Doctor Zomanian, who was known to everyone as Dr. Z, waited impatiently at the nursing station. His face was bulging and pink, the color only slightly subsiding after half a dozen minutes of continuous growling. He didn't like to yell at the nurses, but sometimes it was necessary. Nothing personal, but his time was not to be wasted. He rounded at one, and all of his patient charts were supposed to be pulled and on a rolling cart so he could stride up to the nurses' station, grab the cart, roll it down the hall and start on his patients without a pause.
That wasn't happening today. There was a new nurse, Emily, in charge of the unit. She must have been new. Dr. Z would have noticed such a beauty before. Red hair in chaotic waves. His daughter had hair like that, or at least he thought so, but his daughter changed her hair sometimes and he hadn't seen her in awhile. Come to think of it, the last time he saw his daughter she was probably blonde. No telling what her original color was.
Emily looked about twenty-five. Obviously unused to dealing with authoritative doctors such as himself. She moved fast enough when he shouted that he figured he could eventually break her in. Ten minutes and all the charts were on the rack. Not too bad.
By habit, he started with room 401, working down the hall in order from left to right. He always worked from left to right. After he started working at the hospital six years ago, the floor nurses quickly figured that out and always (at least until today) had the charts arranged accordingly.
First up, Mrs. Duncan. Fifty-two years old, gasping for breath. Dr. Z had ordered home oxygen for her the last time she was in, but it was not reducing the frequency of her hospital admissions. And she was a liar. Dr. Z told her the first time he saw her in his office that she needed to quit smoking. She had told him on a clinic visit a month ago that she had quit the cigarettes. Then she tells him the same thing in the emergency room. He could smell the smoke on her, and accused her of lying right there, on the gurney, in ER 4.
"That looks like a pack of cigarettes in your purse there," he had said gruffly. "I told you a dozen times that if you light up with the oxygen around you will be barbecue. Barbecue! And even that is an understatement because pure oxygen burns hotter than wood." She had looked at him like a whipped dog, about to cry.
He studied her chart before going in. As long as all the reports were where they were supposed to be, he could assemble the needed data in his head in a few seconds. Chest x-ray this morning was okay. White cell count up. Creatinine stable. He went in.
"Hello, Mrs. Duncan," he said, in his cheery voice. "How are you feeling?"
"Better, Dr. Z," she said.
"Good. Your white cell count is higher today, but with a negative chest x-ray I am chalking that up to the steroids. I am going to keep you on ceftriaxone for another day at least just in case. I'm also ordering PFTs."
Mrs. Duncan nodded as if she understood it all. Except for one thing. "PFTs?"
"Yes. Pulmonary function tests. You'll breathe into a machine and I'll get the report. Don't worry about it. I'll take care of everything. See you tomorrow!"
He returned to his cart full of charts and turned to a blank page. "Chronic Obstructive Pulmonary Disease," he wrote. "Tobacco abuse. Patient counseled to quit smoking but has repeatedly refused," he concluded.
Moving down the hall, he paused at room 413 and pulled a chart labeled "T Shears." Mr. Shears was admitted for chest pain. Dr. Z quickly turned to the cardiology section of the chart. He checked the morning EKG, and looked for the echo and stress test he had ordered yesterday. Not back yet.
He went into the room. Mr. Shears was sitting in a chair at the bedside, monitor wires running all over his chest, an IV in his left arm. T Shears was an enormous man, 400 pounds at least, so large his hips barely fit between the arms of the chair. His calves, visible below the hem of his gown, were deep red and purple, discolored from years of venous stasis. Dr. Z saw that the IV was running normal saline at 70 cc an hour. "I probably should stop that before he develops edema," he thought to himself.
"How are you doing today?"
"I'm doing OK," Mr. Shears said.
"Any more chest pain?"
"Well, yes, I still have a little tightness here." He pointed to his sternum.
Dr. Z put the stethoscope to the patient's chest. "Good, good," he said. "Any shortness of breath?"
"I have some, and a bad cough."
"Fine, fine," Dr. Z said. "It will be some time before I get the echo and the stress test results. They may not be ready until tomorrow. But if they check out, I will send you home then."
