Reaching Down the Rabbit Hole by Allan H. Ropper Read Free Book Online

and was now ninety minutes away from the end of her mandated maximum of fourteen consecutive hours. For the next hour and a half she would complete the “handoff,” an unfortunate, policy-driven ritual in which the doctor who knows the most about the new patients, the only one who has actually met and examined them, presents the essential details of the cases to the rest of the team, and then leaves, often unwillingly. If all goes well, the baton passes smoothly and we don’t break stride. But every now and then we miss a step, or drop the damn thing. It would take us over two hours to run the patient list that morning, and during that time we would squeeze in speed rounds early so that Elena could go home and get some rest. “Just the news,” I kept telling the residents, “not the weather.”
    Among the new admissions, one patient worried me: Mrs. Gyftopoulos, a fifty-year-old mother of three. Was she stable enough to be here? I didn’t think so. As we headed off on rounds, I said to Hannah, “We’ve got too many patients. This is getting a little unsafe.”
    Elsewhere on the ward, we had Mrs. Newlin, a ninety-year-oldwoman with such explosive headaches that Elliott suggested putting her on a terrorist watch list. We had two drug abusers sharing a room, one a burnt-out addict with horrible teeth (he had thrown away his toothbrush because it reminded him of his wife, who had left him six months ago), the other a pure drug seeker in his early twenties, who I had admitted from the outpatient clinic after he exhibited such excruciating sciatic pain that I felt I had no choice. Later in the day, Elliott informed me that he had seen the guy down in the lobby eating a fruit cup while perched on the edge of an armchair. “No evident signs of distress, in fact quite the opposite,” Elliott informed me. It would take a concerted team effort and a final bribe of intravenous Dilaudid just to get rid of the kid.
    We had our aging rocker in the luxury suite, accompanied by a small retinue, including a personal trainer, an aromatherapist, and a bodyguard (strictly against hospital rules). In turn, I brought my own entourage of residents and med students, most of whom had never heard of the guy, having been born well after his last album had gone gold. Back on the ward, we had Doc Vandermeer, with the lemon-sized tumor in his frontal lobe. As patrician a man as one might meet, he had the endearing habit (or infuriating one, depending on your outlook) of never saying anything directly that could be couched in clever circumlocution. When Hannah asked him if he needed anything to make him comfortable, he replied, “No, but my equanimity and support services appear to be compromised in a telling way, and to get back my life would be gratifying.” It was already clear to me that he would not be getting much of his life back unless we removed his tumor, and even then it was not a sure thing.
    Nearby we had a larger-than-life, left-leaning economist and activist who, with very good reasons that I worked hard to deflect, harbored a destabilizing conviction that she was experiencing the onset of Lou Gehrig’s disease. Next door, a Boston firefighter was coming to grips with the fact that he had a glioblastoma, a rapidly growing, incurable, and inoperable tumor that would kill him within six months.Down the hall, a sham epileptic was manifesting theatrical seizures that registered nary a blip on the EEG. And scattered here and there were a variety of ischemic and hemorrhagic strokes, both catastrophic and benign, one a Wernicke’s aphasia and one a Broca’s aphasia, the first of which plays havoc with word selection, the second with speech production.
    Then there was Mrs. G herself. The details of her case were presented at morning conference by Callie, a second-year resident with an MD and PhD from Yale, who would have looked more at home on Melrose Place than on Chapel Street. Callie spoke with an up-lilting intonation, and