Chapter 40
First On-Call
The permits for private work had been signed but hadn’t come through yet. What did arrive was a call from the hospital reminding me I was on duty that evening. The closer my shift drew, the more nervous I became.
The thought that in just a few hours I’d be responsible for the ER and a significant number of the hospital’s patients made me restless.
It’s no small thing to be the only “fresh” doctor in a hospital where, as everyone knows, things can turn dramatic fast. The first thing you learn in clinical work is to call for help when something happens.
In a big center, within seconds you’re not alone; here it could take a long time – even though “everything’s five minutes from the hospital.
” Five minutes is an eternity in medical terms. And what if the on-call senior is in the shower?
Does that double, triple, or quadruple the response time?
Why isn’t there an in-house on-call? Are they that stingy – or is their staff just that good?
I even thought about phoning the department head at New-Hope Medical Center and asking what to do “in case of.” That’s how anxious I was.
What if a couple of ambulances showed up from all over after a bus-on-bus crash?
This really isn’t for me, I thought, as the jitters started nesting in me.
All this for a few dozen lira a day – so why?
Why did I agree? Questions raced through my head.
I paced everywhere like a caged lion. At some point – I honestly don’t remember how – I found myself in the hospital lobby at exactly seven in the evening.
“I’m Michael, the night on-call doctor,” I introduced myself to the nurse on duty.
“Dr. Whitney?”
“Yes. I prefer Dr. Michael…”
“Dr. Lahav is on his way. He’ll take you around,” she said, giving me the once-over.
I was used to those looks by now. I knew she didn’t believe I was the doctor.
My baby face did me no favors in my early days.
More than once, after I’d examined a patient in New-Hope Medical Center’s ER, made the diagnosis, treated them, and written the admission or discharge – either the patient or a family member would ask, “So when is the doctor coming?”
The emergency room was completely empty. All the curtains were drawn back, exposing empty beds. The waiting area was deserted too.
“Dr. Lahav, this is the new doctor. He’s on tonight,” the nurse introduced me. He was in his white coat, stethoscope looped around his neck.
“Aaron,” he said, extending a hand.
“Michael,” I answered, and we shook hands.
“Let’s go through the wards, then we’ll come back to the ER.” He was all business.
I don’t recall how long the “round” took – the handover routine between shifts.
We went through all the departments, but when we reached Internal Medicine, something made me slow down.
Turned out the most critical patient in the ward was about thirty, suffering from an undefined autoimmune disease.
She was unconscious, intubated, and until recently had been receiving dialysis.
The monitor showed a completely regular heart rate and respiration.
“Her condition is extremely grave,” Aaron said. “Even her family understands by now that she has no chance. They’re all waiting for her to take her last breaths.”
“She looks so young,” I said.
“Yes, the disease hit her relatively early. She had arthritis in the past, and deteriorated into severe renal failure. She was hospitalized at Parkview Medical Center, and now they’ve brought her here, near home, to ease things on the family.
” He filled me in on her medical history and current condition.
The encounter set off an explosion in my head. I don’t know how I managed to look like I was listening and actually take it in. I suppose if it had been daytime, they would’ve sent me to the ER for observation.
I couldn’t stop thinking about Lily. Aaron was basically describing her, her illness – and here I was, meeting reality, and maybe the future. The patient was close to Lily’s age too. I tried not to react, but I couldn’t help it.
“Can I get a glass of water?” My throat felt parched. I gripped the bed’s side rail and sank into a chair.
Aaron asked the nurse with us to bring water, and as soon as she stepped out, he asked if something had happened.
“No,” I lied, “I just don’t think I’ve drunk enough. I’m still not used to this brutal heat.”
“In a few days, you won’t feel it,” he tried to reassure me, like everyone else.
“I’ve heard that already. I’m still waiting. Tell me – what’s she getting?” I asked after a few swallows of cold water and some deep breaths.
“Everything we’ve got. Mainly steroids, in industrial quantities. There’s nothing more to give.”