"But doctor, what is causing my chest pain?" Mr. Shears asked. He asked it to the air, because Dr. Z had already left.
Out in the hall, the doctor opened the chart. He figured the echo had already been read, and possibly the stress test, too. He considered yelling to the nurse to get the reports on the chart, but he decided that would take too long. By tomorrow it would all be there.
He wrote: "Acute Coronary Syndrome. Morbid obesity. Chest pain likely brought on by failure to take medication. Needs to lose a lot of weight." He closed the chart. Another patient who refuses to help himself.
Sometime later he reached his final patient, Mrs. Arnaz, who was admitted for intestinal bleeding. In contrast with the enormous Mr. Shears, Mrs. Arnaz was a wraith of a woman, hardly more than a hundred pounds. It is easy to keep one's weight down, Dr. Z had observed to a nurse the other day, when ninety percent of your calories come from a whiskey bottle. Mrs. Arnaz had drunk herself into three bleeding ulcers. This time she had almost bled to death, which, if Dr. Z were completely honest about it, as he often was when not talking about himself, would not have been an entirely bad thing.
The nurse told Dr. Z in the hallway that Mrs. Arnaz had been confused all night. No surprise. She had been in the hospital for three days, and delirium tremens would certainly have set in by now. Z was not always aggressive about treating DTs -- in a way, he thought any patient that drank that much deserved to suffer a little -- but from what the nurse was telling him it sounded pretty bad. He might have to boost her sedation.
He went into the room. Mrs. Arnaz was much sicker than he expected. Overnight she had gone from mildly yellow sclerae to completely yellow. The color was completely unnatural, almost orange, as if an iodine tincture had been painted everywhere on her skin. Dr. Z walked around the bed and shook his head.
"You've had one too many, my dear," he said. "You've probably had your last."
Mrs. Arnaz moaned in reply. With her liver failing she was barely conscious. After looking her over, Dr. Z concluded she only had a couple of days. The room was still except for the television, which muttered from the corner of the room. It always amused Dr. Z to see what comatose patients watch on television. Most of the time someone on the staff would turn the TV on to a good background channel -- news, sports, or weather -- the kind of channel that staff, coming in for a few minutes at a time, can glance up at. A news channel was on. Dr. Z saw that there was a shooting at a university, and 31 people had been killed. He was stirred when he saw that the shooting had taken place at Virginia Tech; he had gone to college at Wake Forest, just down the road.
The nurse walked in. She checked the patient's IV, then flushed it with heparin. Dr. Z turned and looked at her. She was one of the new nurses, one of the ones he had yelled at. She was short, black hair cut to the shoulder, dark eyes, in her twenties. She was attractive, he realized. "Sad about the college kids, isn't it?" she said.
For the second time in a few minutes, he shook his head. "Innocent kids shouldn't be cut down like that. They didn't deserve it." He looked up at the TV again, then at the nurse, who was now leaning over the patient in the bed. As she leaned forward, he saw the faint outline of her panties through her white trousers. He walked out.
In the hall, he wrote a note in Mrs. Arnaz's chart, something to the effect of "she's going to die soon," except that he phrased it as "prognosis grim" and "poor prognosis" and "needs DNR status." He resolved to talk to a family member, if he could find one, to emphasize that she will die soon and should not receive CPR. He rolled his chart full of charts down the hall and pushed it mindlessly towards the clerk at the unit desk.
Dr. Z went to the end of the hall and down the steps and out the back door of the hospital. His car was parked at his personal spot, only fifty steps from the door. As he stepped out of the door he felt a breath of hot air pouring between the decks of the parking garage. April and finally it was summer in Louisiana. He was looking forward to it this year.
As he walked to his car he remembered something. "Damn. I forgot to stop the IV fluids on that patient." He paused, and briefly considered going back. "Oh, I'll do it tomorrow."
He slid into his car and turned on the conservative radio show. Dr. Z was not very political, but the guy on that show always made him angry with his stories about the evil things liberals were doing. He liked getting angry. He got angry a lot at work, but somehow his raging never seemed to do any good. Every year the nurses got worse, the clerks in his office got younger and more incompetent. Only Nina, his clinic nurse for thirty years, was any good. And even she got on his nerves from time to time. But on his drive home, he could get angry about things that didn't matter like work did, and it felt good. He had trouble remembering the name of the Angry Man on the radio, but little did his patients and the staff at the hospital and clinic know what a monster he would have been if he couldn't be angry along with the Angry Man on the radio.
