My eyes popped open. A moment’s disorientation gave way as I took in the scene: running shoes, scrubs, bleak little room — I was on call. My pager was bleeping away. Call to me was a dreamy, sort of psychedelic experience. I would have difficulty sleeping the night before, and so would begin the thirty-six hour stint already somewhat deprived. By the middle of the call night, I would feel sluggish and somewhat giddy. If there was any sleep to be had, it would be intense, dream-rich and brief, leaving me dazed upon waking. I would talk to nurses on the phone in the dark from under the covers, giving orders and answering questions, but remaining in a wavy grey area between sleep and wakefulness.
I looked over to my pager as I swung my legs over the side of the bed and sat for a long moment collecting myself. I had just accomplished an unusual two hours of uninterrupted sleep, and my mind resisted being pulled back into consciousness. Sighing deeply, I took a look at the call back number. It had a 666 suffix denoting another intern paging. It was a little trick we employed as a courtesy and to expedite a call back.
I knew it was Pete since at 2:39 AM no other house staff but those on call would be around. I picked up the phone.
“You gotta come up here.”
“Where are you?”
“Just come up. What are you sleeping?”
Pete never slept on call. If not busy, he would sit and read, drinking Coke and bouncing his knees. I opened the call-room door and steered out into the corridor. The VA had huge turn-of-the-century corridors with lots of wood and tile that I found forbidding but evocative. It was easy to imagine this hallway ninety years ago: an entourage of white-coated sycophants bobbing in the wake of some luminary clinician, his stentorian baritone bouncing from tile to tile as he held forth on the topic of the day. In fact, with slight variations of style and topic, in about five hours a similar scene would be played out here. Pete would be spiritedly leading the whitecoats, less brown-nosing than simply riding his caffeine wave; I still found it unseemly.
I arrived at the seventh floor nursing station to find Pete in an unusual state of calm. “So what’s up?” I asked him.
“You just gotta see.” We moved to a room just down the corridor, Pete slowly shaking his head. We entered. An elderly man lay on the bed asleep or unconscious, with IV’s and monitors bleeping away. “This is Myron Flint,” Pete began, adjusting his glasses with a crinkle of his nose. “Mr. Flint was admitted early this evening by two of our esteemed colleagues. Mr. Flint is in heart failure. Our colleagues, who are surely at home sleeping like angels, prudently began Mr. Flint on an aggressive regimen of diuretics.”
“Yeah,” I said waiting for the punch line.
“Nurse came in to place a Foley.” A Foley is an indwelling bladder catheter. It would be a standard order for a patient like this.
“OK,” I responded, wincing a bit as the possibilities unfolded in my sleepy mind.
“Little issue,” he said, grabbing the edges of the sheet and blanket and slowly peeling them back. I narrowed my eyes. Pete reached up and adjusted his glasses on the bridge of his nose.
“Oh my, my, my,” I slowly intoned.
“Yeah.” Pete nodded. “Yeah. Seems our colleagues weren’t so thorough in their examination.”
“Seems not.” We silently turned to the dispenser on the wall and gloved up. I moved to the opposite side of the bed facing Pete. He reached down and took hold of the patient’s penis. At the base was a solid silver ring, expanded to an oval at the top. The tissue beyond was grotesquely swollen. Pete parted the swollen flesh surrounding the ring’s flat plate revealing a roughly etched “Algiers 1944.” The writing was sandwiched between a simple design suggesting two half suns, the rays beaming towards the plate’s edges.
“Algiers 1944. Huh,” I said quietly.
“Now that there is commemorative,” he suggested. Pete went to the ER to get a ring cutter, and I grabbed the chart: born 1920, two previous admissions for heart failure, no family, lives alone.
Pete returned a few minutes later and we set to work. It was difficult to steer the tool’s guard under the ring with all the swollen and sensitive skin, but we managed and began turning the grinding disk.
We both recoiled at the sound of grinding metal issuing from such a delicate locale. Silver flecks gathered among the engorged tissue. We took turns cranking the device, having to make cuts on both sides to free it. As it gave way, the swollen member flopped onto the patient’s thigh like a landed elephant seal. “That’s progress,” Pete stated gruffly.
“A definite step in the right direction,” I agreed, examining the ring’s remaining top portion. “What’s the story behind this?” I asked, mostly to myself.
I flipped it over in my palm a few times and dropped it into my jacket pocket. Pete leered at me from over his glasses. “What are you gonna carry that around with you?”
“Don’t worry,” I replied. “I plan to rinse it in tepid water. Were you planning to send it to pathology for analysis?” Pete laughed.
“Hey, enjoy, enjoy. I doubt he’ll miss it.”
“Has he been awake?” I asked.
“According to the nurse, he was found unconscious by his friend and hasn’t raised an eyelid.” We tossed our gloves and pulled the blankets up to Mr. Flint’s neck.
Tomorrow, Part 2