M&M

M&M/Danielle Ofri THE BODY WASN'T EVEN COLD when they informed me that I would be presenting the case at ?&?. For the next forty-eight hours, I grappled with the minutiae of the chart, trying to absorb every laboratory value and X-ray report, hallucinating blood gas numbers and ventilator settings. My intestines were roiling from caffeine. I had never killed anyone, so I didn't know what to expect. I mean, I had been to M&M before, but never as victim. One year, Ui a brief fit of morbid humor, the chiefs actually passed around M&M candies at Morbidity and Mortality rounds. Lord. I hesitated at the door, determined to control my hyperventilation. I'd started to sweat under my stiff white coat, and I could feel my skin growing sticky. I made a damp grab at the doorknob. The conference room was aUeady packed, but it wasn't the usual crowd of scruffy medical students and overtired residents. It was aU attendings—all real doctors. I scanned the crowd of gastroenterologists, cardiologists, radiologists, surgeons and critical-care attendings. I saw junior attendings, senior attendings, division heads, nursing supervisors and hospital adrriUiistrators. There was even someone from legal affairs. The case summary was in my right hand, a cup of coffee Ui my left. A few drops spiUed onto the typed sheets as I squirmed into my seat under the weight of aU the stares. I wasn't the only person who had made the error, but as medical consult , the senior medical resident, I'd been Ui charge. Of course, the attending was reaUy Ui charge, since this was University Hospital; I guessed he'd be cited first in the lawsuit. There were all those consultants on the case too, but in my experience it was always the resident who got flayed for the screw-ups. Residents at University Hospital were cheap labor for the private attendings. We carried out their orders, did all their scutwork, but had Uttle say Ui the important medical decisions , unlike Bellevue, the municipal hospital where we did most of our training. Of course when something went wrong, who got tossed into the fire at M&M? After all, it was an academic institution, and we were all there to learn! KUling a patient just a couple of months before the end of residency —what a way to launch a career in medicine. I had hoped for some salvation this morning, maybe a coUision with the First Avenue The Missouri Review · 37 bus on my way to the hospital, but no such reprieve was forthcoming . The head of the department uttered some platitudes about how this session was intended to be a learning experience. I felt faint. He nodded at me to begin. A sour taste filled my mouth, and I couldn't speak. I stared straight at the page. The buzzing of the fluorescent tights droned in my ears. I quickly sipped my coffee, realizing too late that I'd forgotten to put sugar in. Finally, my dry words emerged. "Mr. Herían is a thirty-one-year-old white male who attempted suicide three years ago by ingesting a bottle of lye. His esophagus was destroyed, but a piece of colon was surgically inserted between his mouth and stomach. Periodically he experienced esophageal strictures, but they were easily opened with balloon dilatation, and he had no difficulty eating or drinking. He had no other medical history, and his only medication was an antidepressant. "Last Wednesday he was admitted to University Hospital with symptoms of nausea, vomiting and dizziness. His admission labs were within normal limits. On Thursday, endoscopy showed esophageal strictures. On Friday he underwent successful balloon dilatation of the strictures. By Saturday the patient was already able to swaUow soft foods." I'd been medical constat at University Hospital tliat weekend. As the senior medical resident I was responsible for all the interns and residents on call. I had to handle all admissions and transfers—and, ofcourse, any codes. I was irritable just having to be there; I preferred to work in Bellevue. If Bellevue didn't have as many amenities, at least we residents got to make all the decisions about patient care. At...