Nothing Lasts Forever

At five-thirty the following morning, when the new residents checked in, members of the hospital staff were standing by to guide them to their various assignments. Even at that early hour, the bedlam had begun.

The patients had been coming in all night, arriving in ambulances, and police cars, and on foot. The staff called them the "F and J's" - the flotsam and jetsam that streamed into the emergency rooms, broken and bleeding, victims of shootings and stabbings and automobile accidents, the wounded in flesh and spirit, the homeless and the unwanted, the ebb and flow of humanity that streamed through the dark sewers of every large city.

There was a pervasive feeling of organized chaos, frenetic movements and shrill sounds and dozens of unexpected crises that all had to be attended to at once.

The new residents stood in a protective huddle, getting attuned to their new environment, listening to the arcane sounds around them.

Paige, Kat, and Honey were waiting in the corridor when a senior resident approached them. "Which one of you is Dr. Taft?"

Honey looked up and said, "I am."

The resident smiled and held out his hand. "It's an honor to meet you. I've been asked to look out for you. Our chief of staff says that you have the highest medical school grades this hospital has ever seen. We're delighted to have you here."

Honey smiled, embarrassed. "Thank you."

Kat and Paige looked at Honey in astonishment. I wouldn't have guessed she was that brilliant, Paige thought.

"You're planning to go into internal medicine, Dr. Taft?"

"Yes."

The resident turned to Kat. "Dr. Hunter?"

"Yes."

"You're interested in neurosurgery."

"I am."

He consulted a list. "You'll be assigned to Dr. Lewis."

The resident looked over at Paige. "Dr. Taylor?"

"Yes."

"You're going into cardiac surgery."

"That's right."

"Fine. We'll assign you and Dr. Hunter to surgical rounds. You can report to the head nurse's office. Margaret Spencer. Down the hall."

"Thank you."

Paige looked at the others and took a deep breath. "Here I go! I wish us all luck!"

The head nurse, Margaret Spencer, was more a battleship than a woman, heavyset and stern-looking, with a brusque manner. She was busy behind the nurses' station when Paige approached.

"Excuse me ..."

Nurse Spencer looked up. "Yes?"

"I was told to report here. I'm Dr. Taylor."

Nurse Spencer consulted a sheet. "Just a moment." She walked through a door and returned a minute later with some scrubs and white coats.

"Here you are. The scrubs are to wear in the operating theater and on rounds. When you're doing rounds, you put a white coat over the scrubs."

"Thanks."

"Oh. And here." She reached down and handed Paige a metal tag that read "Paige Taylor, M.D." "Here's your name tag, doctor."

Paige held it in her hand and looked at it for a long time. Paige Taylor, M.D. She felt as though she had been handed the Medal of Honor. All the long hard years of work and study were summed up in those brief words. Paige Taylor, M.D.

Nurse Spencer was watching her. "Are you all right?"

"I'm fine." Paige smiled. "I'm just fine, thank you. Where do I ...?"

"Doctors' dressing room is down the corridor to the left. You'll be making rounds, so you'll want to change."

"Thank you."

Paige walked down the corridor, amazed at the amount of activity around her. The corridor was crowded with doctors, nurses, technicians, and patients, hurrying to various destinations. The insistent chatter of the public address system added to the din.

"Dr. Keenan ... OR Three. ... Dr. Keenan ... OR Three."

"Dr. Talbot ... Emergency Room One. Stat... . Dr. Talbot ... Emergency Room One. Stat."

"Dr. Engel ... Room 212. ... Dr. Engel ... Room 212."

Paige approached a door marked DOCTORS' DRESSING ROOM and opened it. Inside there were a dozen doctors in various stages of undress. Two of them were totally naked. They turned to stare at Paige as the door opened.

"Oh! I... I'm sorry," Paige mumbled, and quickly closed the door. She stood there, uncertain about what to do. A few feet down the corridor, she saw a door marked NURSES' DRESSING ROOM. Paige walked over to it and opened the door. Inside, several nurses were changing into their uniforms.

