepped forward and took Mr. Shepherd’s hand, looked at him squarely in the eye, and said in his deep southern drawl, “It’s a pleasure to meet you, Mr. Shepherd. We’re going to continue the good care you’re getting here and try to get you out of this hospital as soon as possible.”
Jason put his hand on Mr. Shepherd’s shoulder, turned around to his resident and the students, and proceeded to give a concise but detailed history, including all the pertinent laboratory results and the current diagnosis and treatment plan. He could see Dr. Goldberg’s growing surprise–clearly he did not expect such a performance.
Mr. Shepherd had been admitted four days previous with pneumonia and sepsis, and although he had been critically ill when admitted, he was improving rapidly with antibiotics and fluids. After Jason finished his presentation, he performed a rapid physical examination, with Dr. Goldberg and the students looking on, stunned at Jason’s confidence. Jason felt Mr. Shepherd’s neck, listened to his lungs, asked the students to listen to the abnormal sounds in his left lung, and finally palpated the abdomen. He asked Dr. Goldberg to feel his neck, under the arms, and the abdomen, and then invited the students to do the same.
“Mr. Shepherd.” Jason smiled, taking his hand once again. “From what I’ve read in your chart, your lungs are sounding much better than when you first came in. You’ll be up and running before you know it. I’ll be back a little later to talk with you and answer any questions you might have.”
Mr. Shepherd smiled and nodded, and the group left the room.
Dr. Goldberg stood silently for a moment, looking up at Jason without expression, as the four stood in a circle outside Mr. Shepherd’s room. “Jesus Christ, Jason. How could you know the patient that well? And you just found some things on the physical exam that your predecessor and I missed.”
Jason felt his face flushing as he looked at the students and explained, “He has some enlarged lymph nodes in his neck and under his arms, and he has an enlarged spleen as well. I suspect he has a lymphoma or some other underlying malignancy. It would explain why a previously healthy man would get such a horrible infection.” He paused, his face feeling uncomfortably hot. “If you agree, Dr. Goldberg, I’ll order a CT scan of his chest and abdomen and then an ultrasound-guided lymph node biopsy. That should give us the diagnosis. I’ll sit down with him and explain what we’ve found and our plan after we finish rounds.”
“That sounds good.” Dr. Goldberg nodded. “But my name is Seth.”
Over the next ninety minutes, the team went into each of the twelve remaining patient rooms. Each time, after being introduced, Jason took the patient’s hand and presented a concise but detailed history of the patient’s medical issues, treatment, and plans, followed by a physical examination. After leaving each room, Seth discussed various aspects of the patient’s medical problems, and Jason eagerly took in everything Seth was teaching, frequently interrupting him with challenging questions.
During one lady’s physical examination, Jason pointed out to Seth that her second heart sound was widely split, which Jason explained could be an indication of increased pressure in the pulmonary artery. The woman had been admitted with a bleeding ulcer but started complaining about shortness of breath two days after being admitted. Jason suggested that the abnormal second heart sound could be an indication of a significant blood clot in her lung, which could be causing her shortness of breath. Seth did not hide his look of surprise as Jason described his physical finding and agreed that a CT of the chest be ordered. Later that morning, the CT scan did show a large blood clot in the right pulmonary artery.
Following rounds, Seth directed the students to wait in the conference room for Dr. Glassman’s arrival and turned to Jason. “Jason, you were quite impressive on rounds. But that accent of yours–I think some speech therapy might be in order.”
Jason smiled as Seth chuckled at his own humor. Jason had learned in an orientation session the prior day that Seth had graduated first in his class from Harvard Medical School. He had developed the reputation of being the most brilliant resident in his group and was in line to become the next chief resident, a distinction that would open endless opportunities for his medical career.
Seth laughed. “C’mon, let’s go try to calm the students down before Glassman gets here. They look like they are ready to fall apart.”
