A Doctor Without Borders

"What you got for me this time, Daniel?” His voice was tired. It had been a long night for him too. I had to call him with every stroke page, but at least he was straight to the point.

"I want to push it. However, it's weird."

"How weird?"

“He woke up only with significant painful stimulation. Then he spoke a few words before drifting off. Amanda thinks he is non-focal.”

“And you?”

“I think he has a subtle third. I am thinking, artery of Percheron. We don’t have time for an MRI. I want to push."

He laughed at me. "Chasing another zebra?" I did not respond. We both knew that I was right more often than not. "Have you tried giving him any benzos?”

“Amanda is now. If he doesn’t respond, I plan on pushing the tPA.”

His brief silence was telling, but he didn’t contradict me. “Fine. Just make sure his labs are okay.”

“I will double check.”

I hung up and walked back into the bay. The nurse had just pushed the Ativan. I waited, watching as Amanda re-examined him.

“Seems worse.”

I agreed with her assessment. “Push the tPA."

"Got it old man."

I gave her my exaggerated smile at the now running joke. It helped deal with disbelief and questions that came when people heard about my plan. After all, I was older than many of my attendings. Too many uncompleted residencies. Even when I struggled, it had always been easier for me to make medical decisions than ones about my life. However, the chronic sleep deprivation had finally caught up with me. I had to be done with training.

She stared at me for a few seconds as if debating if to add the next words. “At least you are ending it on an interesting one.”

My smile faltered. The mask had been unnecessary with her. She was one of the few who knew the whole truth. My friends from medical school and residency had long ago moved on while I struggled with the fruits of my indecision. However, I had kept in touch. Still, even most of them didn’t know. Amanda only found out my plans because I let it slip by accident. However, she was one of the few that hadn’t asked the same tiresome question: why are you quitting when you are so good at this?

So, I told her the truth: the thrill of figuring out disease processes was not enough to make up for the drudgery of practicing medicine. It sounded as hollow to her as everyone else I told it to, but it was the truth—just part of it. She somehow finagled the other part out of me: I could no longer find the empathy needed to truly support people who had become sick.

Was that needed? More than I liked would say no. I just wasn’t one of them. Except, mine got consumed by the daily grind that was modern medicine. Too many days I was worn too thin.

It was time for me to be done with it. People thought I was becoming a neuro-hospitalist, but I had turned down all those offers when the industry offer came through. Now I was going to be no different than the people I had snickered at when they went into management consulting after undergrad. At least the pay would be good.

I walked to the bedside to do another exam. "Okay let's see how you—“

My pager went off. I swore under my breath after reading it.

"An admit?" Amanda asked.

"No. Brett." The name said it all.

"Not going home then.”

"No. He wants me to help with his lumbar puncture.” I closed my eyes and exhaled. He should be able to do this by now. “Maybe after that,” assuming this goes okay. My stomach growled. “Do you have this?” She nodded. “Then I am going to get a bite to eat first. Call me if something comes up." My gaze lingered until I got an affirmative response. I hated leaving this patient, but he was in good hands.

I checked my watch. This had taken longer than expected, but I still had a few minutes left before the cafeteria closed.

I texted Brett that I would be there shortly. Then I wormed my way through the bowels of the hospital. The walls stark and peeling, pipes of different colors and varying lengths of insulation dipping and rising as they ran with and across the corridor, the basement had none of the fancy facades being applied to most of the wards. Such a metaphor for medicine. We made it look nice and clear, but underneath it all it was still messy.

Though I was sure it would be the same at my next place, in two weeks I would never see these walls again. I expected some nostalgia. I had been here for over six years. Instead, I found only relief. It was time. Time to not be on call every other night.

I found the right set of stairs and took them two at a time. I exited right outside my goal. I couldn’t help but smile when I saw it. A lone sandwich on the rack. Curried tofu sandwich. No one had taken it.

I moved around the closed food stations faster than I cared to admit, but now that I had left the urgency of that stroke code, my hunger had returned.

I reached for the sandwich. A pleasant, feminine voice froze me in place.

“Code Stroke ED Bay 3. Code Stroke ED Bay 3.”

I cursed, silencing my pager without even looking at the page. John Doe. Something had gone very wrong.