One of them looked up. "Hello. Are you one of the new nurses?"

"No," Paige said tightly. "I'm not." She closed the door and walked back to the doctors' dressing room. She stood there a moment, then took a deep breath and entered. The conversation came to a stop.

One of the men said, "Sorry, honey. This room is for doctors."

"I'm a doctor," Paige said.

They turned to look at one another. "Oh? Well, er ... welcome."

"Thank you." She hesitated a moment, then walked over to an empty locker. The men watched as she put her hospital clothes into the locker. She looked at the men for a moment, then slowly started to unbutton her blouse.

The doctors stood there, not sure what to do. One of them said, "Maybe we should - er - give the little lady some privacy, gentlemen."

The little lady "Thank you," Paige said. She stood there, waiting, as the doctors finished dressing and left the room. Am I going to have to go through this every dayl she wondered.

In hospital rounds, there is a traditional formation that never varies. The attending physician is always in the lead, followed by the senior resident, then the other residents, and one or two medical students. The attending physician Paige had been assigned to was Dr. William Radnor. Paige and five other residents were gathered in the hallway, waiting to meet him.

In the group was a young Chinese doctor. He held out his hand. "Tom Chang," he said. "I hope you're all as nervous as I am."

Paige liked him immediately.

A man was approaching the group. "Good morning," he said. "I'm Dr. Radnor." He was soft-spoken, with sparkling blue eyes. Each resident introduced himself.

"This is your first day of rounds. I want you to pay close attention to everything you see and hear, but at the same time, it's important to appear relaxed."

Paige made a mental note. Pay close attention, but appear to be relaxed.

"If the patients see that you're tense, they're going to be tense, and they'll probably think they're dying of some disease you aren't telling them about."

Don't make patients tense.

"Remember, from now on, you're going to be responsible for the lives of other human beings."

Now responsible for other lives. Oh, my God! The longer Dr. Radnor talked, the more nervous Paige became, and by the time he was finished, her self-confidence had completely vanished. I'm not ready for this. she thought. I don't know what I'm doing. Who ever said I could be a doctor! What if I kill somebody!

Dr. Radnor was going on, "I will expect detailed notes on each one of your patients - lab work, blood, electrolytes, everything. Is that clear?"

There were murmurs of "Yes, doctor."

"There are always thirty to forty surgical patients here at one time. It's your job to make sure that everything is properly organized for them. We'll start the morning rounds now. In the afternoon, we'll make the same rounds again."

It had all seemed so easy at medical school. Paige thought about the four years she had spent there. There had been one hundred and fifty students, and only fifteen women. She would never forget the first day of Gross Anatomy class. The students had walked into a large white tiled room with twenty tables lined up in rows, each table covered with a yellow sheet. Five students were assigned to each table.

The professor had said, "All right, pull back the sheets." And there, in front of Paige, was her first cadaver. She had been afraid that she would faint or be sick, but she felt strangely calm. The cadaver had been preserved, which somehow removed it one step from humanity.

In the beginning the students had been hushed and respectful in the anatomy laboratory. But, incredibly to Paige, within a week, they were eating sandwiches during the dissections, and making rude jokes. It was a form of self-defense, a denial of their own mortality. They gave the corpses names, and treated them like old friends. Paige tried to force herself to act as casually as the other students, but she found it difficult. She looked at the cadaver she was working on, and thought: Here was a man with a home and a family. He went to an office every day, and once a year he took a vacation with his wife and children. He probably loved sports and enjoyed movies and plays, and he laughed and cried, and he watched his children grow up and he shared their joys and their sorrows, and he had big, wonderful dreams. I hope they all came true. ... A bittersweet sadness engulfed her because he was dead and she was alive.

In time, even to Paige, the dissections became routine. Open the chest, examine the ribs, lungs, pericar-dial sac covering the heart, the veins, arteries, and nerves.

Much of the first two years of medical school was spent memorizing long lists that the students referred to as the Organ Recital. First the cranial nerves: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, auditory, glossopharyngeal, vagus, spinal, and hypoglossal.

