Christmas Ten Years Apart

The thirty-year-old medical student walks out onto the floor for the first time in this new hospital.  The intern, a mere six months into the program and the first job of his life, calls to the third-year medical student.  “Hey, you’re with me so let’s go.”  The medical student falls behind the intern and tries to introduce himself.  The intern ignores him reading one of the plethora of books and scraps of paper jutting out of his coat pockets.  The student has seen this before and realizes that silence is the best strategy here.  The intern mumbles to himself as they walk, “…don’t forget to ask birth history, check the nurse’s vitals, check to see if the child is breathing first…”  The medical student rolls his eyes and knowingly realizes that he will be taught very little this day.  They arrive at their destination, the pediatric emergency department where they meet the residency director who is running the department today.  “Hello, doctor, who is your shadow?”  “Don’t know,” said the intern, “he won’t talk to me and hasn’t even introduced himself yet.”  The attending turns toward a patient room and recites the patient’s history and finishes by asking the intern what he would want next.  The intern answers correctly saying labs and starts to frantically search for the equipment he desperately needs.  The student meanwhile is standing at the bed talking to the child and the mother and even making them laugh while he places the tourniquet.  The intern notices that the student has all the equipment he needs and sternly states, “Stop!  What are you doing?  The child needs the labs I want drawn and he needs to be stuck by someone who knows what they are doing, not some wet-behing-the-ears medical student!”  The mother looks at him in surprise and at the student with pity.  The intern continues, “How do you even know which tubes to draw, let alone what the right tests to draw are?  You don’t!” he blurts out before the student explains.  The intern takes the needle and the tubes and proceeds to remove the tourniquet.  “You should always use the right arm since most people are right-handed.  What are you thinking?”  The intern then asks, “What are you using this twenty-gauge needle for?  This kid is nine years old.  We should only use twenty-four gauge needles on kids.  Didn’t someone teach you the meaning of gauge?”

The twenty-year-old man walks into the hospital.  It is his first day at his new job as a nuclear medicine technologist.  He is working for the physician who helped invent the speciality and the techniques of Nuclear Medicine.  The young man is quiet, but not for long.  He has worked at many other jobs prior to this, including his job as a phlebotomist, as well as a number of nonmedical positions.  He knows that until he realizes the temperament of the others, he should remain soft-spoken.  Over the next few months, he develops his techniques and improves his skills and is even leading some research, but he has yet to be on call.  December comes and it is Christmas time.  His probation ends, and he is allowed to be on call.  Since he is the newest member of the team, he gets the Christmas holiday.  It turns out that he is on call with the head attending who is rumored to scream and destroy techs and reidents who are not competent and make mistakes.  Christmas Eve is almost over and the pager has not yet gone off.  The young tech goes to midnight mass with his girlfriend and her family and as luck would have it as soon as they sit down the pager blares.  He looks at the readout, his hand trembling.  Is this it – the first call?  Yes!  He bolts out of the church, grabs his cell phone and calls to tell them he is on the way.  The Father of Nuclear Medicine, the physician, tells him it is to be a portable brain death scan in the ICU and he is to have the equipment on the floor and ready to go – and by all means start the IV before he gets there.  The young man arrives and realizes that the only camera working is the one he has never used.  “Oh great,” he thinks, “I am on call with the meanest physician around and I have to go see if a twenty-year-old-guy is brain dead from falling out of a pick-up truck on Christmas Eve.  I hope he doesn’t yell at me.”

The thirty-year-old medical student helps to restrain the nine-year-old while biting his tongue to keep from saying something to this intern.  He has experienced this kind of doctor before and has always known that he will only make matters worse by answering his chastising.  The intern has stuck the child three times now and each time it was in an area that questionably had a vein.  “I see it right there, hold still kid.  Every time you move the vein ‘rolls’ and I miss it.  It’s your arm, but I wouldn’t want it to look like a pin cushion.”  The child is screaming and is now livid.  He would have kicked the intern damn near in the mouth if it wasn’t for the student kicking away the stool, making the intern roll a hair’s width out of the wya.  “You stupid student, I am going to miss this stick if you keep kicking my chair.  Are you stupid or a klutz?”

The twenty-year old gets to the floor.  In the room is a young man, not much different from him: thin, athletic, light brown hair, and blue eyes; only these are lifeless.  A frantic woman and a frail-looking man immediately pounce on the tech.  “Will this machine save him?  Will it fix the damage?  Don’t tell me it is here to confirm his death!  GET IT OUT!  TAKE IT AWAY FROM THIS ROOM!  I DON’T WANT TO SEE YOU RETURN WITH IT!”  At this moment the tech can see what was once a strong father and his young protective wife, the mother of his child, and the mere boy lying in the room.  With nowhere to escape and nowhere to hide, the tech is on the verge of panic.  He thinks, “I have seen many a dead person, I have even helped with their pronouncement, but I never dealt with a family during it.”  Like an angel, the attending Nuclear Physician steps into the room and sternly but lovingly says, “Mother, Father, I am the physician.  I am here to assist you. To start that process, we should let this young man do his job.  He is here not to confirm the death of your child but to ascertain that he is still filled with life.”  During the brain scan the physician leans over and speaks softly to the technologist, “What do you see on the screen?” The tech replies, “I am not licensed to read these.  Only a physician with knowledge and training can do that.”  “Don’t give me that crap.  You know exactly what I know to look for.  You can probably read these as well as a seasoned resident.  What do you see?”  The tech looks at the screen and timidly whispers, “I don’t think the family will be having a joyous Christmas ever again.”  The physician states, “I agree.  Now the hard part, telling the family that the life I discussed before is going to be in the form of organ donations.”  At that moment the surgical intern comes running into the room and excitedly ejaculates, “What’s the result?  Can I start harvesting his organs?  Where’s the family I ned to consent so I can do this case?”  The nuclear medicine physician lifts his head up in time to see the family falling to the floor crying.  As they hit the floor he grabs the intern and literally drags him to the hallway.  In front of the staff and the families and the patients he loudly speaks directly into the face of the intern, “Don’t you ever pull a stunt like that again.  That man was someone’s loved one, their child, their lover, their father, their brother.  Your actions and reproachable words have destroyed a family almost as much as the loss of their loved one did.  You will not do that case, and you will be lucky to finish the year here.”

