Bellevue

Chapter 7

Monday, July 1, 6:35 p.m.

Mitt pushed his food tray forward on the stainless-steel railing that ran along the front of the glass-enclosed cafeteria food service line and stopped at the drink offerings. Back at the main-course selections he’d chosen meat loaf and mashed potatoes, and the aroma drifting up from his plate was making him salivate. A few hurried bites of a bagel that morning in his apartment had been the only food he’d had all day, and he was understandably starved.

The last forty minutes of his first surgical case as a resident had gone reasonably well. As planned, after Dr. Rodriguez and Dr. Wu had closed the abdomen’s midline incision with wire, he and Dr. Wu had closed the subcutaneous layer with gut sutures. Dr. Wu had placed the first two, then handed the needle holder to Mitt. Self-conscious under the supervision of two more senior residents, Mitt had struggled to a degree but managed to imitate Dr. Wu’s placement for his first suture as a resident. When no one said anything to make him question what he’d done, Mitt fumbled with tying the knot. With commendable patience despite the length of time the operation had been going on, Dr. Rodriguez instructed Mitt on the proper technique and how to keep tension on both ends of the suture while running down and securing the second tie.

After observing the placement of several more subcutaneous sutures, Dr. Rodriguez followed Dr. Washington’s lead and left the OR. From then on, Dr. Wu watched Mitt finish with the subcutaneous level and begin the silk sutures for the skin.

“Try to roll your wrist when placing the skin sutures,” Dr. Wu had suggested, and she demonstrated what she meant. “The idea is to close the skin by just having the edges come together so as not to pucker out or roll into the wound.”

“I get it,” Mitt had said. When he’d finished, the skin edges were just “kissing.”

“Not bad,” Dr. Wu had said.

When the case had finally been over, Mitt hung around at Dr. Wu’s suggestion to help the nurses and the anesthesiologist move the patient onto a gurney for the trip to the Post-Anesthesia Care Unit, or PACU. By that time, the patient was awake and responding to his name and his vital signs were normal. Once in the PACU, Mitt also participated with Dr. Wu in writing the postoperative orders.

A few minutes later, while staring at his clothes hanging in his open locker, Mitt made a sudden decision not to change but rather merely to put his white coat over his scrubs. He had no idea what the evening and night would bring, but he thought he’d be more prepared in scrubs, come what may. What he was secretly hoping was that he would be able to get some rest, and he thought the scrubs could serve a dual function as pajamas as well as hospital work clothes.

When he’d finally left the operating suite, hunger pains forced him to head to the cafeteria before going around to introduce himself at the various inpatient wards as well as locate the three patients he needed to work up. No matter what, it was going to be a long night, and he definitely needed calories to face it.

“Can I help you?” the food service woman said, seeing Mitt pause before the drink selection apparatus.

“Thank you, but I’m just having trouble deciding what I want,” Mitt said. The choices were legion: all manner of soft drinks, various types of milk, and sparkling and still water. Although he didn’t usually drink sodas due to their overabundance of sugars, he thought a bit of caffeine in a cola might stand him in good stead as he faced his first night on call. Deciding on a diet cola, he proceeded to fill one of the large paper cups. Since the dispenser functioned so quickly, the cup brimmed before he was ready, and a small amount spilled over the top.

“Oops, sorry,” Mitt said to the food service woman standing behind the counter and watching him.

“Not a problem,” the woman said. “It happens all the time.”

Still feeling like a klutz, Mitt lifted the overfilled cup and placed it on his tray. Letting go of the cup, he was about to push the tray on to the dessert selection when the full cup of cola tipped over, flooding his entire tray with soda, including drenching his meat loaf and mashed potatoes.

“Oh, shit!” Mitt said by reflex before remembering where he was. With a sense of shock, because this had happened although he had not yet touched the tray, he reared back with his hands raised at chest level as if he expected the tray itself to do something equally unexpected.

