Read Reaching Down the Rabbit Hole for Free Online Page B

in Madrid with a visa problem. To add insult to an entire roster of injuries, an aging rock star, a Boomer legacy act, was scheduled to arrive sometime that morning and be whisked to a pavilion suite on the sixteenth floor, shielded from the prying eyes of the press under a pseudonym. He was going to want our full attention. Which is to say we were short-staffed, overbooked, and had a celebrity admission to boot. It was a potentially dangerous situation, not for our rock star, but for some of our higher-risk patients like Mrs. G. And I had only myself to blame.
    For years now, I have scheduled myself for “the service” during the first two weeks in July and the last two weeks of December, meaning that I sign up to serve as the attending physician on the neurologyinpatient ward and the neuro-ICU, partly as a favor to those who would rather not work through the big holidays—the Fourth of July and Christmas—and partly to show them up. I don’t mind. I’m happy to do it even though these tend to be slow times on the wards. To compensate, I encourage the residents to admit as many patients as they can. “Keep an eye out for interesting cases!” I tell them. “Go walk up and down the sidewalk in front of Au Bon Pain and see if you can spot anyone who can’t walk straight.”
    It was July 3, the third day of my service. I had taken over from Elliott, who was now on neurological consult to the Emergency Department. I had been relieved to learn that I would be getting Hannah as my senior resident. She had started her rotation a week earlier, so she was up to speed on most of the patients. As for the rest of the team, I never know who is scheduled until they show up. Given the situation with Flavio, we had been forced to go to the bullpen and come up with two first-years from Children’s Hospital, who would have to be tutored in the Brigham’s arcane medical ordering system, written in DOS sometime during the Ford administration.
    It should not come as a shock that the daily routine at a teaching hospital does not much resemble the tightly choreographed one-hour dramas that dominate prime-time TV schedules. The sheer numbers of patients, their tendency to pass in and out of our service due to medical rather than plot-driven priorities, restricts our time with each one of them, and sometimes scatters our focus. During those two weeks, Hannah would often tell me that if she simply had the time, she could crack some of our most baffling cases. If not for the paperwork and the bureaucratic overhead, perhaps she could have. But time is a luxury, and sometimes it feels as though our primary function is just to check off boxes on a never-ending punch list. As I said to one of the new residents, “You may get the idea that we’re constantly draining the swamp.”
    That morning, like every morning, the neurology team had gathered in the conference room on the tenth floor of the hospital tower—acramped, windowless, cluttered way station where the various medical teams convene to discuss their cases, order lab tests and consultations, and steal an occasional power nap. The room is a study in off-whites: an uninviting, fluorescent-lit, purely functional space. Melamine counters and computer workstations run along the right side, white boards dominate the left, and a conference table with office chairs is crammed into the middle. A fifty-inch LCD flat screen mounted on the far wall is used to display scans and test results. There was barely space for eight of us and the food we had brought: enough bagels, doughnuts, muffins, Danish, and coffee to ensure an elevated glycemic index for the next eight hours.
    As she handed me the patient list, Hannah informed me that one patient, a Mr. Williams, the man who had coded three times in one night, should never have been sent to the service in the first place, and had kept Elena’s hands full. As the overnight resident, Elena had had almost no downtime on her shift, was clearly drained,