The students used mnemonics to help them remember. The classic one was "On old Olympus's towering tops, a French and German vended some tops." The modern male version was "Oh, oh, oh, to touch and feel a girl's vagina - such heaven."

The last two years of medical school were more interesting, with courses in internal medicine, surgery, pediatrics, and obstetrics, and they worked at the local hospital. I remember the time ... Paige was thinking.

"Dr. Taylor ..." The senior resident was staring at her.

Paige came to with a start. The others were already halfway down the corridor.

"Coming," she said hastily.

The first stop was at a large, rectangular ward, with rows of beds on both sides of the room, with a small stand next to each bed. Paige had expected to see curtains separating the beds, but here there was no privacy.

The first patient was an elderly man with a sallow complexion. He was sound asleep, breathing heavily. Dr. Radnor walked over to the foot of the bed, studied the chart there, then went to the patient's side and gently touched his shoulder. "Mr. Potter?"

The patient opened his eyes. "Huh?"

"Good morning. I'm Dr. Radnor. I'm just checking to see how you're doing. Did you have a comfortable night?"

"It was okay."

"Do you have any pain?"

"Yeah. My chest hurts."

"Let me take a look at it."

When he finished the examination, he said, "You're doing fine. I'll have the nurse give you something for the pain."

"Thanks, doctor."

"We'll be back to see you this afternoon."

They moved away from the bed. Dr. Radnor turned to the residents. "Always try to ask questions that have a yes or no answer so the patient doesn't tire himself out. And reassure him about his progress. I want you to study his chart and make notes. We'll come back here this afternoon to see how he's doing. Keep a running record of every patient's chief complaint, present illness, past illnesses, family history, and social history. Does he drink, smoke, etc.? When we make the rounds again, I'll expect a report on the progress of each patient."

They moved on to the bed of the next patient, a man in his forties.

"Good morning, Mr. Rawlings."

"Good morning, doctor."

"Are you feeling better this morning?"

"Not so good. I was up a lot last night. My stomach's hurting."

Dr. Radnor turned to the senior resident. "What did the proctoscopy show?"

"No sign of any problem."

"Give him a barium enema and an upper GI, stat."

The senior resident made a note.

The resident standing next to Paige whispered in her ear, "I guess you know what stat stands for. 'Shake that ass, tootsie!' "

Dr. Radnor heard. " 'Stat' comes from the Latin, statim. Immediately."

In the years ahead, Paige was to hear it often.

The next patient was an elderly woman who had had a bypass operation.

"Good morning, Mrs. Turkel."

"How long are you going to keep me in here?"

"Not very long. The procedure was a success. You'll be going home soon."

And they moved on to the next patient.

The routine was repeated over and over, and the morning went by swiftly. They saw thirty patients. After each patient, the residents frantically scribbled notes, praying that they would be able to decipher them later.

One patient was a puzzle to Paige. She seemed to be in perfect health.

When they had moved away from her, Paige asked, "What's her problem, doctor?"

Dr. Radnor sighed. "She has no problem. She's a gomer. And for those of you who forgot what you were taught in medical school, gomer is an acronym for 'Get out of my emergency room!' Gomers are people who enjoy poor health. That's their hobby. I've admitted her six times in the last year."

They moved on to the last patient, an old woman on a respirator, who was in a coma.

"She's had a massive heart attack," Dr. Radnor explained to the residents. "She's been in a coma for six weeks. Her vital signs are failing. There's nothing more we can do for her. We'll pull the plug this afternoon."

Paige looked at him in shock. "Pull the plug?"

Dr. Radnor said gently, "The hospital ethics committee made the decision this morning. She's a vegetable. She's eighty-seven years old, and she's brain-dead. It's cruel to keep her alive, and it's breaking her family financially. I'll see you all at rounds this afternoon."

They watched him walk away. Paige turned to look at the patient again. She was alive. In a few hours she will be dead. We'll pull the plug this afternoon.

That's murder! Paige thought.