Having witnessed the accident, the food service woman immediately came out from behind the cafeteria counter to lend a hand. “Not a problem,” the woman reiterated graciously. She used a dish towel that she had slung over her shoulder to sop up some of the cola from the brimming tray before taking it to the nearby soiled-dishes window.

Although Mitt had lowered his hands, he hadn’t moved, feeling dumbstruck as his mind replayed the episode. Had he touched the tray? He must have to cause the cup to tip over, yet he was certain he hadn’t. Was his mind playing tricks on him? Was his blood sugar that low from not having eaten anything for twelve hours? Even more unnerving, the incident reminded him of the curious forceps episode in the operating room.

Stepping back to get out of the way of people moving along the food line, an embarrassed Mitt watched a janitor who had appeared with a mop clean up the small amount of cola that had spilled onto the tiled floor. A moment later the food service woman pressed a clean tray into his hands and directed him back to the beginning of the cafeteria line.

The next time Mitt stepped in front of the drink dispenser with the new tray and a second serving of meat loaf and mashed potatoes, he made certain to fill the cup far short of the brim. This time he put the cup on the tray and let go of it slowly, watching it intently, ready to grab it if it showed any inclination to tip over on its own accord. As expected, it stayed perfectly upright, making him believe he must have inadvertently and unknowingly hit the previous cup. Attributing the entire episode to a combination of fatigue and hypoglycemia, he moved on to the dessert section. He wasn’t a big dessert guy, but having no idea when he might eat again, he decided on a wedge of apple pie.

Picking up his tray, Mitt scanned the room. It was moderately crowded, reminding him that Bellevue Hospital was a huge operation 24/7, with a support staff of over five thousand people, including more than a thousand doctors, one of which he was for the next two months. After spotting an empty table against the far wall, he headed toward it. He wasn’t being asocial. His plan was to wolf down his meal and get started on his evening’s work. He was well aware that doing three admission workups would take considerable time and effort, and that job was on top of being on call. He really had no idea of what the evening’s demands were going to be and whether he was up to the challenge. In short, he felt nervous as hell.

“Excuse me,” a cheerful, clear voice said about twenty minutes later, halting a forkful of apple pie en route to Mitt’s mouth. He looked up into a tanned oval face framed by a nimbus of remarkably curly blond hair. Her surprisingly dark eyes were bright in contrast to her hair, and her expression was cheerful but questioning. “Are you Michael Fuller?”

“I am, but I prefer Mitt.”

“Fine and dandy, Mitt,” the woman said agreeably. Like Mitt, she was dressed in scrubs overlaid with a doctor’s white coat. She was holding a tray of food. “Mind if I join you?”

“Of course not,” Mitt responded immediately. By reflex he started to get to his feet.

“Don’t get up!” the woman commanded. She put her tray onto the table and took the seat across from Mitt. “My name is Madison, Madison Baker. I’m a second-year surgical resident along with Nancy Wu, who you met this morning.”

“Yes, we were on a case together.”

“So I heard. I also heard it went on a little longer than planned. I’m afraid you experienced a bit of trial by fire. Dr. Washington, bless his soul, isn’t the easiest person to get along with.”

“He and the scrub nurse weren’t seeing eye to eye.”

“So I also heard. Not unusual. He has a reputation for flying off the handle when things don’t go smoothly and then blaming everybody but himself.”

“That doesn’t surprise me,” Mitt said, trying to be diplomatic.

“Please,” Madison said, pointing at Mitt’s apple pie. “Don’t let me keep you from your dessert.” She then picked up her knife and fork and started to work on a pork chop on her plate. “I wanted to meet you because Dr. Van Dyke told me you were on first call tonight. I’m on call, too, so I’m your backup so to speak. We have a handful of ‘sickies’ sprinkled around the wards and in the ICU, so you might not get a lot of shut-eye. I hope you are prepared.” She took a bite of her meat and started chewing, giving Mitt a chance to respond.

“I have three workups to do,” Mitt said, more as explanation than an excuse.

