Omar
My month on outpatient service went ok. It reinforced what I already knew about myself, I did not have the aptitude to see 40 patients a day in clinic, then go home and finish clinic notes. I did realize, though, how important preventive care was. Its no joke when doctors keep beating the drum about getting that mammogram done to look for breast cancer in women, or annual checkups to make sure there are no signs of prostate cancer or colon cancer in men.
That said, my current ICU rotation was where I truly felt at home. This was my domain, my comfort zone where the itch to use my hands to save people's lives was satisfied. In the last couple of weeks I had done everything from emergent intubations on dying patients, to doing bedside drainage of lung fluid and placing people of the heart-and-lung-bypass machines.
And all that wasn't even the best part of it.
A certain resident was.
"Hey Omar." Jake whispered stealthily to me as we both sat in the resident's room putting in our patients' orders after morning rounds.
"What?" I looked at my harried co-intern, instantly feeling sorry for him.
"Let me work with Madi, for just one week, please."
"No can do man. Madi is mine."
"Madi is yours?" Jake replied with a smirk on his face.
I sat up immediately, "Oh shut up. You know what I mean"
Of course, I knew that he knew what I meant, but for some reason I could still feel my face heat up. I quickly looked around the room to make sure she wasn't there, or that no one had over heard our conversation. I had nothing but respect for my senior resident. And would hate for that to be misconstrued into something that would embarrass her.
Was I absolutely mesmerized by her, and looked like a puppy following her around? Probably.
But she was the undisputed queen of ICU.
Others could probably match her intellect, however, it was her soft skills that put her poles apart from everyone else. Her kindness and bedside manners impressed the staff and patients alike. Her competence let everyone blindly trust her. She knew everything about every disease and every patient, yet her humbleness meant that she never took credit for a job well done.
In short, I was one lucky intern.
The door to our work room opened and in came the three senior residents that lead the three teams covering our large ICU.
Liam headed towards Jake and yelled at him, making the poor guy stumble out of the room.
Kylie headed towards the corner desktop, ignoring the intern who worked with her.
Madi smiled at me and said, "Great job on rounds today, Omar," then handed me an article on causes of excessive bleeding. "Let's discuss this in the afternoon sometime"
"Sure thing," I grinned back at her.
Yeah, Madi is mine. Sorry Jake.
*******
I was surely living the dream, but being on call every third night was catching up. I had been too exhausted to cook, and had been living off frozen dinners and energy bars. Neither of which I had with me right now as my stomach growled.
The cupboard where snacks for patients were kept had been calling out to me all morning. Around noon I finally gave in and was rummaging through it when I heard Madi's voice behind me.
"If you didn't bring lunch, I am going over to the food court..."
The food court? Hell no, was my instant reaction.
"No thanks, I'll be fine with the peanut butter and crackers here," I interrupted her.
She gave me a knowing smile, "I wasn't asking you to come, I was just going to offer to bring you something from there."
"Oh, of course. Thank you so much. I'll just take that Tuna sandwich you got me last time."
She nodded and started to walk away. But just before the corner of the hallway she paused and turned to give me the look that I had seen her give our patients so many times. The one that said, I am not certain myself but I wish for my words to come true.
"Even the deepest of wounds heal with time," I heard her say quietly.
She didn't wait for me to reply, she just gave me instructions to follow up on the blood tests for our patient in Room 1502, and disappeared around the corner. Leaving me a with mix of emotions suspended between my past and present.
Perhaps, she was right and time was all I needed.
Till, then being holed up in this ICU, away from the Children's Hospital, was just what I desired.
Little, did I know.
*******
Our 40 year old patient in Room 1502, was suffering from a blood cancer and was admitted with severe bacterial infection. The chemotherapy drugs he had received had suppressed his bone marrow, resulting in decreased levels of all his blood cells. Right now his biggest problem were his platelets, the cells critically important for clotting blood.
"Dr Khan, your patient's platelet test came back. They are less than 10 right now", the nurse popped her head into the resident room to update me.
Less than 10,000 per microliter was significantly lower than the normal which should be more than 150,000.
"Thanks for letting me know, I am putting in an order for platelet transfusion. Could you make sure he gets it right away," I replied to the nurse.
