Intern by Sandeep Jauhar Page A

chronic anxiety and depression; others develop post-traumatic stress disorder. Drugs like morphine and fentanyl are used not just for pain relief but to keep patients from remembering their suffering.
    I tried sitting him up so I could listen to his lungs, but he resisted. I tried pushing him gently onto his side but he would not budge. Tears streamed down his sunken cheeks. I looked around for a nurse to assist me but no one was available. His lungs made deep, guttural groans, like a foghorn, so clogged were they with fluid and muck. I placed my hand on his abdomen and pressed gently. He opened his mouth, as if to emit a blood-curdling howl, but because of the tube in his throat, there was no sound. “I’m sorry, sir,” I kept saying.
    Outside the room, I jotted down a few notes. It was already seven forty-five. The encounter had taken almost fifteen minutes. I was going to have to scramble to finish seeing the rest of my patients before eight o’clock.
    I hustled to the bedside of Camille Panizzo, an eighteen-year-old with a rare blood disorder requiring frequent blood transfusions. Over the years, the excess iron from the transfused blood had accumulatedin her vital organs, including her heart, which had enlarged and thickened, leading to congestive heart failure. In the CCU she had had numerous runs of ventricular tachycardia, a potentially life-threatening heart arrhythmia. Electrophysiologists were considering implanting a defibrillator in her chest to shock her heart in case it stopped, but in the interim they had decided to treat her with intravenous lidocaine, an anesthetic that suppresses arrhythmias. The infusion had worked—the ventricular tachycardia had subsided—but now she was deeply somnolent, a side effect of the drug.
    When I arrived, she could barely open her eyes. She had delicate, appealing features—blond, curly hair, high cheekbones, and a narrow nose. Her jaundiced skin was the color of polenta, probably because of all the iron in her liver. Her eyelids only fluttered when I introduced myself, but I could still make out that she had green eyes, and that they were beautiful. Her mother, also blond and pretty, like a middle-aged flight attendant, was sitting by the window. She asked me if a decision had been made about a defibrillator. I told her that it was my first day but that I would check on it and get back to her. “They have to do something about this medication,” she said wearily. “I can’t stand to see her like this.”
    The mood next door could not have been more different. Ramón Ojeda, a middle-aged taxi driver, had had angioplasty, where a tiny balloon and a coil of wire called a
stent
was used to open a severely blocked coronary artery. Now, just a day later, he was sitting up in bed, admiring a magnificent view of the sun-soaked East River and the Queensboro Bridge. He was going to be transferred to a regular floor today. When I informed him of this, he feigned disappointment. “Look at me here,” he said, arms outstretched. “I’m king of the world!”
    Across the hall, my last patient, Irving Waldheim, was lying on a cardiac recliner, staring at a wall. Waldheim was a wizened man in his late sixties with a shock of wild, professorial hair and gray bushy eyebrows. His skin was pallid and shiny, with a residue of perspiration. Like Mr. Fellini, my first patient, he had suffered numerous complications during his monthlong stay in the CCU, the latest being unremittingfevers of unknown origin. The workup, including numerous blood cultures and CAT scans looking for occult infections, had been negative. Now his doctors were saying that, ironically, the antibiotics he was on might be causing the fevers.
    The room was dark, one of four in the CCU without windows. Next to the wall was a plastic bucket filled with foamy secretions. On the bed was a quilt knitted with a verse from the Twenty-third Psalm: “The Lord is my