The Witches’ Sabbath

Cotton

Outside, it was sweltering.  The cotton pollen was swept away by the northwesterly winds so fast and so hard that it looked like a snowstorm.  Like manna from heaven it fell.  It was the first of July, the first day of my internship at the University of New Mexico Medical Center.  No more than five minutes had elapsed since I walked through the doors of UNM, when my beeper went off.  The number displayed on the beeper was the emergency room.  Five minutes into my internship and I already had an admission.  I looked about the emergency department.  Every bed in the emergency room was taken.  Occupying four or five gurneys, their legs over the sides of the bed, were asthmatics, huffing on their snakes of misting albuterol tubes for precious air.  Asking a nurse if she’d seen Ira Silverstein, my third-year resident, she pointed toward the trauma beds where the more medically mangled patients were parked upon their gurneys, like sailors washed overboard who had found a lifeboat to cling to.  A covey of doctors and nurses, respiratory technicians and medical students, gathered round the gurney in the bay.  I edged my way in. “Anyone seen Silverstein?” I shouted above the hubbub that surrounded the gurney where a patient was lying on her left side, breathing out of one of the nebulizers that snaked about the bed.  The doctor standing next to her head looked up at me.  It was Ira Silverstein.  One of those permanently dour people you encounter, Silverstein more properly should have been a mortician. 

“This is Marge Edgerton.”   She was to be my wheezing fallen angel, my first admission of the day.  She called the ambulance just in time.  I forget how many times she’s been intubated.  We got her blood gases back: “She’s acidotic,” pronounced the Silverstein, “and her carbon dioxide pressure is twenty points higher than her oxygen pressure.  I was just going to intubate her.” 

“She’s my patient; I’ll intubate her.”

“I’m your senior resident.”

“Like hell you are.  I worked as a paramedic for a year at Denver General before I went to medical school.  I’m much better at this than you are.”

“Knock it off,” said a middle aged man in scrubs, whom I took for one of the attendants in the ER.  “Give the kid a chance.  Dr. Jordan, this will be your first intubation at UNM.  Two nurses were in the process of snipping her T-shirt off as she lay in the gurney.  She lay wheezing like a puppy locked in a hot car on the Fourth of July, her intercostal muscles moving in and out like fireplace bellows.  He face, all puffy, displayed the remnants of long corticosteroid use for her asthma.  Her lip was also inexplicably avulsed and swollen.  With the red hair and the constellation of red freckles, all pure stars, she looked like a Celtic fairy. 

“Where did she get that lip laceration?” I asked.

“From her lover,” replied Silverstein, pouting being denied his intubation.

“Tough love,” I said.

Sweating like a horse who’d just run in the Belmont Stakes, I guessed she’d be a 7.0 endotracheal tube.   

“Gentlemen, let’s get on with it.  Jordan, you get one try, then I’ll do it.  That’s the way it is,” said the ER attendant, Norton Coles, who was the captain of the ship in the emergency department on a day that promised no little excitement. 

Setting my backpack down, I took the laryngoscope that the respiratory tech handed me.  Taking it out of the wrapper, I applied K-Y gel to the tip that I’d be slipping into her trachea.  “Give her 5 milligrams of morphine,” I said to the nurse standing closest to me.  “Then 20 milligrams of valium.”  As those two drugs began to do their work, she finally relaxed, slipping into a supine position on the gurney.  While the respiratory tech hyperventilated her, I stared at the dial of the pulse oximeter, a small apparatus that, when attached to a patient’s finger, read their oxygenation from the capillaries in the nail bed; hers were in the low eighties.  With the bag mask in place, I opened her mouth and put an airway in it to keep her tongue from lolling over the epiglottis that I was trying to visualize.  Having done this, I slid the laryngoscope blade down to it.  Lifting the epiglottis up, I slid the plastic endotracheal tube home into her trachea.  We went through all the motions of making sure that the endotracheal was in the right spot before we hooked the endotracheal tube to the ventilator.  The arterial blood gas we got five minutes after I had intubated her was as good as could be expected.  I looked at my watch.  It was not yet seven-thirty. 

With Silverstein’s help, I wrote admission orders for her admission to the medical ICU.  Mad that I cheated him out a procedure, Silverstein spoke only in monosyllables.   We made it to the ICU in time to round.  There, I met the rest of the team; Tammy Ferguson, the other medical intern, and two medical students, whose names I long ago lost, were waiting for us.  When we had rounded on all the patients we’d picked up from the former team of interns, I sat down next to Tammy in the ICU.  For medical school, she’d attended UNM.  Edgerton had been her patient when she was a third year student.  “You see she’s Lesbian.  It’s only important from the standpoint that she gets in these really abusive relationships.  At some point, her lover beats the shit out of her.  That sets off an asthmatic crisis.  She’s got severe asthma, but then she gets in fights with her lovers and doesn’t take her medications.  When she comes into the hospital, she always comes in in extremis.  She’s been intubated over a dozen times.  Someday, she’s gonna be too late.  As soon as she comes off the ventilator, she signs herself out AMA (against medical advice).

And Tammy was prescient.  No sooner than she had been extubated and freed from the reins of the ventilator, she filled out the AMA form, gathered her medicine, and shot out the door with an appointment to see me in a week.  Needless to say, she missed that appointment.  But to my surprise, she came in to see me a week later.  The effect of tapering her steroids was bringing on another attack.  Now, out of hospital garb, she looked like an ordinary individual.  Though she was moon-faced from the steroids, she had high cheekbones, and a sharp angular curve to her nose, which reminded me of my first girlfriend.  Though her asthma was worse, she could speak in complete sentences.  Her lover of the moment was with her, two nose rings protruding from her face, and one through the right eyebrow.  They both seemed overly attentive to each other.  When I went to listen to her lungs, I noticed constellations of love bites on her neck.

I didn’t see much of Edgerton after that.  More than once, I heard she had been admitted to the ICU, and once I went by to see her.  Except for the time I saw her with her one lover, I never saw her come into the hospital with any other lovers, friends, or relatives. 

It was in March that she slipped and fell.  It was no big injury, but it provoked a blood clot which was swept away into her pulmonary vasculature.  This misadventure bought her another epic stay in the ICU, one where she threw a plate, striking a nurse on the head.  More visits followed.  In May I was scheduled to work in the emergency department.  Now, it was to manage the various cuts and contusions that she’d received at the hands of a lover.  With the blood thinners on board, the contusions and love bites flowered like the columbines.  Her arms were black and blue where I assumed she tried to bat away the lover’s jabs; ochre patches of maturing contusions surrounded both eyes. 

My last day on call was June 30th. Another resident called me down to the ER.  Again, it was pollen season, and the bays of the emergency room were full of wheezers, all on their nebulizers and intravenous drips.  While I was upstairs in the medical ICU attending to a gastrointestinal bleeder who had had more than his fair share of Wild Turkey in his time,

I heard the sound of the emergency squad’s ambulance far in the distance, but growing closer and closer.  I was called down to the ER.  When the paramedics opened the doors, I saw the shock of red hair, and I immediately knew who it was.  When I went to intubate her, her heart stopped.  The paramedics started CPR right away.  I shocked her with the defibrillator paddles four times.  But it was all to no avail.  Margie slipped the chains that tortured her in this world.

 

By Joseph Dylan

 

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