“We still on for dinner at Ethan’s tonight?” Cameron asks me in the residents’ lounge as we both catch up on paperwork.
“Yup,” I answer, not looking up from the pile of charts I’m updating. I stifle my yawn. “After I sleep for about twelve hours today, I’ll be ready for some serious drinking.”
“I heard that,” he says, slapping my arm on his way out of the room.
I look at the clock on the wall. 6:00 AM can’t come fast enough. As residents, we are assigned one weekend per month when we’re on call from Friday night through Sunday morning. Makes for a long damn weekend.
My oldest brother, Ethan, invited me over for dinner and some much-needed drinks. My other brother, Chad, will also be there. They are both married, so when we get together I usually try to bring Cameron with me just to make an even number.
My pager goes off, so I close the chart and carry the pile with me back to the ER.
Jessica hands me Elizabeth Smith’s chart. “All of her test results are in,” she says.
“Thanks.” I flip through the results, going over her blood work, which looks normal. When I see her ultrasound findings, however, I blow out a deep sigh. “Did they go over it with her yet?”
“Nope. OB was backed up, so they sent a sonogram tech down to do the ultrasound.”
“Right.” That means Elizabeth hasn’t been told anything. Techs aren’t allowed to reveal results to patients. “I’ll go tell her now. Can you please gather some literature on her condition for me, along with whatever you can find for pregnant women in need of assistance?”
“Right away, Dr. Stone.”
“And, Jessica? I’d prefer it if in the future, you don’t ever refer to patients as indigent. At least not in front of them.”
“I didn’t—”
I hold up my hand. “I know you didn’t say it about her, but it was inferred. Just please don’t let it happen again. Their dignity is already compromised when they are sick and in need of medical care.”
“Sorry, doctor,” she says. “I’ll go get that information right away.”
I don’t know if this patient is homeless or not. On the surface, it doesn’t seem like it. She’s clean, put together, and she doesn’t have any belongings with her other than her purse. Then again, people have a lot of pride. She might just be good at hiding it. It’s possible she could be newly homeless, kicked out by a husband who didn’t want a child. Or maybe she’s living in a shelter. New York City has a lot of shelters for women, and pregnant women would be taken as priority.
I consult with Dr. Manning and then take a breath before I enter the exam room to give Elizabeth the bad news.
“Ms. Smith, I have the results of your tests.”
She looks up at me wearily. She looks exhausted. She looks scared. And I’m about to make her day a whole lot worse.
“Your blood tests were all normal. That means you didn’t lose enough blood to have consequences for you or the baby. And the good news is that according to the ultrasound, the baby is right on track for thirty-two weeks. It looks completely healthy.”
Her hand comes up to her mouth, where she chews on the nail of her pinky finger. Looks like something she does when she’s nervous. She takes it out for a second to ask me a question.
“What’s the bad news?” she asks. “Whenever someone says ‘the good news is…’ that means there’s bad news, too. Am I in labor?”
“No. You aren’t in labor. We had you on the fetal monitor for two hours and didn’t detect any contractions. However, the ultrasound did alert us to a condition that would explain your bleeding. You have what is called placenta previa. What that means is the placenta is attached down by your cervix. There are varying degrees of placenta previa. Yours is called partial previa because the placenta doesn’t cover the entire cervix, just a portion of it.”
“But the baby is okay?” she asks, chewing on her nail.
“Yes, the baby is fine right now. But there are potential dangers with this condition, and you’ll have to deliver via C-section.”
She gasps in horror. “C-section?”
“It’s a relatively safe procedure, and in your case, much safer than a vaginal delivery.”
She closes her eyes. “But a lot more expensive.”
“You can’t worry about that, Elizabeth. Having a healthy baby is the only thing you should be concerned about. And that means taking care of yourself. I feel comfortable discharging you because the bleeding stopped and you aren’t showing any complications. But you’ll have to take it easy. Stay off your feet as much as possible, refrain from sex, and don’t put anything in your vagina. And come back if you experience more bleeding.”
“Stay off my feet? I’m a dog walker. That’s just not possible.” Her head slumps and her chin falls to her chest in defeat. “How will I make money? I won’t be able to afford this as it is.”
“Staying off your feet is imperative to your health as well as the baby’s,” I say adamantly. “You’ll have to coordinate more frequent check-ups with the clinic. I’ll send you with your records so they can go over them. Jessica will provide you literature on your condition as well as forms for getting possible aid through government programs.”
“I can’t get any aid,” she says.
“Everyone who needs it can get aid.”
“I can’t,” she says.
“Why?”
Jessica comes in with Elizabeth’s discharge papers and an armful of pamphlets. I pull out my business card and write my cell number on the back before I hand it to our patient.
“Here’s my card. My personal number is on the back. I’m available twenty-four-seven.” I point to the literature Jessica put on the side table. “Follow those instructions, Elizabeth. Jessica will get you ready for discharge and answer any more questions you might have. If you need me to explain anything else, have Jessica come get me. I’m here all night.”
I step over next to her bed and put my hand on her trembling arm. “Take care of yourself, okay?”
She nods and mumbles words of thanks before I walk out of the room.
I think about how I love being an emergency medicine doctor. I love everything about it except one thing. We don’t have the patient follow-up that most other specialties have. Patients come into the ER and we treat them, but then they either go home or get admitted. We rarely get to hear about outcomes.
But the excitement, the adrenaline rush of being the first to deal with the carnage that comes our way, the multitude of procedures we get to perform ‘on the fly,’ far outweighs the lack of patient relationships that goes along with working in emergency medicine.
I think.
Damn it. Sometimes I hate my job for the very same reasons that I love it.
An hour later, when I’m paged back to the ER for a gunshot wound, my hands wrist-deep in a gangbanger’s abdomen until a trauma surgeon can be paged, I remember why I chose this specialty. And I completely forget that I haven’t slept in almost two days.