3. Rohit
“ G ood work today, guys. Great hustle,” I say as I give out high-fives to the stream of sweaty kids filing off the tennis court.
“See you tomorrow?” Kylie asks hopefully.
“You know it! I traded hospital shifts so I wouldn’t miss it.” I smile at her little face. She’s only eight years old, but she has a forehand that shoots balls over the net like a missile.
Once all the kids have been claimed by their guardians, I gather my things and head to the locker room. I love my job as an ICU nurse at New York Hospital, but my time coaching kids’ tennis is equally as rewarding.
I grew up playing tennis. Playing is probably an understatement. I grew up living and breathing tennis. My parents undoubtedly enrolled me in lessons as a resume-building activity, without knowing that it would end up being such a big part of my life. They were proud enough when I played varsity tennis in high school, but only because they thought it would cinch a spot at an Ivy League college and, ultimately, medical school. I chose a different route, one that they are still wrapping their heads around. And, while they’d never say it overtly, the implication is there that they aren’t completely proud of my choice to pursue nursing, instead of getting an MD.
In the locker room, I take a quick shower and change into a fresh set of scrubs. I’m working the eleven AM to eleven PM shift in the ICU today, which isn’t my first choice of shift on a Saturday, but beggars can’t be choosers. Plus, this way, I could teach the morning classes and be off for the kids’ tennis tournament tomorrow.
I take the subway a few stops downtown. In July, the heat on the train is stifling, but as a lifelong New Yorker, I’m used to it. A few short minutes later, when I walk through the hospital’s sliding doors, the blast of cold air from the air conditioning of the lobby takes me by surprise. By the time I walk into the ICU, it’s exactly 10:55 AM.
“Hey, Jenna,” I say with a smile. “How was your night?”
“Rohit! Right on time, as always.” Jenna smiles back. “The night was good. I’m only signing out one patient to you, but I think another might be coming up soon. The fellow went down to the ER to assess a new DKA.” She hands me a signout with the patient’s name, demographic info, and a short summary of what’s been going on so far in the hospitalization.
“Great, so what’s going on with bed 3?” I ask. As my gaze travels from the paper to Jenna’s face, I notice fatigue sitting heavily under her brown eyes.
“Mr. Rodney is an 85-year-old man with a 60 pack-year smoking history. He’s intubated for a COPD exacerbation. You can start lightening up his sedation, so they can try to wean,” she explains. When patients are on mechanical ventilation, a machine is literally breathing for them. Having a tube down your throat to push air into your lungs can be uncomfortable, so most patients are sedated. But, to get them off the ventilator, you have to slowly wake them so you know if they can breathe on their own and be weaned off the ventilator.
“Got it. Thanks so much, get home safe, and get some rest,” I say while jotting down a few notes on the signout.
Jenna waves and hightails it out of the ICU and I get busy trying to lighten Mr. Rodney’s sedation safely. After fiddling with the drips, I watch the monitors closely, looking for any signs of distress like a spiking heart rate or elevated blood pressure. After a few minutes, I see the patient’s respiration rate increase. He’s overbreathing the vent, which means he’s awake enough for his body to breathe on his own a little bit. All good signs.
“Hey Rohit.” I hear the unit receptionist call over to me. My head turns and I catch his eye. “ER nurse on the phone to give you report.”
“Thanks Manny, I’ll be right there,” I yell back. I take one last look at Mr. Rodney’s monitors and walk over to the phone.
“ICU, Rohit speaking,” I say, as I sit to take notes.
“Hey, I have a DKA coming up to you. Transport is already here,” a beleaguered voice responds. “Nice lady, Rhonda Smith. MRN 403251. She’s in her 60s, and has type two diabetes, but she came in with DKA. Initial glucose was 500, anion gap of 16, alert, but drowsy. Anyway, she needs an insulin drip, so to the ICU she goes.”
“Got it. Her vitals are stable?” I ask. The ER always gives a short and sweet report, but sometimes I need a few more details.
“Yeah, BP 130/80, heart rate steady at 75, on room air. She has some nausea, but that goes with the territory. She’s not on any monitors.”
“Okay, great. Is insulin hanging?” I ask, as I quickly scribble the vital signs on my signout.
“No, her potassium was only 2.8, so we hung potassium. It’s going slow because it was burning like hell. You’ll have to start the insulin up there. Listen, transport is here, I gotta go,” she says hurriedly, and then I hear the dial tone.