He was home in the usual twenty-six minutes. As he entered the front door, Dr. Z stumbled over a box and had to reach out to the wall to steady himself. "That bitch!" he said aloud. "When is she going to come to pick up this worthless crap!"
The box was filled with his soon-to-be ex-wife's personal effects -- makeup, family pictures, a pair of $600 boots, a half-used dispenser of contraceptives, a Bible, and a bottle of champagne they had bought in Europe and planned to open on their tenth anniversary. Mandy was supposed to pick the box up while he was at work and leave the house key, but the box had remained there for three weeks. Dr. Z was sick of looking at it, but he couldn't justify throwing out such expensive boots or a champagne bottle worth at least $300. So it sat.
The house had been all his for over a month. It was spotless, partly because he continued to pay the housekeeper to clean it twice a week, and partly because he had so little free time to live in it. It was well nigh time, he thought, to bring a girl over for the night. Well nigh time. The nurse in Mrs. Arnaz's room seemed a fair candidate.
He had poached nurses from the hospital before. Mandy was a hospital nurse, before she became his second wife. He guessed that with alimony she wouldn't be going back to nursing again. Dr. Z had started sleeping with Mandy before he left his first wife. That was why he could not understand her wanting to leave him. After all, she had stolen him from someone else. How could she complain if he sometimes strayed? All his hours at work paid for the boots, the champagne, the antiques. This was the cost of living with a doctor.
If she doesn't pick up that damned box before I get that nurse in here, I am going to use the champagne to get her drunk, he said to himself.
Lost in his bitterness, Dr. Z suddenly remembered he needed to deactivate the house alarm. He moved quickly and almost didn't make it in time. Then he went through the kitchen and opened the door to the back porch. His golden retriever, Percy, bounded in and started jumping on him repeatedly.
He filled Percy's bowl with dog food and watched contentedly as he devoured it. Then he walked over to the kitchen table and sat down to look at the mail. The housekeeper had left it there for him. After Percy finished his meal, he came over and pushed his nose into Dr. Z's lap.
Dr. Z scratched Percy under the chin. "You're lucky someone competent is taking care of you," he said.
That wasn't happening today. There was a new nurse, Emily, in charge of the unit. She must have been new. Dr. Z would have noticed such a beauty before. Red hair in chaotic waves. His daughter had hair like that, or at least he thought so, but his daughter changed her hair sometimes and he hadn't seen her in awhile. Come to think of it, the last time he saw his daughter she was probably blonde. No telling what her original color was.
Emily looked about twenty-five. Obviously unused to dealing with authoritative doctors such as himself. She moved fast enough when he shouted that he figured he could eventually break her in. Ten minutes and all the charts were on the rack. Not too bad.
By habit, he started with room 401, working down the hall in order from left to right. He always worked from left to right. After he started working at the hospital six years ago, the floor nurses quickly figured that out and always (at least until today) had the charts arranged accordingly.
First up, Mrs. Duncan. Fifty-two years old, gasping for breath. Dr. Z had ordered home oxygen for her the last time she was in, but it was not reducing the frequency of her hospital admissions. And she was a liar. Dr. Z told her the first time he saw her in his office that she needed to quit smoking. She had told him on a clinic visit a month ago that she had quit the cigarettes. Then she tells him the same thing in the emergency room. He could smell the smoke on her, and accused her of lying right there, on the gurney, in ER 4.
"That looks like a pack of cigarettes in your purse there," he had said gruffly. "I told you a dozen times that if you light up with the oxygen around you will be barbecue. Barbecue! And even that is an understatement because pure oxygen burns hotter than wood." She had looked at him like a whipped dog, about to cry.
He studied her chart before going in. As long as all the reports were where they were supposed to be, he could assemble the needed data in his head in a few seconds. Chest x-ray this morning was okay. White cell count up. Creatinine stable. He went in.
"Hello, Mrs. Duncan," he said, in his cheery voice. "How are you feeling?"
"Better, Dr. Z," she said.