“Yes, I know. But you should have time to get that done. No problem. During the early evenings, there are a lot of residents around, finishing up for the day. Same with a handful of attendings who do their hospital rounds after their office hours. If nurses have questions or problems, they turn to whomever is available. That will save you from running around doing stupid, insignificant stuff. Remember, the nurses here are an impressive group, which isn’t surprising since there’s been a nursing school at Bellevue for a hundred and fifty years. Anyway, are you interested in a bit of advice from someone who’s just finished her first year?”

“Of course,” Mitt responded. As nervous as he was, he could use all the advice he could get.

“With these admission workups, don’t take the time and energy to do a full medical school workup, like finding out what disease their maternal great-grandmother died of. Do you know what I’m saying? These patients have already been worked up to the nth degree and it will all be in their electronic health record, which you will have access to. Your job is to make sure that something hasn’t come up since they’ve last been seen in clinic that would make their imminent surgery problematic or contraindicated. For example, like they’ve developed a sore throat or a sudden fever, or, God forbid, you feel an enlarged liver that’s not in the EHR. Do you get my drift?”

“I think so,” Mitt responded. What she was saying about medical school workups rang true: All of his had literally taken hours and included very detailed medical histories.

“You can do a good admission workup in twenty minutes, a half hour tops, unless, of course, you find something abnormal and not already documented. If you do, the attending surgeon has to be called immediately and apprised.”

“I think I get it,” Mitt said. Her advice made a lot of sense. He was beginning to feel a modicum better about facing the night. Her confidence was encouraging. She’d obviously learned a lot in her first year of residency. Mitt could hope he’d be in a similar position a year from now.

“I also encourage you to go around and introduce yourself to the various head nurses. The more they know you as a person, the better off you’ll be. You can learn a lot from the nurses. Believe me!”

“I was planning on going around introducing myself,” Mitt said. “My partner, Andrea Intiso, advised the same.”

“Good advice! I see you’ve finished your pie, so don’t let me hold you up. I’m sure we’ll be seeing each other during the course of the evening. I assume you have a key to one of the on-call rooms.”

“I do.”

“Perfect. You might not have a chance to spend too much time in it, but at least it is there. Good luck.”

“Thanks,” Mitt responded. He stood up and lifted his food tray. “And thanks for seeking me out and offering the advice. I appreciate it.”

“You’re welcome. Try to remain calm. You’ll get through this.”

Mitt nodded and smiled, but it was a nervous smile. His intuition was sending warning signals that he was in for a struggle, and from experience he knew his intuition was rarely wrong.

After depositing his soiled tray at the appropriate window, Mitt left the cafeteria and walked to the elevator bank. His plan was to head up to the seventeenth floor, where the surgical inpatient rooms were, meet the head nurses, then do the same on the sixteenth and fifteenth floors before heading down to the tenth, where the surgical intensive care unit was located. In the process he’d find out the location of the three patients whose histories and physicals he needed to do. Well, maybe he would skip the ICU.

When the elevator arrived, Mitt was relatively surprised to find it almost full, not with house staff and nurses but with people of all ages, from crying babies to the elderly. As he squeezed into the cab, it dawned on him that it was the middle of normal visiting hours. Thanks to the crowd, the elevator stopped on almost every floor, but by some strange coincidence, by the time it reached seventeen, he was the only passenger still in the car.

As the doors slid open, Mitt hastened off but immediately froze in his tracks as though he had collided with a brick wall. But what stopped him wasn’t a physical impediment; he was assaulted by the worst and most nauseating smell he’d ever experienced. It was so bad it defied description, and he literally retched. Mitt clasped a hand to his mouth and pinched his nostrils shut to keep from vomiting. It was as if he’d been dropped into an open sewer, pungent and fecal.

Rapidly, his eyes darted around in search of the source of the revolting stench. But he saw nothing amiss. In the distance he could hear the normal sounds of a hospital. And then, as quickly as the smell had assaulted him, it dissipated as if a sudden wind had blown it away. But there was no wind.