Unfortunately, when I went to see the patient just a few minutes later, multiple IV sites were oozing blood. I asked the nurse to give a second bag of platelets to the patient, clearly one was not going to be enough. His blood pressure was becoming dangerously low, and his blood oxygen was was starting to dip below normal, despite him being on maximum Oxygen through the nasal cannula. All signs pointed towards worsening bacterial infection that was probably spreading through out his body.
"Could you give him another bolus of fluids," I told the nurse while urgently paging Madi.
"Dr Khan, I am running out of IV lines to put all these fluids through," the nurse let me know. I knew we would have to get another line in him quickly if we were going to get ahead of his rapidly worsening condition.
Thankfully, both Madi and the attending walked in soon after and I appraised them of the patient's condition. We all agreed that we would need more line access to give him the platelets, fluids, antibiotics and heart medications all at the same time. Plus, he was breathing very rapidly now and not responding to us when we asked him questions.
"Omar, go ahead and intubate him so we can put him on the ventilator. And I'll get a femoral line in," Madi said, as she took charge of the situation. (A femoral line is put in to the femoral vein, a major vein in the groin area. Its a good place to access the blood in emergencies since it is relatively easy to put in...though not always)
I nodded and immediately set about getting the ventilator equipment ready before I put the breathing tube in. Meanwhile, Madi tried to put the femoral line in the patient's right leg but failed. She then switched over to the left side, as the attending looked over shoulder. I could tell that she was starting to get worried.
It wasn't that she didn't know how to do this procedure, I had seen her get these lines in expertly multiple times before. But because this patient had been sick for a long period of time he had required these same lines previously as well, which meant that his veins were quite damaged and scarred.
"Its ok Madi. You got this," the attending encouraged her.
He turned to me and said, "Order another bag of clotting factors, we really need these lines to stop oozing blood."
When Madi still couldn't get the femoral line in, the attending asked her to do one more maneuver and if that failed they would try to put a line directly into the long bone of the lower leg or the large vein in the neck. Unfortunately, when she tried that maneuver she went in to the groin too deep and struck the femoral artery instead of the vein. Arteries, especially the major ones like the femoral artery, carry blood that is coming straight from the heart so the blood flow is rapid and under pressure. Not surprisingly then, as the IV line struck the femoral artery, blood immediately gushed out splattering all over Madi.
"Oh crap," she exclaimed, as she frantically tried to stop the bleeding. "Omar, I need extra hands"
I immediately went over to help her, and placed my hands over hers so together we could put as much pressure on the artery as possible. The patient was already having difficulty clotting his blood, and with a cut in a major artery it was obvious that things were not going well.
I looked at Madi as I stood next to her. She had blood on her face and scrubs, yet her facial expression was calm and collected as usual. The distraught look in her eyes though, was unmistakable.
"Its not your fault," I whispered to her.
She shook her head, "I should have done better"
If we weren't the kind of people we were, I would have told her that I thought she had done her best under immense pressure and that I was so proud of who she was. But I was an intern and she was my senior resident, and I didn't trust myself to say those words with the objectivity that our relationship demanded. So I remained quiet, pressing my hands over hers, holding pressure over our patients groin area till the bleeding eventually stopped.
In the meantime, the attending was able to get a line into the patient's neck and with all the therapy we had given him, he had stabilized. At least for now.
"Good job with putting our patient on the ventilator. I am glad you gave him platelets early on, he would have been much worse off without them," Madi told me as we left the room.
Maybe I should have done, what any other intern would have. Taken her praise and walked away with it feeling good about myself. But one look at her slumped shoulders told me exactly what she was doing. It was what she always did; be kind-hearted and generous with her praise, because propping up others was her default nature.
Her deep brown orbs partially obscured by a curtain of thick lashes, told a completely different story; she blamed herself for causing harm to the patient. I doubted self-forgiveness came easily to her.
In that moment, I decided to put aside the hierarchy in our profession temporarily. There was no reason that I could not reciprocate her praise, support and comfort.