Dr. Glassman arrived a few minutes later, shook Seth’s hand, and looked at Jason. “So you’re Dr. Green. Your genetics professor at Mississippi, Franklin Deutsch, is a good friend of mine. He speaks pretty highly of you. I hope you don’t make a liar of him.”
Jason was surprised at Dr. Glassman’s demeanor. There was not a hint of emotion and he certainly was not pleasant. “It’s a pleasure meeting you, sir. I was–”
Dr. Glassman turned to the students, interrupting Jason. “And what are your names?”
The students introduced themselves, and then Dr. Glassman turned around and motioned everyone to follow him. “Let’s go. Grab the charts. I want to hear about the patients. This is a dangerous time for patients in this hospital. Brand-new interns who know nothing and students who know even less. Dr. Goldberg, I expect you to be on this floor with Dr. Green and the students to make certain things go smoothly.”
“Things will go smoothly.” Seth chuckled as Dr. Glassman gave him a dour look.
Jason grabbed the cart with the charts, and they entered the first patient’s room. This time around, Jason introduced the patient to Dr. Glassman, once again placing his hand on the patient’s shoulder and presenting a complete but concise history of the patient’s medical problems. He pointed out interesting findings on the physical examination and invited Dr. Glassman to listen and palpate. Dr. Glassman stared at Jason, stone-faced, during the entire presentation, except for a brief glance at Seth–who, Jason noticed, was smiling.
After leaving the room, Dr. Glassman asked Seth a few questions, and they went into the next patient’s room. Jason repeated his performance for all the patients, each time talking to a stone-faced Dr. Glassman.
The patient presentations ended at noon, and Dr. Glassman looked at Jason. “Dr. Green, take the students and get busy. You have a lot of work to do. Walk back to my office with me, Dr. Goldberg.”
Jason watched the two as they walked quickly toward the elevator.
“I thought this was the first day of his internship, Goldberg,” Jason overheard Dr. Glassman say. He saw Seth respond with a few inaudible words and then laugh. Jason felt almost despondent at Dr. Glassman’s lack of interaction with him, and his aloofness sent a chill through him.
Jason was already in Mr. Shepherd’s room when Seth returned to the nursing station, and for the rest of the day, Jason went back into each patient’s room, spending considerable time with each, answering their questions, and allaying their fears. He made mental notes on each patient, ordered necessary tests, changed antibiotics after looking at culture results on several patients, and saw that every patient was getting his or her needs met. He discussed each patient with the nursing staff to make certain the nurses were aware of the patients’ problems. Jason also spent time with his two students, going over their assigned patients and discussing how to write a proper history and physical examination. Seth came to the floor several times during the afternoon to review patients with Jason and, at six o’clock, announced to Jason that he was going home. Jason had already let the students go home for the evening.
“You have my number,” Seth said as he headed for the elevator. “Call me if you have any questions at all. And finish here soon, go home and get some rest. We’re admitting tomorrow, and it will be hectic.”
During the afternoon and evening, Jason attended three additional Code Blues. He was not familiar with the layout of the huge hospital, and by the time he arrived at each code, he found himself observing from the back of the room. But he was fascinated and eager to learn the resuscitation procedures. After each code, he went back to his nursing station and read about the various medications that had been given. He was, however, disturbed because not one of the patients in the four Code Blues he had attended survived, and even though he didn’t know anything about these patients, the outcomes saddened him. Four codes, four deaths: Not a happy first day of internship.
By midafternoon, Jason noticed that the other intern on his floor, Zachary Kline, who was the admitting intern the first day and whom he had met at the intern orientation session earlier in the week, appeared to be very upset. Zachary had graduated from Stanford University School of Medicine near the top of his class and was obviously very bright. Jason approached him to ask if everything was going okay. Zachary said that he was having difficulty with an admission and that he couldn’t find his resident to get advice. In fact, after further discussion, Jason realized that Zachary had three admissions and was having difficulty assessing all three cases. He appeared literally panic-stricken. Jason spent the next two hours with Zachary going over the three cases, helping him with a spinal tap on a lady who had been admitted with confusion and a high fever, and went over admission orders on all three patients. Zachary’s resident finally returned at five-thirty, and Jason was able to return to his own duties.
