“The next patient is a morbidly obese 74-year-old with a DVT and PE, on heparin. We are starting Coumadin now,” began Stubb.
Suddenly Ahab erupted: “Why is this patient in the hospital? Why isn’t he on LMWH and home already?”
“I thought he needed heparinization, and I’m concerned about hypoxia,” stammered Stubb.
“Aye, but what’s your evidence that inpatient is better than outpatient treatment? Can you drive blindfolded? Are your thoughts and concerns worth the wasted resources?” hissed Ahab.
The pen fell from Stubb’s hand and lay lifeless on the floor.
Suddenly the nurse ran from the patient’s room, calling a code. We rushed into the room. The patient was a huge man—a leviathan—his flesh an off-white in the fluorescent light. Flask jumped on his chest and began to pump; Stubb intubated and bagged, while Starbuck sipped his coffee. Queequeg plunged a needle into the patient’s femoral artery for a blood gas and a central line in his subclavian before I could move my feet. A small jet of blood streamed out while Queequeg positioned the tubing. The patient was resuscitated and wheeled to the ICU. I stood helplessly, thinking about evidence.
I then noticed that Ahab, who seemed shaken, was rooted to the floor. He stared at his own chest, a streak of clotted blood across his perfect white coat.
“Oh, lonely stats of death and life. Toward thee I strive, thou all-consuming data. From a cohort’s heart I randomize thee; to the last I graph with thee; for evidence sake I control my last study.” He stumbled from the room.
Chapter 10: Epilogue
I watched Ahab head to the elevator, his perfect coat tinged now with red. He waved to me three times, beckoning me to follow. But I leaned against the chart rack; it was solid. It kept me afloat. I stood there until the other team came by and joined them for their teaching rounds. TH
Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, senior associate consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine at the Mayo Clinic College of Medicine, Rochester, Minn.