Intern by Sandeep Jauhar

quipped. Nancy forced a smile and handed me a stack of sheets. “You’ll need these for rounds,” she said curtly.
    The CCU was a rectangle, with most of the rooms arrayed along a long wall running parallel to the East River. There was a central bay with a nursing station and a medication room. At the front entrance were a clerk’s desk and a pneumatic tube system for ferrying specimens to the laboratory in the basement. At least once an hour one could hear the
hut-hut-hut
of a test tube containing a blood sample beingwhisked away for analysis. Sleek and modern, constantly buzzing, the CCU occupied a world apart from the rest of the hospital, which by comparison was relatively staid. Staff were constantly walking through, wheeling machines. Alarms rang incessantly. Consultants were always around, scribbling notes. That first morning, the nurses were in the middle of their change-of-shift routine. “Bed Two is still constipated,” a nurse announced. “She hasn’t had a bowel movement for me in three days. Bed Four got agitated again last night, requiring Xanax, which he’s still getting PRN. Seven is status-post a 250 cc bolus of normal saline because he was running tachycardic most of the night. Twelve was suctioned once: large, yellow . . .”
    I hurried to see my patients before attending rounds began at eight o’clock. The first of them, Paolo Fellini, was a well-to-do businessman who had been enjoying his retirement for years when he was felled by a massive heart attack. Over the ensuing weeks, he had suffered numerous complications, including respiratory failure requiring a ventilator, blood infections requiring broad-spectrum antibiotics, and a stroke, which incarcerated him in a sort of dementia that left him unable to recognize even his grandchildren, whose get-well cards were pasted all over the walls. On his bedside table was a picture of him standing on a boat, smiling broadly, looking every bit the Connecticut waterman he once was, a stark contrast to the man who lay before me. He was now wearing a diaper—judging by the fetid odor, it was filled with stool—and a hospital gown that was more off his body than on. His mouth was open: a thick crust coated his lips and tongue. His legs were twisted into an unnatural position, a result, no doubt, of his stroke. On his arms were large purplish bruises where attempts had been made to draw blood, and several tears in his paper-thin skin were still oozing. A plastic tracheotomy tube jutted out of his throat, connecting to a blue baffled hose that originated from a spigot in the wall. A bag was attached to his bed railing, filled with Coca Cola–colored urine. At the bedside were a teal blue IV monitor, several oxygen canisters, a ventilation bag, and a bundle of purple tubes which snaked across the floor and fed into inflatable cuffs on his legs. A bag of milkytube feeds and several bags of clear medicated fluids were hanging on a metal hook suspended from the ceiling. Above his head, connected to a flexible metal crane, was a small television, which was off.
    When I got near him, his eyes jiggled apprehensively in their sockets. “Good morning,” I said. “I’m Dr. Jauhar.” His breath faintly smelled of old rice. “What is your name?” He did not respond. “Do you know where you are?” I reached for my stethoscope. On the monitor, his heartbeat quickened and his breathing became more rapid and shallow. The ventilator started wailing. For all the talk of coma, he clearly sensed my presence.
    His ribs poked out of his bony chest like spokes on a wheel. So rippled was the topography of his chest that I could not find a flat place to put my stethoscope. I finally wedged it between two ribs. “I’m not going to hurt you,” I said as he grimaced horribly. I had read that patients who make it out of intensive care units often liken the experience to combat. Many suffer