Meet me on 5 south for a new consult.Īm I supposed to run? she wondered. No, it’s not a code. Simi would have said if it was a code. Right? It had taken less than two hours from start to finish for the whole thing to happen. One minute she was in the call room not sleeping. Staring at the ceiling. Wired from the 8pm cup of coffee and also the terror of being on call for the first time overnight in the ICU. She had practically levitated at the sound of her pager going off, and her heart rate, already clipping along in the 90s, rose to the 110s as she read the page from Simi, the critical care fellow. The patient is a 68 year old male with metastatic gastric cancer, initially admitted with bright red blood in his stool. She rubbed her eyes to clear them, then repositioned her fingers over the keyboard, pausing as she tried to gather the right words. The opening lines of her admission note swam and blurred in front of her. Those practice sessions had felt real and useful at the time, but now she realized how woefully inadequate they were. She realized how woefully inadequate she was. Use simple language and be direct. Don’t be afraid of silence. She had practiced for this. In standardized encounters in medical school and patient simulations during residency orientation, Ella had learned all sorts of tips and tricks for this situation. Find a quiet place with no distractions. There was so much work to do: an admission note, an event note, a discharge note, check the midnight labs for the patient in 475, check to see if the patient in 360 needed to have his furosemide re-dosed. She was so tired. What she should be doing, needed to be doing, was focusing on the tasks at hand, but instead her mind kept wandering between half-formed explanations and wordless apprehension. Every second was an eternity, but ten minutes passed in the blink of an eye. As Ella waited for the phone to ring, trying to decide what she would say when the moment came, she felt acutely how terrible it was to be caught, trapped, between the world of knowing and not knowing. The impending collision of these two worlds was imminent- the next ringing of the phone would be the warning shot- and not knowing exactly when that would be was its own type of torment.
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