Chapter 17

17

CALL #3

My first admission of the day is pregnant.

On the Medicine service, we're not supposed to admit pregnant patients. They're supposed to go to OB/GYN. But this one is okay. Mostly because it's a man. And he's pregnant not with a fetus but with a lot of fluid that can't get through his liver because his liver is hard as a rock thanks to years of drinking.

He really looks pregnant though.

His name is Jorge Sanchez and his belly is tense with fluid. His belly button has gone from innie to outie. His testicles are huge —I'm talking elephant testicles here. The plan is for me and Alyssa to drain the fluid in his belly then make sure it isn't infected. I'm supposed to be telling him about this.

Except like every other patient at County Hospital, he speaks no English.

So I'm standing in Mr. Sanchez's room, waiting for the translator phone to come through for me with someone who speaks Spanish. The phone is sitting on Mr. Sanchez's night table, the speakerphone filling the room with the music of Taylor Swift, the same song over and over. I am starting to believe that we are never, ever, ever going to get that translator on the phone. I have literally been waiting for ten minutes, just standing here and twiddling my thumbs.

Every once in a while, I try to ask Mr. Sanchez a question. I did, after all, take four years of Spanish in high school. Someone told me that Spanish would be a useful language to know, which it definitely would be, if I could actually remember more than a handful of words.

" Uno momento mas ," I say to Mr. Sanchez.

" No me importa esperar ," he says.

"Huh?" I say.

This translator better come through soon. Alyssa is supposed to meet me here in five minutes to do a paracentesis with me, meaning we'll remove his belly fluid. If I don't have consent from him by then, I don't know what she'll do to me and I'm scared to find out. I'm sure Connie would have had the translator on the phone five minutes ago. Connie probably would have taught Mr. Sanchez English by now.

" Puedo tener un vaso de agua ?" Mr. Sanchez asks.

"Huh?" I say. How do you say "slower" in Spanish?

He tries saying it slower but I still have no idea what he's saying. How do you say "this totally blows" in Spanish ?

A heavily-accented voice comes out of the speakerphone: "Hello?"

"Hello!" I say. "Are you the translator?"

"Yes, I am," the voice confirms.

I lunge forward excitedly, in an attempt to get closer to the phone. Unfortunately, in my eagerness, I trip over a wire. The phone goes crashing to the ground. I stare at it for a horrified second before scooping it up off the floor. "Hello? Hello?" I cry into the receiver.

I lost the connection.

This is one of those moments where you can do one of two things:

Burst into tears, shaking fist at the heavens, and yell out, "Nooooooo!!!!!!!"

Laugh.

Somehow, against all odds, I start to laugh. I cover my mouth with my hand so that Mr. Sanchez doesn't see and I attempt to stifle my snickers. It's not funny. But I guess it sort of is. In a really horrible kind of way.

At that moment, Alyssa pokes her head into the room. "Jane," she says. "Did you get the consent done yet?"

Screw this. I don't need a translator to get consent. "Give me a minute," I say.

I take the consent out of my pocket and put it down in front of Mr. Sanchez. "Es una consenta," I explain. "Necesita… um, sign. Sign-a." I make a motion like I'm signing a form. "Necesita put una needle in su estomago. Por la agua in su estomago." I pantomime fluid gushing out of the stomach. "Um, comprende?"

Mr. Sanchez looks up at me, then down at the paper. I have no idea if he had any clue what I just said, but he signs the consent anyway. Thank you, Mr. Sanchez!

I come out of the room, holding the consent up like a medal. Alyssa seems unimpressed by my ability to obtain a signature. "Did you get the supplies?" she asks.

"Um. No."

She sighs. "Okay, go get them."

I stare at her. "What supplies do we need?"

Alyssa raises her eyebrows. "Really, Jane. Come on, you should know this by now."

I should? I've been an intern less than two weeks. This is my first peritoneal tap. Why should I know this?

When it becomes obvious that I'm not going to magically know what supplies are needed for the tap, Alyssa starts ticking off what I need to get: "We need a red top tube, a purple top tube, a 25 gauge needle, a 20 gauge needle…"

I scramble to write everything down, knowing I'll get my ass handed to me if I forget a single item. I run to the supply room, and stock up on two of everything, figuring I'm sure to mess up at least once. I return to Mr. Sanchez's room, my arms brimming with supplies. Alyssa looks over the contents of my arms, probably secretly hoping I've forgotten something. I haven't.

"All right," Alyssa says. "I guess we can start." She eyes my face. "If we're worried about peritonitis, how many PMNs are we looking for in the tap?"

Say what? I have no idea what she's talking about, and I don't even know what the order of magnitude should be for the answer. Finally, I take a wild guess: "A hundred thousand?"

Alyssa couldn't look more shocked. "Are you kidding me?"

I try again: "Ten thousand?"

Alyssa gets these little pink spots on both her cheeks. "How could you do a paracentesis without knowing the number of PMNs diagnostic of peritonitis?"

It's probably a rhetorical question but I feel compelled to answer: "I figured I'd look it up after?"

Alyssa's lips become a thin, red line. "Go find out right now. Don't come back before you can tell me the answer."

Cursing to myself, I run out of the room to figure out the answer to the question. I don't want to miss the entire tap, so I've got to get an answer fast. Luckily, I see Connie at the other end of the hallway. Connie did a paracentesis a few days ago, so she surely knows the answer. Hopefully, she doesn't hate me so much that she'll refuse to tell me .

I race down the hall, yelling, "Connie!" She turns and her face sours considerably when she sees it's me. "Hey, I have a question."

"What is it?" Connie asks impatiently, doing an excellent impression of Alyssa.

"You did a paracentesis, right?"

Connie nods warily.

"Okay, so how many PMNs is the cut-off for peritonitis?"

I'm holding my breath. Connie shrugs. "I don't know. My patient didn't have peritonitis."

"But how do you know he didn't if you don't know the cut-off?"

Connie gives me a dirty look. It's becoming clear that she has no idea what the answer to the question is and also that this conversation isn't going in a positive direction. Luckily, Nina walks by at that moment. Nina, my savior.

"Nina!" I say. "Do you have a second?"

She holds her index finger and thumb about a millimeter apart. "I've got this long. What's up?"

"Have you done a paracentesis?"

Nina nods.

"Great!" I say. "So how many PMNs is the cut-off for peritonitis?"

And guess what? She has no idea. Neither do the next three interns that pass by. Yet somehow nobody but me has been thrown out of the room for not knowing.

Finally, I give in and go to a computer to look it up. The computers have a ridiculously slow internet connection, but I finally find out from Wikipedia that the answer is 250. (I'm embarrassed that I wasn't even remotely close in my guesses.)

I return to Mr. Sanchez's room, armed with my answer. "Two-hundred-and-fifty!" I gasp heroically as I burst into the room.

"Right," Alyssa says.

She places a Band-Aid over the puncture site on Mr. Sanchez's belly. I can't even believe it. I missed the whole goddamn thing. She threw me out of the room for nothing , and I missed out on my procedure. This is so, so unfair.

Alyssa is not going to get away with it. Not this time.

Hours Awake: 5

Chance of Alyssa getting what's coming to her: Like 5%?