I lean back in the chair as I digest the information relayed to me. Diabetic ketoacidosis, or DKA for short, is common in type one diabetics, but not so common in older patients with type two diabetes. Regardless, it needs to be treated with a continuous insulin drip and the frequency of monitoring required of both electrolytes like potassium and glucose levels needs an ICU setting.
A few short moments later, the ICU doors open and transport is rolling a patient into bed 2. I walk over to help.
“Ms. Smith?” I ask, peeking at the patient in the bed. She’s wearing a white dress shirt and black slacks, with a slight frown on her face. She’s scratching her arm just above the IV site, probably because the potassium infusion can be a little uncomfortable.
“Call me Rhonda, honey,” she clarifies for me. “My, aren’t you a tall one. Are you my doctor?”
“No, ma’am, I’m going to be your nurse today,” I reply.
“Don’t ma’am me! I may have my first grandbaby on the way, but I’m not that old. Call me Rhonda, seriously,” she chides. “Now, is all this burning normal?” She gestures to the IV.
I quickly examine the IV to make sure there’s no infiltration or other problems with the line. I see no issues. “Sometimes the potassium infusions can be uncomfortable,” I explain. “I can slow down the rate a little and give you an ice pack.” I pat her arm in what I hope is a reassuring manner. “We have to bring your potassium level up before we can start the insulin to treat the high glucose from your diabetes,” I tell her.
“Wow, you’ve explained more to me than any of those doctors down in the ER,” Rhonda says with a chuckle. “I’ll take that ice pack, and you’ll fix me up, won’t you, honey?”
“You got it, Rhonda. I’ll be right back.” I walk out of her room and slip into bed 3 quickly to check on Mr. Rodney. He seems to be doing well, so I send the respiratory therapist a quick message to take over the weaning trial. Then I pop across the hall to the med room and grab an ice pack for Rhonda.
As I return to her room, I see that she’s chatting away with the ICU fellow.
“Listen, I know you have to do what you have to do, but all I’m saying is I have a pregnant daughter who needs me to help set up the nursery. We are supposed to go crib shopping tomorrow,” Rhonda pleads.
“Ms. Smith, I know you normally manage your diabetes at home, but you have a serious and rare complication that needs ICU management right now,” the fellow grumbles, looking overwhelmed. I’m sure he’s not used to his ICU patients talking this much. Usually, they are too sick. “Since your potassium infusion just finished, we are going to draw a repeat level, and if it’s better, we will start an insulin drip.”
“Okay, okay, I’m not trying to give you a hard time. It’s just that I don’t really feel that sick. I’ve had some nausea and lost some weight, but I can stand to lose a few more pounds.” Rhonda raises an eyebrow as she pats her rotund belly.
The fellow shakes his head and walks away. I wave the ice pack in the air and say, “I guess you don’t really need this anymore, but let me draw your blood.” I turn to the wall and pull a pair of large gloves from the mounted box. From the cart next to the bed I collect alcohol swabs, a small gauge butterfly needle, and a vacu-tainer to collect the blood. “This will just be a small stick, okay?”
Rhonda inhales and whispers, “I don’t really like needles.”
“Me neither, yet here we are,” I joke, hoping to put her at ease. Rhonda looks away as my gloved hands wrap a tourniquet on her arm. After I find a good vein, I disinfect the area and quickly use the butterfly and tube to draw the blood. “All done, Rhonda,” I say. She looks back at me with a look of surprise.
“Honey, with those magic hands of yours, I hope you’re going to be my nurse the whole time I’m here,” she exclaims giddily.
I smile and shake my head. I don’t want to get into how complex nursing assignments in the ICU are, so I deflect. “We’ll have results in about twenty minutes,” I reply as I walk out of the room.
I send the blood to the lab in a pneumatic tube. As it whooshes away, I check in with the ICU fellow. Winston is a second year fellow, so I’ve worked with him before. He can be a little curt, but he’s smart and knows how to manage complex cases, so I respect him.
“Is it really DKA? In a type two diabetic? Don’t they usually get HHS?” I ask.
“Yeah, DKA is less common, but it can definitely still happen. It’s more common in certain populations, though. It’s actually named after our friends across the river; Flatbush diabetes. I guess they see it there a lot,” he adds. “We will manage it just like any other DKA—insulin drip, check electrolytes, and stabilize her to get her out. She’s chatty and I like my patients sedated,” he complains.
“I think it’s kind of cool to actually be able to talk to someone for a change,” I say with a smirk. While that’s true, right now I’m just trying to push Winston’s buttons because it is easy to do.
“You just say that because people like you,” he grumbles.
