allison's story I

Today I thought of Allison. Hard to believe she'd be in kindergarten now. I used to think of her all the time, picturing a curious baby with a frizz of black hair pinned with plastic barretts, framing a round brown face. That was just my imagination, though. Actually I never met her, or even saw a picture. She was coming up on one year old when her life and mine swandived toward eachother, almost but not quite colliding, before she slid past me into her future and I went a different way, into my own.

This is her story, what I know of it.

It all started with the ICU. Every second-year did at least a one-month rotation there. It was the toughest rotation for us Medicine residents: we carried six or eight patients apiece on average, did all their procedures (intubating them, putting in lines, sticking needles into chests and bellies and spines and so forth) and took call every third night. You were guaranteed to never see the inside of your call room -- a closet big enough for a bed and a phone -- because you'd spend the whole night on the run between the ER and the six intensive care units on the first two floors of the University hospital. The team consisted of three residents, one Pulmonary fellow, one attending, and a pharm.D. student. There was a mirror-image team called CCU, or Cardiac Care Unit, which took the critical heart cases. Residents on CCU took call every third, as well, so at night the ICU resident and CCU resident could call on eachother if things got hairy. Both residents were on the code team, which meant we carried a code pager that alarmed and sent us running when a patient anywhere in the hospital had a cardiopulmonary emergency. In addition to that we had our regular pagers, which went off every five minutes. The code pager was honkin' big and really annoying to carry around. Plus, it sent me into a cold sweat when it went off.

First-year residents -- interns -- never rotated in ICU or CCU, not anymore. One time I asked an upper-level why that was. "Too many mistakes," he answered, "and too many cases ending like this--" He put his left hand down on Harrison's Internal Medicine and raised his right hand like a man solemnly swearing to tell the truth, the whole truth and nothing but the truth in a malpractice trial.

It was the only month I ever felt any resemblance to those stupid doctors on TV shows. It was scary and exhausting and I wasn't any good at it, but, God, it sang in my blood like a drug. Every patient had a flashy story and ten sobbing relatives, and most of them came in balanced on a knife's edge between living and dying. I felt all the way alive, like I'd made it to the throbbing passionate heart of everything that mattered. It was a soap opera. It was glorious; it was terrifying; I couldn't wait for it to be over and then I felt lost and let down when it finally was. And I miss it so much: miss it like you miss the wild bad boy who stole your heart and took you on a mad ride across Mexico, doing ninety miles an hour with a posse on your tail. I didn't have the cojones to do a Pulm fellowship myself, so I'm going to be missing it for the rest of my sorry chickenshit life.

One day a guy was flown in, a suicide attempt. He was a family man who'd drunk away his job and his money and then decided to end it all, so he downed several glasses of antifreeze while driving around in his car. Eventually the police stopped him and asked what the hell he was doing, at which point he declared, "I'm drinking antifreeze!" The cop asked, "How many glasses did you drink?" but the man, in lieu of answering, fell unconscious behind the wheel.

The great thing about this guy was his name. See, when I was a kid in grade school we had jump-rope songs, and my favorite went like this:

Lincoln, Lincoln, I've been thinkin --
What the heck have you been drinkin?
Looks like water,
Smells like wine,
Oh my gosh it's turpentine!
How many glasses did you drink?
One! Two! Three! Four!
(and so on)

The antifreeze man, believe it or not, was named Lincoln. That cracked me up. It was so damn good I couldn't keep it to myself. So the next morning, after I presented his case to my team -- told them about his medical problems and the treatment I'd started him on -- I added, "Now, listen. There's a song I have to sing for you, a jumprope song." And for the rest of the month the ICU nurses would whoop and chant "Lincoln, Lincoln!" when I walked through the halls.

All of this, by the way, has nothing to do with Allison. So I'll get to it.

I was on call one night when the ER paged. They had a sick guy needing a bed in the ICU, and as resident it was my job to pick up where the ER left off -- examine the patient, ask him a million questions, look over all the tests the ER had ordered and then come up with a treatment plan and write his admission orders. He was a 35-year-old black guy, a bit slow mentally, with no known pre-existing health problems -- in fact he was afraid of doctors and had avoided them his entire life. He was brought in by his brothers after four days of belly pain and nonstop vomiting. When he got to Triage, the nurses noticed right away that his heart rate was 150 and he looked bad. So they ushered him into the first open bed on Side A -- where the serious patients go -- instead of sticking him back in the waiting room. (The ER docs see side A patients right away; it's the people with sniffles and cuts who spend three hours in the waiting room and then two more hours in a bed on side B, before they finally get seen by an intern who doesn't know what she's doing anyway.)

So, that's how it started. It was about to get much worse. It was maybe five or six o'clock when I got the page, and I don't know what Allison was doing right then -- maybe playing or napping or chasing cheerios around a plate in her mom and dad's apartment on the slightly crappy side of town. She was too young to know about the ER, and she never had a clue what was coming.