The nine-year-old’s mother finally turns to the medical student and using his first name asks why he doesn’t try to get the blood.  The student weakly smiles, looks at the intern, and says, “Why don’t we give him a break and we can return in a few minutes.”  The intern begrudgingly leaves the room and begins to chastise the student when his pager rings.  He excitedly leaves to answer the page.  The student turns and reenters the child’s room.  He makes a deal with the patient, “You know I have to get some blood to find out why you are sick, don’t you?” The child nods yes.  “Well here is the deal.  I will look at your arm first, whichever one you think is best.  I promise to not even get any needles out until I find a good vein, show it to you, and see if you agree that it would be a good one to get the blood from.  Is that a deal?”  The child warily sticks out his left arm and nods yes.  The tourniquet is placed, and a bouncy invisible vein is found in the forearm.  “Place your finger here and tell me if you feel a rubber band,” says the medical student.  The child tenderly touches the spot the student points to expecting something unknown.  Suddenly the child is wide-eyed and surprised.  He feels it.  He asks, “That’s a vein?”  The student says, “Yup, do you think it is a good one?”  The chidl says, “I think so.  Cool.”  The student grabs a twenty-gauge needle an dtells the child to count to three and then take in a deep breath.  “One, two, three.”  The child inhales, the needle pierces the skin, the child’s breath hitches, the blood is flowing into the three tubes that the student origianlly set out.  The Band-Aid is placed and the child says, “That didn’t even really hurt.  How did you do that?”  As the student goes to answer, the intern walks into the room, “What are you doing?  How did you get the blood?  Why didn’t you get the other tube?” The student has had enough.

Back in the department the tech is trying to transfer the files from the portable computer to the main system and things are going quite badly.  Suddenly, the door opens and looming in the doorway is the shadow of the physician.  He is a large man as it is, but at midnight after the recent events, the tech is genuinely terrified.  The physician asks what the problem is and the tech tells him realizing that with the excuse of first call or not, he is probably doomed.  Now that he has seen the wraths of this man, he assumes that his is the next head on the chopping block.  The physician walks into the room and sits down next to the tech, “Hasn’t this system been giving us similar roubles all week?”  “Yes, but I can’t find the other cord to plug into the computers.”  The physician stands up, goes to his office, and brings the cord out and pugs it in to the computers.  He then sits down and demonstrates some shortcuts on how to send the data faster.  While the data was transferring he turns to the tech and asks, “How do you like call now?  If you ever make it to medical school remember what you saw today and don’t eveer forget it.  Some doctors are nothing but pompous asses, but many of them change and mature.”  The day after Christmas comes and the tech is called into the hospital anxiously hoping that the physician will be there to offer more wisdom.  The nuclear medicine resident is on call and asks, “How was call with the physician?  Did he yell at you for anything?”  The tech realizes that he would never forget that Christmas morning.

In the hall the intern yells at the student until the student turns around and says, “Enough! I won’t stand here and let some 26-year-old, spoiled rich kid, tell me I don’t know how to do my job!  I have spent the last ten years starting IVs, giving radioactive injections, drawing blood, and running lab tests.  What were you doing?  Borrowing mom’s BMW?  Figuring out how to score with your prom date?  I was one of your lab instructors in medical school and you are too arrogant to even realize it!”  The student takes in a breath and continues, “While you may have an MD after your name, I still have experience.  I have pulled dead children from under cars as an EMT and did brain scans on age-mates with no skull.  I don’t have an MED but I do know how to treat people with compassion.  If you don’t want to work with me because we don’t get along that’s one thing, but if you don’t want to work with me because I make you look bad, I am sorry.”  The intern tells the student to go to the one of his many hours of scheduled lectures that day.  As he walks out of the pediatric emergency room he hears the intern tell teh residency director that he has finished getting the blood and sent the worthless, ignorant, arrogant student to class.

The next day the residency director calls the student into his office and tells him, “Starting today you will be working with this other intern.  I have told her about your experiences and showed her a copy of your CV.  She will give you some freedom and autonomy. Is that ok with you?”  The student warily nods yes.  The residency director proceeds, “Continue to work at becoming a physician and don’t stop at being a doctor.  The patient told me everything that had happened as well as a nurse on the other side of the curtain.  That intern has other complaints against him and I don’t think he will last the year here.  Regardless, you should never ‘show up’ a superior no matter how much more you think you know, it usually will reflect badly in your grade.

“So I understand you know a friend of mine, the nuclear medicine physician at…”


Roy Werner, Class of 2001