"Good. Your white cell count is higher today, but with a negative chest x-ray I am chalking that up to the steroids. I am going to keep you on ceftriaxone for another day at least just in case. I'm also ordering PFTs."
Mrs. Duncan nodded as if she understood it all. Except for one thing. "PFTs?"
"Yes. Pulmonary function tests. You'll breathe into a machine and I'll get the report. Don't worry about it. I'll take care of everything. See you tomorrow!"
He returned to his cart full of charts and turned to a blank page. "Chronic Obstructive Pulmonary Disease," he wrote. "Tobacco abuse. Patient counseled to quit smoking but has repeatedly refused," he concluded.
Moving down the hall, he paused at room 413 and pulled a chart labeled "T Shears." Mr. Shears was admitted for chest pain. Dr. Z quickly turned to the cardiology section of the chart. He checked the morning EKG, and looked for the echo and stress test he had ordered yesterday. Not back yet.
He went into the room. Mr. Shears was sitting in a chair at the bedside, monitor wires running all over his chest, an IV in his left arm. T Shears was an enormous man, 400 pounds at least, so large his hips barely fit between the arms of the chair. His calves, visible below the hem of his gown, were deep red and purple, discolored from years of venous stasis. Dr. Z saw that the IV was running normal saline at 70 cc an hour. "I probably should stop that before he develops edema," he thought to himself.
"How are you doing today?"
"I'm doing OK," Mr. Shears said.
"Any more chest pain?"
"Well, yes, I still have a little tightness here." He pointed to his sternum.
Dr. Z put the stethoscope to the patient's chest. "Good, good," he said. "Any shortness of breath?"
"I have some, and a bad cough."
"Fine, fine," Dr. Z said. "It will be some time before I get the echo and the stress test results. They may not be ready until tomorrow. But if they check out, I will send you home then."
"But doctor, what is causing my chest pain?" Mr. Shears asked. He asked it to the air, because Dr. Z had already left.
Out in the hall, the doctor opened the chart. He figured the echo had already been read, and possibly the stress test, too. He considered yelling to the nurse to get the reports on the chart, but he decided that would take too long. By tomorrow it would all be there.
He wrote: "Acute Coronary Syndrome. Morbid obesity. Chest pain likely brought on by failure to take medication. Needs to lose a lot of weight." He closed the chart. Another patient who refuses to help himself.
Sometime later he reached his final patient, Mrs. Arnaz, who was admitted for intestinal bleeding. In contrast with the enormous Mr. Shears, Mrs. Arnaz was a wraith of a woman, hardly more than a hundred pounds. It is easy to keep one's weight down, Dr. Z had observed to a nurse the other day, when ninety percent of your calories come from a whiskey bottle. Mrs. Arnaz had drunk herself into three bleeding ulcers. This time she had almost bled to death, which, if Dr. Z were completely honest about it, as he often was when not talking about himself, would not have been an entirely bad thing.
The nurse told Dr. Z in the hallway that Mrs. Arnaz had been confused all night. No surprise. She had been in the hospital for three days, and delirium tremens would certainly have set in by now. Z was not always aggressive about treating DTs -- in a way, he thought any patient that drank that much deserved to suffer a little -- but from what the nurse was telling him it sounded pretty bad. He might have to boost her sedation.
He went into the room. Mrs. Arnaz was much sicker than he expected. Overnight she had gone from mildly yellow sclerae to completely yellow. The color was completely unnatural, almost orange, as if an iodine tincture had been painted everywhere on her skin. Dr. Z walked around the bed and shook his head.
"You've had one too many, my dear," he said. "You've probably had your last."
Mrs. Arnaz moaned in reply. With her liver failing she was barely conscious. After looking her over, Dr. Z concluded she only had a couple of days. The room was still except for the television, which muttered from the corner of the room. It always amused Dr. Z to see what comatose patients watch on television. Most of the time someone on the staff would turn the TV on to a good background channel -- news, sports, or weather -- the kind of channel that staff, coming in for a few minutes at a time, can glance up at. A news channel was on. Dr. Z saw that there was a shooting at a university, and 31 people had been killed. He was stirred when he saw that the shooting had taken place at Virginia Tech; he had gone to college at Wake Forest, just down the road.