Lily was also left on steroids alone – another rogue thought darted through my head.
“And the final diagnosis?” I asked.
“Her family brought in physicians from Jerusalem Med-Center – names I’ve only seen in the journals. They examined, probed, and ordered tests, but had nothing to add. Everything’s shut down in her. Have you heard of vasculitis?”
I thought I might faint. I nodded a few times.
“If, God forbid, she deteriorates, don’t call the on-call senior. The family knows,” he concluded. He must have sensed something was bothering me – that something tied me to this patient in particular – or maybe he just figured I was anxious about the night.
Before I left the room, I threw her one last glance, turned, and moved on, pretending I’d left it behind me.
By eleven p.m. I’d seen a few routine cases, no tougher than the ones in the morning army clinic.
None had referrals. The rhythm of work made me forget the patient in Internal.
Around eleven, the curtains around the beds were pulled back and the ER was empty again.
No one had been admitted. I managed to discharge them all home.
“Are you the new doctor?” asked the night nurse who’d just come on.
“Yes – Michael,” I said.
“Gali,” she replied. “I was just with the critical patient – she’s calm.”
“I have to go see her.”
I couldn’t resist the inner pull to look in on her again.
On the way, I thought about Lily, who must have gone to bed. I realized I hadn’t spoken with her since I got to the hospital. She knew I was on call and hadn’t phoned. It was close to midnight, and I didn’t want to wake her.
Will she look like this in a year or two? A dark thought flashed through my mind. I pictured the scenario my friends had sketched before my wedding as about to come true – this time in full, raw reality.
I did the math again: last September, she’d been given two years. Almost a year had passed, so one year remained. Just one year – God! It was unthinkable. It can’t happen. Not to my Lily. We’re together forever – and we will prevail.
Over the past year, you could hardly tell Lily had any health problems. She behaved completely normally. True, on the stairs I sometimes helped her – but only when I was there.
Those were her only symptoms. We didn’t go for morning runs or long walks, but we lived like any couple, with no real limitations.
The monitor above the patient’s bed showed exactly what I’d seen at the start of the shift. The IV was dripping properly, her breathing was spontaneous, so the machine she was connected to barely engaged. I held her wrist to feel the pulse – weak, but regular.
She looked very still. Her eyes were closed, with an ointment smeared over them to prevent sticking and infection. Her blood pressure and temperature were normal. There was nothing for me to do there, so I returned to the ER.
“I’m heading downstairs to try to sleep. Call me the moment anyone arrives,” I told Gali.
“Are you sure? Some doctors ask not to be woken unless a few patients pile up.”
“I know – but please wake me as soon as anyone walks in.”
“Yes, sir!” she said with a smile and a mock salute. Her husband was a senior NCO, and she knew I’d come from that world too.
I went down to the room set up for sleeping. When I got into bed, I realized it was the first normal bed I’d gotten into in four nights.
The phone ringing woke me, and I jolted awake.
“There’s a five-year-old boy here with a fever of 41.5,” I heard Gali on the line.
“I’m coming up.”
It was two in the morning.
“How long has he had the fever?” I asked the anxious mother as I entered the ER.
“Since last night.”
“Has he vomited?”
“No.”
“Is he taking anything?”
“No – just gave him acetaminophen.”
“Did you go to the clinic?”
“Yes, yesterday. The doctor said if the fever gets high and I can’t get it down, to come back.”
I examined the boy gently and saw that his tonsils were coated with white follicles.
“He has acute tonsillitis,” I told her.
The penicillin skin test Gali did was negative. She gave the injection and a fever-reducing syrup. I asked that he not be discharged yet and that she keep monitoring his temperature, and I went back down to rest.
A pounding on the door jolted me awake. I wondered why no one had phoned. I got up and opened.
“Come quickly to the ward,” said a voice from a figure I didn’t recognize.
“Did something happen? Why didn’t you call?” I rubbed my eyes.
“You didn’t answer,” the messenger apologized. “The patient in Internal is showing signs of agitation,” she added.
