SCENE 21

 

Scene 21 opens with Richard running down the hall. Cut to rounding room, where Becker and Sam are sitting there quietly. Pan to view from rounding room, Richard flies by at full speed. Sam and Becker see him run by, but do not react. They sit calmly, and a few seconds later, Richard pokes his head into the room and then walks in, a bit short of breath.

 

Richard

Sorry I'm late.

 

dr. mehta

Richard, it's 1:45. Do you know what happens at 2:00?

 

Richard hesitates, then shakes his head.

 

dr. mehta

The Weakest Link comes on.

 

Sam stares sternly at Richard, who doesn't know how to respond to this. A few seconds pass.

 

dr. mehta

Richard, do you want me to miss The Weakest Link?

 

Richard

shakes his head

No sir.

 

dr. mehta

Okay then. Let's make these presentations short and sweet. Becker, tell me about Ms. Silver.

 

Becker

Ms. Silver is a 29 year old female who presents in status asthmaticus. I reviewed her old records and noted that she has had over 20 emergency room visits this year. When I asked her about this, she reported that she suffers a life-threatening asthma exacerbation every time she smokes crack.

 

Pause.

 

Becker

She got three breathing treatments and intravenous steroids in the emergency room, but is still wheezing diffusely and putting out about one third of her expected peak flow.

 

dr. mehta

Great. We'll continue scheduled breathing treatments until the steroids kick in. She'll go home tomorrow. What's Mr. Roberts' story, Richard?

 

Richard

Ms. Roberts' chief complaint is chest pain. Her heart sounded okay to me.

 

Dr. Mehta puts out his hand to stop Richard from continuing.

 

Dr. Mehta

History before physical exam.

 

Richard

Um, I didn't get a chance to take a history.

 

Dr. Mehta

contemplates this for a moment

You didn't get a chance.

 

Richard shakes his head.

 

dr. mehta

Okay. What were your physical exam findings?

 

Richard

Well like I said her heart sounded great. Her lungs and abdomen were normal, too. Her skin, eyes, ears, nose and throat all seemed normal. I didn't see anything wrong with her arms, legs, or her back.

 

dr. mehta

Richard did you find anything abnormal on exam?

 

Richard gets gravely serious.

 

Richard

Yes, I did.

 

Dr. Mehta stares at Richard, blinking, waiting. A few seconds pass.

 

dr. mehta

Ten minutes to The Weakest Link, Richard.

 

Richard

She has a two millimeter healing ulcer on her cervix.

 

Dr. Mehta stares at Richard, incredulous.

 

dr. mehta

Ms. Roberts came in with chest pain, and you did a pelvic exam?

 

Richard smiles proudly at himself.

 

Richard

I leave no stone unturned.

 

Dr. Mehta

How thorough of you.

 

Richard

Thank you.

 

dr. mehta

irritated

Did you get blood from Mr. Shilling?

 

Richard

dejected

No, I tried, but I couldn't get it.

 

dr. mehta

Well you've had a very productive morning, Richard. How about you reevaluate Ms. Roberts with Steve. I'll find somebody to draw Mr. Shilling's blood after the show.  Becker, I'll page you when we get our next patient.   Okay, guys?

 

Richard and Becker motion to leave.

 

DR. Mehta

to Richard

Steve is on seven west.

 

Sam walks out of the room. Cut to seven west nursing station. Richard walks up to a doc writing in the chart. Richard taps him on the shoulder.

 

Richard

Are you Steve?

 

Doctor turns around, looks at Richard's face, and then very conspicuously looks at Richard's name tag, which says "Medical Student." As soon as he sees the name tag, his face becomes twisted by disgust and irritation at being interrupted. He looks at Richard with unmasked contempt.

 

Dr. vile

Steve Lewitton?

 

Richard nods. Dr. Vile points to the other side of the nursing station and begins to turn around to continue what he was doing.

 

dr. vile

He's on the phone.

 

Cut to closeup of Richard looking across the station; he walks up to a doctor whose back is to him, with a phone in his ear and writing in a chart.

 

Richard

Dr. Lewitton?

 

Steve wheels around.

 

Steve

Yeah.

 

Richard

I'm Richard, one of your third year students.

 

Steve smiles and extends his hand.

 

Steve

How are ya. I'm Steve.

 

Richard

Great. Hey listen we're supposed to go see Ms. Roberts -

 

Steve extends a "one moment" finger as someone's talking him to him on the phone now.