I was already out of the cafeteria when Amanda called.

"I heard. I’m coming down now.” I took the stairs four at a time. “What's going on?”

“I think you were right about the stroke. He looked like he was waking up. Then he screamed and started convulsing.”

“Seizure?”

“Sure looked like it.”

"Get him to the scanner. Did you-"

"I gave him another 2 mg of lorazepam, and he is out. Totally unresponsive. Maybe drug-induced or post-ictal.”

She didn’t say the other reason. A bleed…from my decision. Leave it to neurologists to create a treatment that had to be given in an hours-long window, had benefit only after months, and had a significant chance to cause more harm than good. I gritted my teeth and pushed down the guilt. We didn’t know that he had bled, but we soon would.

“Have you started to get him to the scanner?”

She didn't respond. She didn't need to. She saw me coming around the corner as she walked into the room with the CT. She was going to be a damn good chief. She had already started the whole process before calling me.

I walked into the scanner. John Doe was being pulled alongside the table. I joined to speed up the transfer. My mind laid out the plan: ICU admission, EEG, probably an MRI.

"He looks good,” the tech said.

We followed him back to the computers and huddled behind him waiting.

I clamped down on my question of “how much longer?" The tech was moving quickly.

“Scanning now.” He pushed the button, and a low-volume whine filled the room as the CT started scanning.

I stared at the small screen as the images populated slice by slice. I didn’t blink once.

“Do you want to re—“

I grabbed the tech’s mouse before he could finish and scrolled through the images.

I let out a breath that I did not realize I was holding. No bleed. Just—

"What did you do to me,” screamed a voice from the room.

My head shot up. The patient was thrashing.

"Fuck. He is going to hurt himself."

Amanda was right. “Go grab a nurse and get some more lorazepam…”

“What’s going on?”

I wanted to answer the tech, but I couldn’t move my mouth. It hung open as blue sparks arced from the scanner to the ceiling. The scanner was big, easily as wide and tall as a truck, but four to six feet were still between the top of the scanner and the ceiling.

“We have to get out of here.” The tech’s voice quavered with fear. “I don’t think a CT can blow, but I’m not going to risk it.”

“The patient.” I started moving towards him, but Amanda grabbed my arm.

“The lightning. You will get killed.”

“I don’t think so. Look, no sparks.” I pointed to the wall and the lights. “Current is low. I think it is like a Van de Graaff generator.”

“A what?”

“You know like the—“ I stopped. I didn’t have time to explain a machine at science museums which let kids watch electricity arc when they touched the glass sphere surrounding the generator.

With each second, I became more confident. The bolts had thickened and increased in number. They alternated from vivid purple to blue. They would have been mesmerizing to watch if the event didn’t seem to defy natural laws and if I wasn’t worried the machine would explode.

As I approached, the arcs of electricity still were not causing any damage to the surroundings. Maybe it won’t blow. It didn’t matter. I needed to get him out even though I had a growing feeling that the origins of the phenomenon were not the CT scanner but rather the object in the center.

I peered into the center of the donut to look at John Doe. He was no longer screaming, but blue and purple lightning radiated from his head. God. He was the source.

This is all some weird natural phenomenon from the CT’s radiation…

I held onto that thought as I rushed to his side. “We’ve got to get you out of here.”

He opened his eyes at my words. He was awake. That would make things easier. I would have struggled carrying him.

"You saved me." The lucidity of his response froze me. "By the Gods, what have I done?”

He stared at me with his heterochromic eyes. Each one seemed to have an age that defied comprehension. They captured my attention and refused to let it go.

"I'm sorry."

His words broke me from my reverie, and I suddenly realized that I had failed to notice the high-pitched whine filling the room.

“Daniel!” I jerked my head around to find Amanda yelling my name from the doorway. They had abandoned the control room, which was good because the sparks had extended into it.

Shit. I turned back to John Doe. An ozone scent filled the air. I grabbed him.

“We’ve got to--”

I finally registered his face. It carried an expression with which I was intimately familiar. I had seen it. I had worn it. So had most of my colleagues. It came after a bad call. Guilt.

"This is poor thanks for saving a--"

Something punched me in the chest, and the world flashed blue and then white.