“Winston, man, it’s not that hard. You smile, you make a little small talk, that’s all there is to it,” I say while patting his back.
“Don’t patronize me, man.” He rolls his eyes, then turns back to the computer in front of him. “Hey, her K is back. It’s 4.0 on the dot. Perfect. I’m putting in an order for the insulin drip. Check her sugar first, okay?”
“You got it, boss.”
“I’m not your boss and you know it.” He shakes his head as I walk away to call pharmacy to send up the insulin.
The rest of the day I juggle Mr. Rodney and Rhonda. Mr. Rodney eventually does get extubated, and since he’s awake and breathing on his own, I have the most loquacious corner of the ICU.
Over the next ten hours, I hear all about Mr. Rodney’s time in the Vietnam War where he picked up his smoking habit that he just can’t shake. He knows it’s what landed him in the ICU, but he just doesn’t want to quit. I hear all about Rhonda’s pregnant daughter and the baby that’s due in two months. She has another younger daughter too, whom she shows me pictures of, repeatedly, with exaggerated winks. What she doesn’t realize is I’m not in the market for a relationship. By the time eleven PM rolls around, even I’m tired of talking and I can’t wait to get home.
My phone alarm goes off at exactly ten AM. I quickly shower and wrap a towel around my waist. Looking in the mirror, I realize my beard needs a quick trim; I like to keep it tight with my electric razor. I wipe the sink of the small hairs that accumulate because my mother beat that habit into me. I mess around with my hair a little, but can’t get it quite right. Annoyed, I walk over to my bedroom and put on my athletic shorts, my tennis academy tee shirt, and after battling with my hair a little bit more, I decide a backwards hat is definitely the way to go.
I get to the tennis academy right around eleven AM. The tournament doesn’t start till noon but I know some of my kids will be there early to warm up. I immediately see Kylie and her dad on one of the courts and walk over to them.
“COACH RO!” Kylie screams, ignoring the ball coming her way from her father across the net.
“Hey there, kiddo.” I can’t hide the smile in my voice. “Ready for your first tournament?” I extend my hand for a high-five.
Kylie gives me a half-hearted one then looks down at her feet and shrugs. I can tell she’s nervous from the way she’s fiddling with the strings on her racket and avoiding eye contact. Kylie’s father circles the net and comes over to us. He places a reassuring arm around Kylie’s shoulder.
“She’s got this,” he says as he extends his other hand out to me.
I shake his hand and reply, “She sure does!” I look down at Kylie and whisper, “All that matters is that you try, okay? You’ve been working really hard and no matter what, we are all proud of you.”
Kylie looks up at me with slightly glassy eyes. “Coach Ro, I won’t forget the split step, I promise. I’ll get behind the ball, too.”
I laugh, remembering that those are the two things I’m most often reminding her about. “Finish warming up, they’re going to start soon.” I wave at Kylie and her dad as they head back to the court, and then I go check on some of the other kids.
For the next three hours, I watch and score the matches of countless eight to ten-year-olds. I’m so proud of all their hard work—and of how much they’ve improved under my advice. By the end, everyone is exhausted.
Kylie runs up to me with a shiny trophy in hand and grabs my arm. “I won three matches, Coach!” she cheers, showcasing her winnings. “And I only lost one, but I really tried!”
“I saw Kylie! You did amazing.” I give her a high five.
This time she returns it enthusiastically.
“Hey listen, I’m working the next few days, but I’ll see you sometime next week, okay?”Kylie nods as she skips away with her trophy to her dad. I wish I had a regular schedule with the group classes, but balancing my three coaching shifts with my ICU shifts every week is tough, so I’m not always working the same days.
Once all the kids have gone, I seek out one of the other coaches to hit around a little. I can never resist the chance to play some tennis, and neither does David.
“Hey, David!” I call, hustling toward him. He smiles at my greeting. “Wanna rally?”
David moved from Spain to the US to play in college and is as crazy about tennis as I am.
“Always!” he replies eagerly.
We split the first two sets, and decide to play best of three. My competitive spirit takes over and by the end I’ve won the third set and am thoroughly covered in sweat, exhausted but flooded with endorphins.
“Good game,” I say as I shake his hand over the net.
David shakes my hand but also offers some good-natured ribbing. “Next time, I’m not going to hold back, Kumar,” David threatens. “Be prepared.”
With his lilting accent, he sounds anything but menacing, even when calling me by my last name. We both laugh as we walk off the court. I have to eat something and get some rest because I’m back in the ICU tomorrow.