I splashed water on my face and flew up the stairs to the ward, to her room.
Two men I didn’t know were by her bed. I asked them to step outside.
“A few minutes ago, the monitor started beeping. The pulse was fast and irregular,” the ward nurse said.
“What did you do?”
“I checked all the connections – everything was fine. Blood pressure was 60 over 100. I asked the nurse in the Maternity Ward to call you.”
“Good. Give me isoproterenol,” I said. The tracing showed a supraventricular arrhythmia.
Before I could push the isoproterenol through the IV, the patient began moving her limbs involuntarily.
I struggled with her so I could hold the IV arm steady – keep the vein open.
She nearly overpowered me. The nurse brought a bandage, and together we tied that arm to the bed.
Suddenly the patient calmed down, but her heart rhythm remained irregular. I injected the isoproterenol. Its effect was almost immediate. The rhythm returned to normal, but I was still uneasy.
“Call the on-call physician,” I said.
“Are you crazy? She’s terminal.”
“I don’t care. Get him here,” I ordered the two nurses in the room.
The nurse from the Maternity Ward stepped out.
“He’s on his way,” she said when she came back a few minutes later.
The patient’s condition was stable: fast, regular pulse; BP 55 over 85. But I felt something wasn’t right. I stayed by her.
“What happened?” the on-call asked as he entered.
“Something’s going on. Her blood pressure dropped, she had a supraventricular arrhythmia that responded to isoproterenol, then she had involuntary limb movements. We tied down the IV arm.”
“She’s bleeding,” he said after examining her.
“From where?”
“I’m not sure – maybe the intestines…”
Before he could finish the sentence a jet of black vomit erupted from her mouth like a fountain.
“She’s bleeding into the stomach.”
“Order blood?” the nurse asked as she wiped her face.
“Yes. And call in the lab on-call immediately.”
Just a few hours earlier Aaron had told me she was terminal and not to call the on-call – yet now the on-call was preparing to make every effort to resuscitate her.
For what – just to extend her suffering? I thought.
“We have to do everything to keep her alive,” he said – apparently reading my mind.
“I know – and I think you’re right,” I said, backing his lead.
I watched him keep trying everything to save her.
“Run saline wide open so we can maintain BP until the blood gets here,” he ordered.
I opened the IV roller clamp. The flow roared.
Her pressure kept falling and the rhythm again turned fast and wildly irregular.
Suddenly, without warning, a flat line appeared on the monitor.
She lay motionless. Instinctively I climbed onto the bed and began chest compressions.
I felt her ribs give under my hands – some surely cracked.
Whenever I stopped pressing, the monitor line went flat again.
I was failing at compressions, but there was one last chance: electric shock.
Only when I heard the defibrillator had arrived and was ready did I jump down. Even five shocks one after another didn’t help.
“That’s it – she’s gone,” he said. The screen showed a flat line. “I’ll go tell the family.” I followed him, stunned. It had happened so fast.
“She passed away. I’m sorry,” he told the two men, who had already understood from our faces what had happened.
“I’m sorry,” I said to them as well – the brother and his friend. The brother took it with restraint, at least while the department head and I stood there. Only when we stepped away did I hear him cry.
When I came back a while later, I heard the brother say, “The Lord gave and the Lord has taken away; blessed be the name of the Lord.”
“Amen,” I said. “May her memory be a blessing.”
The images of the patient in her final moments – and after – and her brother’s noble bearing accompany me to this day. Not infrequently, they blend with my own personal memories.
Death is, obviously, a mysterious matter, and people’s reactions to it vary widely.
Some express themselves with extraordinary intensity – not only crying or shouting, but sometimes even climbing into the deceased’s bed, hoping that maybe, just maybe, life will return for a moment.
Yes – for a fleeting moment. The sense of a person’s sudden disappearance is inconceivable.
Often, I also ponder the verse “The Lord gave and the Lord has taken; blessed be the name of the Lord,” and I can’t grasp its meaning.
I can’t accept that the reasons for death, when it comes, are known only to God.