Read Online The Shift: One Nurse, Twelve Hours, Four Patients' Lives by Theresa Brown - Free Book Online Page B

disorder . . . abdominal pain.”
    I stand in their circle, concentrating. Dr. Martin grimaces and says, to no one in particular, “I’m an oncologist, not a hematologist.” He’s complaining that he’s trained to treat cancer patients, not people with unusual clotting problems. Sheila doesn’t have cancer, but her disease is rare enough that despite being a teaching hospital we don’t have an MD onsite 24/7 who specializes in her particular illness. An oncologist who’s also trained in hematology is the best we can do, but throw in Sheila’s mysterious abdominal pain and Dr. Martin is out of his element clinically, which annoys him, probably because it makes him insecure. He may feel he’s not expert enough to care for her.
    Regardless, the interns and resident look at him expectantly. They may get his point—that he’s not the ideal physician for Sheila—but they have their own pressures to contend with. They’re on the floor to learn how to be doctors and the attending is there to teach them. He will not help them juggle their many responsibilities by doing some of the day-to-day work that keeps them busy, and they will be equally as abstemious with their empathy for the clinical predicament in which he finds himself. It’s the way the hierarchy works.
    “Could be HIT” he says, half to himself. He’s talking about heparin-induced thrombocytopenia. People pronounce HIT like the word “hit,” but I always think it should be “H-I-T” because that makes it sound a lot more serious. “Hit” is kids squabbling, but H-I-T, like HIV, is a disease.
    Doctors like to tell stories about the rare but tragic case they will always remember, but we nurses have our stories, too, and mine involves a patient with HIT. I met this man when I was a nursing student. He’d come into the hospital for what was supposed to be a routine cardiac test and ended up with a new heart, the lower half of his right leg amputated, and toes dying on his still-intact left foot. An emergency heart transplant had saved his life after a routine cardiac procedure went very wrong, but the heparin he received to prevent blood clots after the open-heart surgery gave him HIT: a rare but very serious allergic reaction to the drug. Heparin is supposed to extend the clotting time of blood, but with HIT the reverse happens and blood clots when it shouldn’t.
    For this patient clots formed in both of his legs, leading to massive tissue death and the amputation, and he was facing the possible loss of his left foot, too. At one point he half woke up and wanted only to die. Then a few days later he really woke up and his wife was there, his sons. He changed his mind. Whatever it took he wanted to live as fully as he could.
    That was the first time I really saw that our attempts at healing can do harm. Everything that happened to this patient fell into the range of rare-but-acknowledged-risk, and the guy was lucky he wasn’t dead. His life was forever changed after receiving our “care.” He would need anti-rejection medicines for his new heart and have to learn to walk all over again with a prosthesis in place of the leg he’d lost. Changing the bandages on his dying toes caused a shadow of pain to fall over his face, like the moon covering the sun during an eclipse.
    Outside Sheila’s room the intern suggests a few blood tests to run. I hope they show that Sheila does not have HIT. Dr. Martin nods. “Order a scan of her belly, too,” he says. That’s routine, a good idea, I think. They’re getting ready to go into the room when the other intern gets a call on his cell phone. He looks startled as he relays the message, but his voice is steady. “Chardash, that patient on five north, is decompensating.” A different patient somewhere else in the hospital, maybe a cancer patient we didn’t have room for on one of the oncology floors, is spiraling down.
    “Well, then we need to go there,” the attending says. “We’ll come back here. But