Momentarily stunned, Mitt took in a few cleansing breaths as he continued to glance around the immediate area of the elevator lobby, still searching for an explanation. Seeing nothing abnormal, he carefully moved forward, watching where he was placing his feet lest he step in something revolting. Reaching the point of the intersecting hallways, he was able to see in three directions. The building’s footprint was a huge square, with the patient areas divided into the points of a compass, 17 East, 17 North, 17 West, and 17 South. All the patient rooms were on the building’s exterior, with windows, while all the support spaces were on the interior.

In every direction from where Mitt was currently standing, he could see snatches of busy, normal hospital activity with uniformed staff darting in and out of sight. He even spotted several food carts being pushed past his line of vision, announcing that it was the dinner hour in addition to visiting time. But most important, there was no explanation for the fleeting, horrid smell. None whatsoever. But as weird and revolting as it had been, at least it was gone.

For a few minutes Mitt remained where he was, struggling to make sense of what he’d experienced... or thought he’d experienced. Since there was no obvious source for the disgusting smell and the odor had vanished so quickly and completely, he wondered if perhaps his tired, overwrought mind had somehow managed to dream it up. Such thoughts begged the question: Was he having an olfactory hallucination? He had no idea but that was the only explanation his tired mind could conjure. He recalled the issue had come up in his medical school third-year neurology rotation. Like a host of other random facts that cluttered his brain from four years of medical school, he somehow remembered such an episode was called phantosmia. How he remembered, he had no idea, but he even recalled that a particularly strong phantosmia had its own name: cacosmia. With a shake of his head in mild disbelief, he thought that maybe he’d had his own cacosmia. If so, it was certainly a first.

Mitt took a couple more deep breaths to fortify himself and set out eastward, down a long hallway, toward one of the nurses’ stations. Each inpatient floor had two such nurses’ stations, one in the east wing and one in the west. He knew it would not be difficult to find because it was literally in his path, serving half of the patients’ rooms on the seventeenth floor. As he headed in its direction, he marveled at how different the new Bellevue was from the old. In the old Bellevue, of which he’d seen pictures, particularly in a terrific Bellevue Hospital history book titled Bellevue, which he’d read that very June, the patients were crammed cheek by jowl into large, elongated wards with beds lining both walls and common latrines. The new Bellevue had a variety of room sizes but mostly sextuplets, with a fewer number of triplets and even some singles. The predominant number, six, had been a compromise between the Bellevue Hospital administrative planning board and Medicare and Medicaid demands. Of course, the real luxury was that each room had its own bathroom, a striking innovation for a public hospital.

The nurses’ station that Mitt approached was a beehive of activity. It was defined by a white laminate counter that formed an enclosure of approximately twenty-by-twenty feet. There were two entrances to this command post, which had a bank of video screens hanging from the ceiling, displaying patients’ vital signs. A host of computer monitors sat on the interior wraparound desk, and every single one was currently being used by an attending physician, a resident, or a nurse. People were scurrying in and out.

It was easy for Mitt to pick out the head nurse. She was acting like a traffic cop at a busy intersection or a conductor in the middle of a symphonic performance. He approached her directly but had to wait for her to deal with several nurses and aides before she acknowledged him.

“Can I help you?” she asked, her rapid, commanding tone befitting her role. She was a sizable Black woman with a striking hairstyle of lots of short braids.

“I just wanted to introduce myself,” Mitt said self-consciously. With so many staff members within earshot and such a tumult of activity, the last thing he wanted to do was draw attention to himself. “My name is Mitt Fuller. I’m a new first-year surgical resident, and I was caught in surgery all day, so I haven’t met any of you evening-shift nurses.”

“Well, glory be,” the head nurse said, putting the backs of her hands on her hips and eyeing Mitt with surprised appreciation. “What a thoughtful gesture, Doctor. My name is Kaliyah Wilson. Everyone calls me Kay. I’m pleased to make your acquaintance. Welcome to the team.”

