Mary Barry, MD
The Death Star
I
got up extra early on Thanksgiving Day 1985,
since the second-year resident I was replacing wanted to drive to New Orleans to see her
folks. I went speeding down Decatur at 0400
and it was not even cold. People had Christmas
decorations lit up. An occasional truck went
past. I saw a cop car at a gas station and waved.
I met Paula on the Death Star, as we called it, the Grady ward
where a whole lot of sick people got what we regarded as shiftless
and unthinking nursing care. Our patients up there had all kinds of
medical problems, but the oncology overflow ones had scary cancers
but no money, and because of the ever-worsening bed crunch in
the ICUs, they got scary drugs on the ward, and then we watched
them. We had no monitors, no oximetry and not enough nurses
who paid attention. We also had services of 12-16 per intern and
25-30 per resident, and we could easily fail to watch them closely
enough to catch them getting septic, before infection took a deadly
hold. I was on Holiday Subspecialty call, and realized immediately
this would be, in a word, godawful.
Paula was in a hurry. “Here’s our list,” she said. “Our interns know
them all, but one is off so you take Dana’s half and get their labs –
the hard sticks all have lines, there are still bunches of full codes,
and I cannot thank you enough for being here early.”
I said, “Full codes and what prognosis?” and she shook her head
and said, “Full codes and families hoping for miracles, is more like
it.” She hugged me and I made her promise not to wreck, she would
be driving on caffeine and hope.
I studied the wavering green type of our computerized lab reports
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LOUISVILLE MEDICINE
– the only part of the record on any computer – and concluded
glumly that half my temporary patients had hardly any white cells
and the other half had too many. I went around, checked them
all, stuck them all, wrote notes and by then it was 7:00, and the
intern appeared, a nice redhead named Willie who was apparently
a future radiologist. We saw his patients together. I doubled the
pain med doses on some of them – he’d had the idea you sort of
rationed morphine; I explained this is not post-op and mobilize,
this is meds everywhere and mercy. Additionally, raising the dose
also raised the likelihood that the nurses would give them any at all,
something we’d learned the hard way as interns, when our patients
suffered needlessly there.
We had time for a real Coke and a cookie and then my beeper
said, “7055 7055 7055,” and we headed to the MEC for three admissions bang bang bang, that the night Admitting Resident was
ready to get rid of.
One was a gracious old lady with breast cancer who had fallen and
pathologically fractured her ribs and was in great pain. We moved
her ourselves, carefully lifting her up and over onto the elevator
and onto the bed. I was glad I’d rounded already and picked the
bed belonging to the good nurse on duty.
One was a moribund young man with AIDS and lymphoma
whom we put at the far end of the ward away from everyone, since
he had exotic germs not good for chemo patients to be around. I
put him on a morphine drip; he had no one with him, and no one
to call. I recognized him; his partner had died on my service in the
spring. Their families had disowned them. Even then he’d been ill
and thin, and I was surprised that he’d lived till November, but not