 

Steve

This is Steve Lewitton, I was paged.

 

Yeah, Mr. Vincent. He's in four-point restraints, right? All his limbs are tied down?

 

Good. Yeah, we're just waiting on surgery to amputate it.

 

OK give him twenty more haldol, ten more ativan.

 

Mm-hmm, then check on him in twenty minutes. If he hasn't shut up just hold his meals and tell him he's not going to get any food until he stops complaining about his leg.

 

Great, thanks.

 

Steve hangs up. He starts talking to Richard.

 

Steve

Yeah I just spoke with Ms. Roberts. I hear you did a pelvic exam.

 

Richard

Yeah, my first one.

 

Steve

a bit bewildered

Yeah.

 

A nurse walks up to talk to Steve, and waits patiently for him to finish his conversation with Richard.

 

Richard

Sam said we need to reevaluate her. Something about taking a history?

 

Steve

Right. I just finished working her up, actually. After talking to Ms. Roberts and, um, Mr. Roberts I think it's probably best that you not follow her. I'll square it up with Sam, and just manage her by myself, so don't worry about it.

 

Steve turns to the nurse, who's staring off into space.

 

Steve

to nurse

What's going on?

 

No response. Nurse is in la-la land.

 

Steve

Ma'am?

 

Nurse comes to. Then tries to remember why she came to talk to Steve.

 

Nurse

Oh yeah. Are you taking care of Mr. Coleman?

 

Steve

Yes.

 

Nurse

He's choking on a chicken bone.

 

Steve

Okay. Is he able to breathe?

 

nurse

shakes her head

No.

 

Steve

nods patiently

Okay. Did you do anything for him?

 

Pause.

 

Steve

Heimlich maneuver or anything?

 

Nurse

I gave him some insulin.

 

Steve

nods encouragingly

Okay. Um, I don't remember him being diabetic. So, uh, why insulin?

 

NUrse

as though this were a silly question

Well I had to do something. I mean he's not breathing.

 

Steve

All right, great. Thanks. I'll go see him in a minute.

 

Nurse smiles and walks away leisurely. Steve returns his attention to Richard.

 

Steve

So, today's your first day of third year?

 

Richard

Yeah, I'm a bit overwhelmed.

 

Steve

Sure. You'll get the swing of things in no time. Actually that's not true. The length of the rotations is measured so that as soon as you figure out how to be productive you change services. Anyway are you familiar with the chart? Let me show you the chart.

 

Steve presents the chart he's been working on.

 

Steve

There are really only two sections that concern you: progress notes and orders. The progress notes section is where everyone taking care of the patient writes their assessment. You'll be writing your daily notes here, even though no one reads med student notes. This is how physicians communicate with each other.

 

Steve shows Richard a note in the chart that is completely illegible, just scribbles.

 

Steve

This is a typical surgeon's note. Surgeons spend most of their time trying to appear busy, and the prevailing feeling among surgeons is that the less legible your notes are, the busier you appear. I happen to recognize this particular variant of chicken scratch as belonging to Dr. Miller. Unreadable notes compromise patient care, so it's important to address this problem when it arises, which brings me to the other part of the chart you need to know about - the orders section.

 

Cut back to chart, Steve flips to physician orders, hold camera on orders as Steve speaks. As he speaks, he starts writing the date and time on a new order.

 

Steve

Anything you want done for the patient, you put here. I say "you" but of course as a student your orders will be ignored, so don't bother writing any.

 

The last order is reasonably well-written, signed by Dr. Miller. It says "Patient's bed is dangerously high. Please consult medicine to adjust bed height."

 

Notice how Dr. Miller writes somewhat more legibly here. Anyway you can read back over previous orders to get an idea of what's been going on with your patient.

 

As he speaks he writes a new order: "Tell Dr. Miller to go fuck himself."

 

Cut back to Richard and Steve, Steve closes the chart and puts it in the new orders rack.

 

Steve

Okay so tomorrow we're going to round with Dr. Toto. He tends to pimp you guys on stuff that has nothing to do with your patients, so in the few hours until you get your next admission you can just read on any topic, and there's about a one in five hundred chance it will come up tomorrow and you'll look good. Don't confine yourself to just internal medicine diseases - Dr. Toto draws his questions from all specialties. All right? And try to get an hour or two of sleep.

 

Cut to black.