"For the record, you are the most brilliant physician I have ever worked with. I can't even tell you how impressed I am with how you handle everything. Seriously, nothing ever seems to faze you. I would consider it a success, if I could be even half of what you are by the time I am in your position," I hesitated for a second, but then finished saying what had been on my mind.
"If you ever need to talk, I am here for you"
She seemed surprised, but the dullness of her eyes had dissipated by the time I finished speaking, and that heartening smile of hers was starting to show up again.
"Thanks Omar," she said softly.
She looked up at me, I gazed down at her. Chocolate brown melted into dark coffee. For just a few seconds the distance between us seemed to disappear. But even a few seconds are enough to cause a tectonic shift between two people, or catch sight of a future vastly different from the past and present.
Is it enough to heal the deepest of wounds? I asked myself and quickly tore my gaze away from hers, trying to tame my rapidly beating heart.
She too, for the first time since I had known her, sounded flustered, "I...uh...have blood all over me, I should shower, I mean...I need to take these scrubs off...and put on new ones"
Her cheeks were flushed when I dare to look at her again, but she recovered quickly, "Could you update the patient's note and document everything that happened just now. In the patient's room, I mean"
"Will do"
And just like that, I was back to being the intern.
I couldn't ever be anything else. That would just be preposterous.
Madiha
I had always enjoyed long showers. In a house full of people, the bathroom was my refuge. Under the warm water is where I could think and let myself be myself for just a moment, before I had to go out and face the world.
"MADIIII get out of the shower! The water bill will be humungous again this month," I could still hear my mother's voice yelling at me.
Right now there was no parent calling out to me, or younger siblings banging on the door. I was free to relish the warm water flowing over me. Even though, the sterile smelling, anti-bacterial hospital soap that I had used to scrub all the blood off me was a constant reminder that I was still on call in the ICU.
But this temporary respite from patient rooms, and botched procedures that I had done successfully dozens of times before, wasn't enough to distract me from the intern who had forced me to lower my guard.
There was something about him that made me want more from life.
Over the years, I had received plenty of professional praise from faculty, peers and staff at work. I knew I was good at what I did, the awards that filled a shelf in my parent's living room were testament to that. But lately it felt that all people saw when they looked at me, was an excellent physician, who had her life together and who everyone could depend on.
Yet, that was not my life's story.
This near-perfect life that I had worked so hard to build, had a void that only his words seemed to be able to fill.
When Omar had looked at me with his piercing brown eyes so full of sincere honesty, and said, "If you ever need to talk, I am here for you," for a second it had seemed like he could see the real me. But then I remembered that even if he did see me, he was my intern and I was the senior resident.
He was nursing a broken heart, and I was engaged.
I shut the faucet off. I didn't need my safe space to think about my fiancé. His incessant texts and phone calls never let me forget him anyway. And sure enough when I looked at my phone again as I walked out of the hospital later in the day, there was a message from him again.
Jawad: Hey beautiful.
That message made me cringe. I don't even know why. Being called beautiful by your fiancé was supposed to be a good thing, but coming from him it just seemed insincere. Unfortunately, a gut feeling wasn't good enough of a reason for my parents to let me break off an engagement.
Jawad: I am coming to Chicago in a couple of weeks. Which day will you be free to meet up?
Jawad: See I am telling you well in advance! You can't say no now 😉
I took a deep breath and replied to him that I would have to look at my schedule. My phone buzzed again almost immediately. Irritated, I was about to ignore it when I noticed who had messaged me.
Salman: Hey Madi. Hope you're well. Had a favor to ask. I have to go out of town for a few days. Would you be able to check in on Noor while I am gone?
Salman: P.s. she doesn't know I am messaging you. You know how she is.
I chuckled at what my friend, Miss-Independent-Noor, would think of her husband trying to get a babysitter for his pregnant wife.
Pyaar ho tou aisa, I thought as I texted him back that I was working tomorrow but would be happy to check in on her by phone.
Salman: Thanks friend, I owe you one.
I decided to let Noor have the night to herself and made a mental note to call her tomorrow morning. Today, I had a lot on my mind already.
Just a few seconds, I had realized, were enough to question one's whole life.
Turns out a lot can happen in one night too.
*******
What can happen in one night, you may ask? You'll see in the next chapter!
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