The Real Doctor Will See You Shortly by Matt McCarthy

Author:Matt McCarthy
Language: eng
Format: epub
Publisher: Crown/Archetype
Published: 2015-04-07T04:00:00+00:00

24

“My gift to you,” Ashley said, handing me my pager ten minutes later. “Thing never stopped buzzing.”

“Gracias.”

“How was intern report?” she asked.

“Fine,” I said. “Listen, I’m gonna give it another shot with Dre.” On the walk back from Wendy’s I had tried to think more about how to break through to her. I hadn’t come up with much, but I felt momentarily invigorated by my lunchtime heart-to-heart with Ariel. “I think what she needs is some tough love.” I imagined what Ariel might say to Dre. “Or the opposite. I really have no idea.”

“I wanted to talk to you a bit more about her. Something that didn’t come up on rounds.”

“Of course.”

Ashley pulled out a sheet of laboratory data. “Do you think she needs dialysis?”

I scratched my head. “Someone mentioned kidney disease, but I’m not sure she needs dialysis.”

“Why not?” She batted her hazel eyes. “Walk me through your thought process.”

“It’s going to be a short walk.”

“Try.”

“Her creatinine is almost three,” I said, referring to the blood test that reflected kidney function. A normal value hovers around one. “Not great but not horrible.”

“Fine.”

I recalled the handful of patients I’d taken care of with kidney failure. “Dialysis is usually an emergency.”

“Sometimes. But not always.”

“Okay. I mean, she looks stable. Sick but stable. I can call and arrange dialysis, certainly.”

“When you call, you have to make a case for it.” She put her thumb and index finger together and stared deep into my eyes. “The nephrologists are busy and it’s a pain in the ass to dialyze someone. You gotta have a leg to stand on. What’s your argument?”

“I’d say her kidneys are only marginal and to be on the safe side we should do it.”

“Wrong!” She made the sound of a gong. “Never say ‘to be on the safe side.’ We’re in a hospital—that’s a given.” She took a large swig of her latte. “Remember your med school lectures on dialysis?”

“Vaguely.”

“It can all be distilled down to this: A-E-I-O-U.” She motioned to my breast pocket, and I pulled out a pen to take notes. “A. Acidosis—is the patient’s blood acidic? If so, dialysis. E. Electrolytes. If an electrolyte is severely off—”

She pointed at me.

“Dialysis,” I said.

“Good. I. Intoxication—did the patient ingest something toxic like moonshine or overdose on something like lithium?”

Dialysis had always confused the shit out of me. Was it really this straightforward?

“O. Overload. Is there fluid overload—too much liquid on the lungs?”

Her approach on this recalled Baio’s, and I knew I wouldn’t forget it. The truth is that complex decisions are often made using simple mnemonics. Linguistic shorthand wasn’t encouraged at Harvard—information needed to be mastered before it could be abbreviated—but Ashley had just simplified a series of baffling medical school lectures on dialysis into a mouthful of vowels.

My pager went off in mid-scribble. I glanced down at it.

THE GREAT MUSTACHE RACE—YOU IN?

I tilted the pager out of Ashley’s line of view. “U. Uremia,” she said quickly, “and that’s it. A-E-I-O-U.”

“Wow.”

“Next year, the Ash Safety Net disappears,” she said, putting a warm hand on my shoulder, “and the Republicans take over.

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