The nurse walked in. She checked the patient's IV, then flushed it with heparin. Dr. Z turned and looked at her. She was one of the new nurses, one of the ones he had yelled at. She was short, black hair cut to the shoulder, dark eyes, in her twenties. She was attractive, he realized. "Sad about the college kids, isn't it?" she said.
For the second time in a few minutes, he shook his head. "Innocent kids shouldn't be cut down like that. They didn't deserve it." He looked up at the TV again, then at the nurse, who was now leaning over the patient in the bed. As she leaned forward, he saw the faint outline of her panties through her white trousers. He walked out.
In the hall, he wrote a note in Mrs. Arnaz's chart, something to the effect of "she's going to die soon," except that he phrased it as "prognosis grim" and "poor prognosis" and "needs DNR status." He resolved to talk to a family member, if he could find one, to emphasize that she will die soon and should not receive CPR. He rolled his chart full of charts down the hall and pushed it mindlessly towards the clerk at the unit desk.
Dr. Z went to the end of the hall and down the steps and out the back door of the hospital. His car was parked at his personal spot, only fifty steps from the door. As he stepped out of the door he felt a breath of hot air pouring between the decks of the parking garage. April and finally it was summer in Louisiana. He was looking forward to it this year.
As he walked to his car he remembered something. "Damn. I forgot to stop the IV fluids on that patient." He paused, and briefly considered going back. "Oh, I'll do it tomorrow."
He slid into his car and turned on the conservative radio show. Dr. Z was not very political, but the guy on that show always made him angry with his stories about the evil things liberals were doing. He liked getting angry. He got angry a lot at work, but somehow his raging never seemed to do any good. Every year the nurses got worse, the clerks in his office got younger and more incompetent. Only Nina, his clinic nurse for thirty years, was any good. And even she got on his nerves from time to time. But on his drive home, he could get angry about things that didn't matter like work did, and it felt good. He had trouble remembering the name of the Angry Man on the radio, but little did his patients and the staff at the hospital and clinic know what a monster he would have been if he couldn't be angry along with the Angry Man on the radio.
He was home in the usual twenty-six minutes. As he entered the front door, Dr. Z stumbled over a box and had to reach out to the wall to steady himself. "That bitch!" he said aloud. "When is she going to come to pick up this worthless crap!"
The box was filled with his soon-to-be ex-wife's personal effects -- makeup, family pictures, a pair of $600 boots, a half-used dispenser of contraceptives, a Bible, and a bottle of champagne they had bought in Europe and planned to open on their tenth anniversary. Mandy was supposed to pick the box up while he was at work and leave the house key, but the box had remained there for three weeks. Dr. Z was sick of looking at it, but he couldn't justify throwing out such expensive boots or a champagne bottle worth at least $300. So it sat.
The house had been all his for over a month. It was spotless, partly because he continued to pay the housekeeper to clean it twice a week, and partly because he had so little free time to live in it. It was well nigh time, he thought, to bring a girl over for the night. Well nigh time. The nurse in Mrs. Arnaz's room seemed a fair candidate.
He had poached nurses from the hospital before. Mandy was a hospital nurse, before she became his second wife. He guessed that with alimony she wouldn't be going back to nursing again. Dr. Z had started sleeping with Mandy before he left his first wife. That was why he could not understand her wanting to leave him. After all, she had stolen him from someone else. How could she complain if he sometimes strayed? All his hours at work paid for the boots, the champagne, the antiques. This was the cost of living with a doctor.
If she doesn't pick up that damned box before I get that nurse in here, I am going to use the champagne to get her drunk, he said to himself.
Lost in his bitterness, Dr. Z suddenly remembered he needed to deactivate the house alarm. He moved quickly and almost didn't make it in time. Then he went through the kitchen and opened the door to the back porch. His golden retriever, Percy, bounded in and started jumping on him repeatedly.
He filled Percy's bowl with dog food and watched contentedly as he devoured it. Then he walked over to the kitchen table and sat down to look at the mail. The housekeeper had left it there for him. After Percy finished his meal, he came over and pushed his nose into Dr. Z's lap.
Dr. Z scratched Percy under the chin. "You're lucky someone competent is taking care of you," he said.