At ten p.m. Jason finally sat down to write a daily progress note for each of his thirteen patients. He knew that he should have been finished with his duties and out of the hospital hours ago, but he couldn’t leave Zach panic-stricken as he was. Jason’s work had also been interrupted by numerous nurses who seemed to come from other floors in the hospital to ask him questions about their patients or borrow supplies from the floor. After another interruption at eleven p.m. by a nurse from a surgical floor, Jason approached the head nurse on his unit, a very pleasant middle-aged woman.
“Mrs. Connelly, nurses have been coming from all over the hospital asking me questions about their patients all afternoon and evening. Is that a common practice around here?” He worried that if these constant interruptions from nurses continued, he would have a problem efficiently completing his own tasks.
Mrs. Connelly started laughing. “Honey, have you looked in a mirror lately. You are gorgeous and single. You could earn a fortune as a highly paid model. All of these nurses are just taking a peek at the best-looking doctor at Sinai.”
Jason’s face turned bright red, resulting in further laughter and pat on the cheek from Mrs. Connelly. Jason knew that he had inherited his mother’s good looks, but it hadn’t occurred to him that all of these nurses had an ulterior motive for their visits.
Just before two a.m., with only one more note to write, Jason became overwhelmed with fatigue and laid his head down, his face resting on his forearm, his long dark brown curly hair covering the progress note that he was composing.
At two-ten a.m., Jason was startled out of a deep sleep by another Code Blue announcement. “Code Blue, room ten two fourteen. Code Blue, room ten two fourteen.” He blinked, dazed, the intense fluorescent lighting making him squint. He looked, bleary-eyed, around the nursing station and saw that he was completely alone. He felt slightly disoriented from his fatigue and sudden awakening, but he took a deep breath and his head cleared. The silence on the floor was in conspicuous contrast to the constant chatter of doctors, nurses, therapists, patients, and patients’ families in continuous discussion earlier in the day. Absent were the constant ringing of phones and beepers.
Code Blue. The echo of the announcement finally registered as the fog of exhausted sleep cleared. On each of the previous codes, the patient’s room had been jammed with doctors and nurses. At each code, initial chaos had transformed into an orderly process because of a resident who took control of the resuscitation. The other twenty doctors and nurses had stood around, observing and occasionally making suggestions.
Jason yawned. He had not slept for almost twenty-four hours and still had one more progress note to write before he could go back to his apartment, sleep for a couple of hours, go for his three-mile run, and return to his unit to begin rounds with Seth and the medical students at seven a.m. He took a deep breath. He’d already been to four codes, and he surely would not be needed at this one. He began writing his final note.
At two-fifteen a.m., as Jason was finishing his final progress note, he heard over the loudspeaker: “Code Blue, room ten two fourteen.” The announcement was repeated three more times. This time the voice was loud and with a sense of urgency, a marked contrast to the Code Blue announcement that had woken him five minutes ago. Jason put down his chart, realizing that the Code Blue was just one floor above him. It seemed strange to him that a code would have to be called a second time.
Uneasy, Jason hurried up the stairs and headed down an empty hallway for room 10214, expecting to see the usual throng of doctors and nurses resuscitating the patient. He walked into the room and halted. A young nurse was on top of a middle-aged man, compressing his chest and then breathing into his mouth. The room was otherwise empty.
She gave him one brief, frantic glance. “Please help me, Doctor.”
Jason pulled her off. “Go fetch the code cart and make sure there are some endotracheal tubes and an Ambu bag.”