“Thank you,” Mitt responded. “I also want to warn you and your colleagues that I’m on call tonight, my first night. I hope I’m up to your expectations, come what may. I’m a bit worried that medical school didn’t train me very well in practical terms.”

“You’ll do fine,” Kay scoffed, giving Mitt a small wave for emphasis. “Relax! There’s always a bit of adjustment, and we nurses often joke about July first being dangerous. But I like your attitude, as I’m sure others will, too.”

“I also wanted to ask if perhaps Ella Thompson, Roberto Silva, or Bianca Perez are here on seventeen? They were admitted this afternoon, and they need admission histories and physicals, which I’ve been tasked to do.”

“Nope, they’re not here with us. We only had one admission today, and it wasn’t any of those three, but I can tell you where they are.” She leaned forward and typed the names into the computer directly in front of her. “Okay,” she added a minute later while straightening up. “Thompson and Perez are on Fifteen East and Silva is on Fifteen West.”

“Thank you,” Mitt said before stepping out of the way. There were now several other people vying for her attention.

Leaving the central desk, Mitt headed back the way he’d come and then over to the west side of the building to stop in at the floor’s second nurses’ station, where he repeated his introduction. Again, it went as well as it had with Nurse Wilson. With the seventeenth floor taken care of, he sought out a stairway, thinking that would be the fastest way to get down to the sixteenth floor, where he intended to repeat the process of introducing himself.

A stairway was easy to find, as it was clearly marked with a red illuminated Exit sign, but before he entered, he checked to see if the door was locked from inside. It was good he checked because it indeed was locked. Had he used the stairs, Mitt would have had to go all the way down to the first floor to exit, which he was obviously loath to do. Instead, he headed back to the bank of elevators just to go down a single floor.

As he approached the elevator lobby at the end of the long hall, he braced himself in case he was assaulted by the same phantosmia he’d experienced earlier. Luckily he wasn’t.

With a bit of relief, he joined a handful of visitors who were waiting for an elevator to arrive. A few of them eyed Mitt, obviously recognizing that he was one of the doctors from his white coat and scrubs. He imagined they were duly impressed, which made him feel strangely proud. At the same time, he was glad they had no idea of all the uncertainties he felt.

When he boarded the crowded elevator, he felt self-conscious pressing the sixteenth-floor button, as it seemed ridiculous to be using an elevator to go one floor. But he need not have bothered because when the doors opened on the sixteenth floor, there were a number of people waiting, meaning the elevator would have stopped anyway. Mitt had to push through them in their eagerness to board.

For a few minutes after the elevator departed, Mitt remained standing in the now-empty lobby for fear he might have to face another horrid olfactory hallucination like up on the seventeenth floor. Hesitantly he sniffed the air as he glanced around the immediate area. Only after it seemed apparent he wasn’t going to be reassaulted did he allow himself a few normal deep breaths. Reassured, he then started forward, once again heading eastward to mirror what he’d just done upstairs.

As he walked, his mind jumped ahead. Assuming his sixteenth-floor visit would be as quick as the one to the seventeenth had been, he’d soon be facing his three admission histories and physicals down on the fifteenth floor. He found himself particularly thankful for Madison’s suggestions. Had she not made them, he would have done medical school histories, which would have taken many, many hours. Mitt was hopeful he could get back to the on-call room for some rest before he had to face whatever it was going to be as “the first line of defense” for all the needs of all the surgical inpatients.

As Mitt approached the busy sixteenth floor east nurses’ station, he found himself wondering if he was going to be lucky that night and not have to face a complicated clinical problem that he was ill-equipped to handle. Regrettably, as soon as the question formed in his mind, his precognitive abilities suggested he was not going to be lucky, and the disturbing thought was combined with a bit of his characteristic tingling. All in all, it was not an auspicious omen.