night slowly wound down. Ben was in the surgical suite sewing up a forehead laceration of a young boy who had fallen off his new bike, which he had decided to ride in the driveway in the moonlight. Bev pushed the wheelchair occupied by a balding, middle-aged businessman in a tailored sports coat and red silk tie across from my desk. Bev’s weary face now had a permanent frown, and her left eyelid twitched rhythmically.
Bev paused the wheelchair across from me and said, “He has chest pains, Doc. He said he’s had crushing mid-sternal chest pain for an hour.”
The businessman looked up from the wheelchair and said, “Look, Doc, I don’t want to be here. What are you, just an intern? Jesus Christ, I told those damn medics to take me to my private hospital, but ‘Oh no,’ they said, ‘You’re having a heart attack, and we’re taking you to the closest ER, Wayne County. Time is really important.’ So here I am.” His face was as white as the moon, and perspiration was apparent on his upper lip.
“What were you doing when the chest pain began?” I asked, noting the contrast between his Harris Tweed jacket and his dirt-stained hands.
He looked embarrassed and hesitated for a moment, but like most men whose lives are in the balance, decided to tell the truth.
“I woke up at 4 a.m. and couldn’t go back to sleep. The moon was huge and shining through our bedroom window. I figured I might as well dress for work. I work for GM in Rochester. After I dressed, I looked out the window again, and the moonlight had illuminated the whole backyard, particularly the part I had been raking last night, but didn’t finish. I’d left the wheelbarrow half full of leaves and those damn walnuts. So I thought, well, might as well finish the job. I loaded up the wheelbarrow and was pushing it up the hill to dump it in the mulch pile when it felt like a vise had grabbed my chest and was clamping shut. I became short of breath and broke out in a sweat. I made it back inside, and yelled to my wife to call the rescue squad. As we drove off in the squad car, you could see the whole yard lit up by the moon. Strange.”
As the man said “strange,” his voice trailed off. After a moment he began to tremble, then shake, and finally his arms and legs began to twitch in tonic clonic movements. Suspecting he was developing ventricular tachycardia during the acute ischemic stage of his heart attack, I leaned across the narrow work desk and hit him firmly in the sternum. An external cardiac thump had been known to cardiovert ventricular tachycardia. After a brief pause, the seizure stopped, he regained consciousness, and said, “Damn, Doc, that really hurt. Why’d you do that?”
Bev nodded at the cardiac room and rolled the stretcher quickly back. Rapidly we undressed him, slid the gown on, and placed the cardiac monitor leads. I slipped an intravenous catheter into his arm and Bev drew up the IV lidocaine. As we checked the monitor, his cardiac rhythm switched from rapid sinus tachycardia to ventricular fibrillation, a serious cardiac arrhythmia that cannot support blood pressure or life. His tonic clonic seizures resumed.
Bev wheeled the defibrillator to the bedside. I pushed the IV lidocaine through the new IV as Bev cranked up the voltage on the defibrillator.
“Ready to go, Doc,” Bev said.
I placed the defibrillator pads on his chest, applied the paddles, and pressed the discharge switches. The defibrillator shocked the patient’s chest, and he rose abruptly from the stretcher.
Ben had entered the room to help, as did two additional nurses. Ten eyes focused on the cardiac monitor. The seizures slowed, then stopped. The monitor displayed the normal rhythm and echoed the reassuring regular beeps.
“We need to get to the Coronary Care Unit quickly!” said Bev.
As we wheeled the stretcher through the exam room door leading to the elevator, the patient resumed groggy consciousness.
“Damn, my chest really hurts!” He focused on me, paused, then said, “I’m going to look for you, buddy, when this is over.”
We wheeled him quickly through the ER, into the elevator, then into the Coronary Care Unit where expert hands took over.
Ben, Bev, and I sat quietly in our small, now-cluttered work area. Three untouched steaming cups of coffee and three large chocolate donuts rested in front of us. Ben’s warm smile was gone, his hair was rumpled, and his hands rested in his lap. Bev no longer smiled or frowned, and her left eye twitched constantly. My insides were empty, spent. Bev looked up first to Ben, then to me, and said, “Just walked outside. It’s dawn. The sun is rising. The moon has set. We should be OK now.”
Ben and I both sighed, but neither of us corrected her.
Ten days later, at the night shift start, Bev poked her alert face around the corner, both eyes arched but not twitching, and said, “Someone here to see you, Doc.”
A well dressed, balding, middle-aged businessman appeared around the corner, a serious expression on his face. Had he at last returned to even the score? A wide smile broke out on his face, and his hand extended to mine.
“Thank you, Doc, for a really good punch. I’m going home today!”
SPECIAL GIRLS DAY
The hospital doctor conference room at University of Michigan Hospital was a long, grey rectangle cluttered with patient medical charts and numerous paper laboratory slips. Electronic medical records and computers were decades away. A small conference table and a set of folding chairs occupied the room’s center. A single window peered out onto a spring courtyard, permitting a thin ray of sunlight to reflect off the wall. The chalkboard was full of patient lists divided by student and intern responsibilities; the probable working diagnosis was handwritten under each name. The room was quiet. The overhead lights were off.
I reclined in one of the folding chairs, feet propped up on the table, eyes closed. My short white coat and starched white pants were crumpled and stained with sweat, patient urine, blood, and pocket ink. My tie was loose and my face carried a two-day beard. It was 5 p.m. on Monday afternoon, the end of a marathon weekend of hospital call rotation. Leaving our apartment at 7 a.m. Friday morning, I kissed Jean goodbye and promised to be home Monday night at 6 p.m. She promised a special spaghetti dinner.
Stan, the medical chief resident, opened the conference room door quietly and slipped into a chair next to me. Stan had served two years in the military after graduating from Harvard Medical School and now was completing his internal medicine training. We all considered Stan a genius and a control freak. He had a buzz cut, his long white coat was spotless, trousers pressed, tie centered, face freshly shaven, and nails trimmed. He shook my chair gently.
“OK, Jack, wake up now, time to check out. The other interns are tied up. Let’s go through the cases. By the way, you look like shit. Have you been here all weekend?” he asked.
I stirred, blinked, and yawned. “Yeah, Stan, all weekend—Friday, Saturday, and Sunday nights. We had five code blues, twenty admissions, and forty-five patients to round on. The students were a big help.” I yawned again.
“Son of a bitch, Jack, you never got home at all, not even for dinner! My wife would have been pissed! Where are the students?” he asked.
“Home, I sent them all home exhausted. Nobody slept over two hours last night,” I replied.
Stan’s speech was always a surprise. No coarse word or vulgarity was beyond him. When he spoke from his perfect military face and neat uniform, it was as if he were occupied by a foul, trash-talking alien.
“Jesus, man, let’s go through the cases. I’ll brief the other interns. You’ve set some sort of fucking record here, Jack!”
After reviewing the admissions, discharges, deaths, and active cases, Stan lead me into the hall. “Go, Jack. Get the fuck out of here, and don’t think of us or the patients,” he demanded.
It was 5:40 p.m. and there was still dinner with Jean. As I turned the corner to leave the patient wards, a harried nurse stuck her head out of a patient room and