The nurse ran off, and Jason resumed chest compressions and mouth-to-mouth respirations. Waves of guilt consumed him. His decision to not attend the Code Blue when it had first been announced would make him responsible for a bad outcome, and that thought terrified him. He had been having vivid nightmares since medical school graduation about making mistakes and causing harm to patients, and he wasn’t sure how he would cope if he were responsible for this man’s death. The nurse returned with a cart containing the electric paddles, endotracheal tubes, and medications.
“Take over the chest compressions, Ms. Chapman.” Jason had read her identification badge before she had left to get the equipment. She appeared very upset, was sweating, and perhaps, Jason thought, even angry. He grabbed what looked like the right size endotracheal tube and the scope. He had never done this on a living human, although he had practiced on cadavers in his anatomy class four years ago. The vivid memory of that intense, noxious smell of cadavers preserved with formalin made him briefly cringe. He inserted the scope down the man’s throat, saw where the trachea and the esophagus diverged, and inserted the tube into the trachea. He blew up the balloon with a syringe, quickly taped the tube to the man’s mouth, connected the Ambu bag to the endotracheal tube, and began forcing air into the man’s lungs. After a few seconds, he asked the nurse to take over the Ambu bag.
Jason ripped off the man’s hospital gown, placed the paddles on the man’s chest, and checked the monitor. He felt his stomach churn as he saw the squiggly lines that meant ventricular fibrillation, an absence of heart muscle contraction.
“Stand back, ma’am.” Jason waited until Nurse Chapman was clear and then pressed the button.
The man’s body arched up into a brief spasm. Electrical waves briefly returned as the heart began to beat once again, but they quickly flattened into the fatal rhythm. The now-familiar smell of burned skin brought a sense of urgency to Jason. The patient already had fluids running through an IV. Jason took lidocaine, atropine, and epinephrine off the cart and quickly injected each medication into the line.
“Stand back,” Jason said again and pressed the button. Another spasm shook the man, and this time the heart erupted into a normal rhythm. Jason grabbed his stethoscope and listened to the heartbeat, which sounded normal. He listened to both sides of his chest and heard air rushing into both lungs as the nurse pressed the Ambu bag.
“Where’s intensive care unit in this hospital?” Jason asked. Nurse Chapman continued pressing the Ambu bag but did not answer. “Nurse Chapman!” he said sharply.
“It’s–” She swallowed. “–it’s two floors down.”
“Let’s go. Keep pushing air into his lungs. I’ll pull the bed.” Jason grabbed the rail and started maneuvering the bed through the door.
“Doctor, we just can’t just take him down there. We have to get permission from the resident who’s running the ICU. They get really mad if we don’t follow protocol.” Her voice sounded almost fearful. Jason thought perhaps the nurses were reprimanded, or even fired, if protocol was not followed.
“I don’t know anything about your protocol, but we’re taking this man to the ICU now!” Jason took a deep breath and moderated his sharp tone. This was not her fault, after all. “Look, I’m new here. I don’t know what this man needs now to survive, and we need to get him to someone who does.” He pulled on the heavy bed and, after some difficulty, moved it into the hallway and then into the elevator. The orderlies made it look so easy.
Two floors down, they stood in front of the large doors that were the entrance to the intensive care unit. They were locked. Jason leaned on the buzzer next to the doors.
“Can I help you?” a sweet voice asked.
“Please open the door, ma’am. We have a critically ill man here we need to drop off,” Jason calmly responded.
“You can’t just bring a patient here.” The sweet voice changed into a harsh pitch. “Have you cleared this with our resident?”
“Just open the door now, lady!” Jason didn’t try to hide his fury and noticed Nurse Chapman’s startled look.
A minute later, a doctor who Jason surmised was the ICU resident appeared at the door. He was in wrinkled blue surgical scrubs and was rubbing his eyes, obviously just awakened from a deep sleep.
He glared at Jason. “What do you think you’re doing?”
“We need your help, sir. This man just coded. We resuscitated him, and he needs the intensive care unit and your expertise. C’mon, let’s get him into a room. I don’t even know if his heart is still in rhythm. He was in ventricular fibrillation.”
