“What do you mean?” she asked.
“Discontinue his DNR order and send him in the ambulance with the other guy. When he gets back from his scan I’ll reinstate his DNR.”
“If central dispatch finds out you’re tweaking DNR orders to facilitate transfers, they’ll go bananas.”
“I’ve got broad shoulders.”
As I was putting on my lab coat one of my colleagues entered the locker room.
“Morning, Donovan! Say, I just noticed that on the new ER schedule you have me on call on the 16th. I won’t be able to work that day – my wife’s parents are going to be in town.”
“You didn’t tell me you weren’t available to work that day,” I whined. Every month I end up revising our call roster six or seven times due to last-minute changes.
“I know, I forgot. Sorry!”
I pulled a copy of the schedule out of my locker.
“Miles is on call the next day. Could you just trade with him?”
“No, that won’t work – the outlaws’ll be staying the entire weekend.”
“Okay, I’ll rework things and get back to you.”
I sat down with the timetable and brainstormed. Five minutes later I had a viable alternative figured out. All right, time to get to work!
I left the locker room and angled across the hallway to our mailboxes. I was glumly eyeing the two new admission cards taped to the front of my box when I heard someone inside the emergency department mention my name.
“… I think I just saw him go by. Maybe he stopped at his mailbox.”
Oh no. Before I could make like Jimmy Hoffa and disappear, one of the ER nurses stepped out into the hallway and collared me.
“Oh, there you are! I have an outpatient sheet from last night that you forgot to sign.”
“Is that all? No problem!” This’ll only take a second!
I trotted over to the main desk and applied my hieroglyphic scrawl to the sheet.
“Oh, and one more thing,” she said. “Remember Mr. Carbuncle? He’s the man who had that nasty abscess on his buttock. You lanced it on Monday.”
“Yes?”
“He’s due to be reassessed this morning to see if his IV antibiotics can be discontinued.”
“That’s nice.”
“He was really hoping you’d be the one to recheck him.”
I was on the verge of deferring the task to the doctor on call when Mr. Carbuncle and his wife both leaned out of the doorway of the nearest treatment room and waved at me cheerily.
“Um, sure, I’d be glad to.”
When I stepped out of the treatment room, the administrative secretary ambushed me.
“Sorry to bother you, Dr. Gray, but we need to schedule a medical advisory committee meeting. There are a number of pressing items on the agenda that need to be addressed.”
“Like what?” Omigod! Wait! Is it too late for me to retract that question?
As she summarized the lengthy list I tried my best to nod at appropriate intervals. When I couldn’t stand it any longer I interrupted her in mid-sentence.
“How about if we have the meeting next Friday at noon?”
“Next Friday at noon sounds great! I’ll send out a memo to everyone.” I turned to go. “By the way,” she said, “The CEO is going to need your help with the upcoming hospital accreditation. Do you think you’ll be able to… .”
Administrative duties fulfilled, I made a beeline for the medical ward. As I was passing switchboard the operator waved me over to her desk.
“That specialist you were trying to track down yesterday is returning your call,” she said.
“Oh, that’s okay – I managed to get the patient I was calling him about stabilized and transferred somewhere else, so I don’t need to speak to him anymore.”
“You might as well tell him that yourself – he’ll be on the line any second now. What number should I put it through to?”
“But – ”
“Here he is now. I’ll patch it through to the phone right behind you in Medical Records.”
Dr. Verbose was in a particularly chatty mood. At his request, we reviewed the details of the case I had been trying to reach him about. He seemed to be satisfied with the way things had turned out. While we were talking I noticed someone from the business office begin to hover nearby. Before long an ER nurse joined her. The instant I hung up they descended like ravens.
“Dr. Gray, the architect wants to know when he’ll be able to meet with you to go over the new medical clinic plans.”
“How about next Friday at noon?”
“Didn’t you just book the next MAC meeting for that time slot?”
“Oh, yeah, that’s right. Okay, make it this coming Monday at 12:30.”
“Super.” She tagged out and the ER nurse took her place.
“When do you want to do that elective electrical cardioversion?”
“What cardioversion?”
“Mr. Brugada.”
“I thought he had decided he didn’t want Ontario Hydrotherapy.”
“He telephoned just now to say he’s changed his mind.”
“Hang on. I’ll check.”
I called the OR and worked out a date with our anaesthetist. The nurse took down the information and departed. Before I could get out of the Medical Records department our transcriptionist asked me to help her figure out a muffled word on one of her tapes. The mystery word turned out to be “dysphoria.” Hmm… .
On my way to the medical ward I stole a look at my watch. It was already 9:30 and I hadn’t even started rounds yet. Now I had six patients to see, two of whom were allegedly falling apart. Cripes! So much for my carefully laid plans. I was within arm’s reach of the door to the ward when the respiratory therapist tackled me.
“Would you be able to help me get approval for a sleep study for Mr. Ondine?”
I don’t even recall the details of the conversation. I just remember a sudden moment of clarity in which a single thought crystallized in my mind: Now I know how those carnival ducks felt.
When I was a kid, every summer a couple of travelling carnivals would come to our town for a few days. Armed with the contents of our piggy banks, my friends and I would wander through the amazing chaos together. We’d go on all the rides, eat loads of candy and try our luck at the games. One of our favourite games was Shoot the Duck. For a dime you’d get to shoot pellets at a metal duck at the far end of the booth. It was “swimming” from one side to the other, but if you nailed it just right it would spin around and go back in the opposite direction. Each time you hit it a loud Ding! would reverberate throughout the booth. Ding! Ding! Ding! Ding! It kept trying to get to the other side, but somehow it never made it. Some days I feel like that duck.
Eventually I arrived at the ward. I had just cracked open my first chart when one of the ambulance attendants bellied up to the counter beside me. He looked annoyed.
“So your guy’s not DNR anymore,” he said.
“That’s right.”
“You know that means we’ll be doing a complete resuscitation on him if he goes sour while we’re on the road, right?”
“Go for it.”
“Does his family know his code status has been changed?”
I lost it.
“The whole world knows, okay? Go ahead and run a full code! Do a heart transplant if you have to! Just do the goddamn transfer!”
“Okay, okay, take it easy,” he muttered. “Just making sure.”
I got home at noon with a newfound understanding of the relief Xenophon must have felt when he and his fellow warriors finally clawed their way to the Black Sea. Thálatta, thálatta! (The sea, the sea!) I was so exhausted, I went straight to bed. Sleep claimed me within seconds. Half a minute later the bedside telephone shrilled. I nearly jumped out of my skin.
“Hi, Sweetie,” said my wife. “I’m stuck in a meeting and Ellen just called to say she forgot her lunch at home this morning. Do you think maybe you could run it down to the school for her?”