The resident scowled for a moment and then opened the doors and helped move him into an empty ICU room. The ICU nurses attached electrodes to the heart monitor, replaced the now-empty IV bag hanging from the pole, brought in a respirator, and attached it to the endotracheal tube. The ICU resident gave orders to the nurse for the settings on the respirator. Jason saw that the man’s heart rhythm was normal and that he was waking up and starting to become combative. The resident ordered the nurse to give him a sedative, and the patient became still once again.
The resident turned to Jason. “So what’s the story with this patient?”
“I have no idea. I responded to his code, and Nurse Chapman and I were the only ones there. He was in ventricular fibrillation, I shocked him a couple of times, and he went back into a normal rhythm. Oh, and I did give him lidocaine, epinephrine, and atropine after the first shock. I guess I should write a note in his chart.” Jason smiled apologetically at Nurse Chapman and asked her to go fetch the patient’s chart.
The ICU resident was staring at Jason. “Who intubated him?”
“I did.” Jason tried to keep the irritation out of his voice, but he was becoming angrier by the minute. “I don’t understand. No one else came to this code. It was just Nurse Chapman and myself. Isn’t there some sort of system when a code is called?” he asked.
“No, when a code is called, everyone is supposed to respond.” The resident cleared his throat, not quite meeting Jason’s eyes. “I guess I didn’t hear the code over the loudspeakers, and the nurses didn’t wake me.”
“That’s insane.” Jason took a deep breath and closed his eyes briefly. “Where was the night float? I was told that there was a resident designated as the night float who was always in the hospital for emergencies.” He couldn’t understand why the night float had not come to the code.
“There is.” The resident shrugged. “He was probably sleeping as well. But relax. You did good.” He smiled and put a hand on Jason’s shoulder. “It looks like he is going to be fine.” The resident took the patient’s blood pressure and listened to his heart and lungs once more and then turned around to face Jason. “You must be one of the new interns. I’m Sean Kennedy. What were you doing in the hospital this time of day?”
Jason managed to force a smile. “I’m Jason Green.”
The nurse returned from the floor with the patient’s chart, and Jason wrote a brief note recording the events. He ended the note by writing: Nurse Chapman saved this man’s life. She still looked rattled as Jason handed the chart to her with a smile. “Thanks for your help, Dr. Kennedy.” He paused at the door, looking back at the patient, and then left the ICU, distressed at what had occurred but thankful for what appeared to be a good outcome.
Jason hurried back down to his unit, finished writing his last progress note, and left the hospital hurriedly at three in the morning. He was still rattled and angry, mostly with himself for not going to the Code Blue at first call. And he needed to get over it if he wanted to sleep. He walked quickly to his apartment two blocks away, set the alarm clock for four-thirty a.m., and fell immediately into a sound sleep.
When the alarm
woke him, he put on his shorts, T-shirt, and tennis shoes and went for his three-mile run, which he had mapped out on his first day of arrival a week ago. It was a humid and stifling hot early July morning, and most New York runners would be in an air-conditioned gym because of the heat. But for a boy from Mississippi, it felt like home, and he finished his run in twenty-two minutes.
The rotten smells of the garbage piled high on the sidewalks, the tall buildings that lined the streets, and the unending noise of the New York City traffic were foreign to him. The concrete slabs on the sidewalks were uneven, and Jason quickly learned to closely watch so that he didn’t trip. He ran fast and took care to avoid running into other pedestrians. He had also learned on his first day in New York City that his salutations of “good morning ma’am,” or “good morning, sir” to people he crossed paths with on the street were usually ignored or met with a nasty look. He had made it his private challenge to get a smile from the locals and so he persisted.
He returned to his apartment, showered, ate a bowl of bran flakes and a protein bar, and walked back to the hospital, arriving on the floor by six-thirty a.m., in time to visit a few patients before Seth Goldberg and his two medical students arrived.
© by John S. Daniels