I don’t know which is worse: disease of the human body or disease of humanity.
I may be a doctor, but I’m not like the rest of them. Docs typically treat without judgment, no matter who the patients are or how they live. Not me. I question the value of my work now and then. Does it really improve society, or is it wasted on the worst among us?
Let me give you some examples. Last week, a patient came to me with severe hyperglycemia. Turns out he ignored his diabetes meds and overindulged on junk food, so I had to bail out his ass. Months before that, I started treating a man for pancreatitis when the police showed up. Guess what? The patient was suspected of raping his ex-girlfriend. Gee, I had no fucking idea what kind of guy he was. Then there’s the COVID-19 pandemic, with so many needless deaths, anti-maskers, and anti-vaxxers. Don’t even get me started on this.
Sometimes, that’s what my job comes down to: wiping away physical sickness within the morally sick. Prolonging people’s lives just so they could go back to being a nuisance, a troublemaker, a menace to society. Not all of the time, but often enough to piss me off.
I’m not supposed to be saying any of this, or even thinking it. If Hippocrates, the great Father of Medicine, knew about me, he’d call on the gods to strike me down. After all, I already took his sacred oath. The one that says “do no harm,” preaching a duty to heal all without playing God. So I can’t be judge, jury, and executioner, deciding who lives or dies. I am a doctor who can stand only on one side, the side of life. I became an angel of health to defeat the demons of disease. Even with the human race so critically ill, with selfishness and stupidity running amok, spreading like cancer, I have a job to do. No ifs, ands, or buts. No questions asked.
So here I am, standing on a high pedestal, basking in the light of praise from the mortals surrounding me. But my base is shaky. My foundation isn’t solid like the true angels have. I must always watch my footing. Any misstep or misdeed as a healer and I am finished. The gods will punish me, strip off my wings. I’ll fall from the heights of heaven, plummet towards the depths of hell, vanish into oblivion. But I won’t let that happen. I’ve spent my life climbing to the stars, and after all this, I am not going to toss it all aside. There is no turning back. The only path left is towards the light, while the fires of sin burn not too far beneath my feet.
I must defend my honor, at all costs.
* * *
As a habit, I don’t drive in silence. Commuting is such a waste of time that hauling my ass to work while doing nothing else is pretty much the equivalent of trimming my precious lifespan. That’s why I have my radio on. The dashboard of my Tesla can provide different types of audio to keep me company, whether it be the news, music from radio stations, or favorite tunes in my Spotify playlist. It’s all at my fingertips. Right now, I’m flipping through various Southern California FM stations and seeing what songs randomly come up. I soon come across a catchy one: the all-girl eighties rock hit “Manic Monday” by The Bangles. I bob my head slightly to the rhythm and almost mutter the lyrics, too. Yeah, it’s so appropriate for today. Something upbeat to start a new week, while longing for the weekend that just passed.
Of course, that’s just for normal people, the five-day-a-week nine-to-five folks. I’m not one of them. I’m a hospitalist, a doctor doing nothing but inpatient care. My work goes from no later than 7 AM to no earlier than 5 PM, twelve days straight. Then six full days off, and repeat the cycle unless I opt for extra vacation time. I’m also paired off with a nocturnist, who watches over my patients whenever I’m off duty to get my nightly rest.
It’s now day ten and I’m almost dead. Plowing through today, tomorrow, and Wednesday is going to be a fucking pain in the ass.
I’m done with music for now, so I tune in to KNX for the local news. The current segment is wrapping up, something about computer malware and how it’s important for everyone to not open strange and unfamiliar emails. Gone are the days when the morning anchor dished out the latest stats about daily COVID-19 cases and deaths. Thank you, Pfizer, Moderna, Johnson & Johnson, and Novavax for those vaccines, plus the Food and Drug Administration for clearing them. These elixirs are giving us auras of protection, the magic we desperately need. It’s also made my job a hell of a lot easier. The last COVID-19 patient under my care was a little more than a month ago.
What a way to start the year. Now I’m back to solving other bodily afflictions, like in the pre-pandemic era. Sure, it’s the familiar endless cycle of “new day, same old shit” and it’s still grueling work, but at least I can breathe. No pun intended.
Another ten minutes and I’m in north Anaheim. Up ahead is Ivory Memorial Hospital, a big shiny white tower that beckons the sick to enter. As one of its healers, I help project the pride of this place. I am Dr. Mark Lin, board-certified internist. Any adults needing nonsurgical care, they may come to me. Anyone else can find other white coats in this place. Don’t forget the nurses, pharmacists, technicians, and other ancillary staff, too. Healthcare is a team effort, as this medical center likes to put it.
After parking my Tesla, I head up to the hospital’s eleventh floor where the Department of Internal Medicine resides. My cubicle is buried in a back corner, well hidden from the entrance to this office space. There, my first few tasks are always the same: log into my work computer and contact Dr. Jay McKinnon, the nocturnist whom the chief often likes to assign to me. Just as I would hand off my patients to Jay at the end of the day, he would return them to me with updates. I would usually send him a text to find out where he is in the hospital and wait a few minutes for a response.
Not this time. Today, he just happens to come into the room and sit in his cubicle, only three spots down from mine.
“Morning, Jay. Hope you had a good night’s sleep.”
“You mean a good day’s sleep.”
“No, I really mean a good night’s sleep. Did any of my patients keep you up?”
“Thankfully, no. Doesn’t mean I relaxed all night, though.”
“How busy were you?”
“I’d say one nurse call every twenty minutes.”
“In other words, the usual?”
“Yeah.”
I nod. Even though this hospital is lucky enough to hire nocturnists, it only managed to attract a small handful. The result: each nocturnist covers the patient load of three or four daytime hospitalists, nowhere close to a chill one-to-one ratio.
“I know how hard it can get,” I say.
“Don’t worry about it,” Jay responds while logging into his desktop terminal. “It’s totally doable.”
“You enjoy the night shift?”
“Do you even need to ask?”
“Just making sure.”
“Of course I love it, you idiot. Wouldn’t you like handling stuff without extra hassles?”
“Good for you. Don’t quit this place.”
“Oh, I won’t. I’m satisfied. Unlike you, who sometimes complains about being overwhelmed.”
“Me, complain?”
“Remember when you gave me your patient list a few days ago? You were pretty damn tense, and you didn’t hide it.”
I nod and put my hands up in surrender.
“OK, fine, I had an unbelievably awful day,” I say. “Anyway, can we do the handoff thing now?”
Jay smiles and adjusts his glasses, then pulls out his hospital-issued tablet from his white coat pocket. On its screen, he taps open an app containing his notes about the patients I signed out to him yesterday. I take out my own tablet from my coat, access the same app, and wait for Jay’s overnight notes to be transferred wirelessly to mine.
“I’m only teasing you, Mark. You know how much I appreciate your work. I don’t remember the last time I ever got swamped on a night shift because your patients were so unstable.”
“Good to know. Even if I’m just lucky.”
“It’s not luck. It’s good patient care. Seriously, you got dedication. You don’t go home until they’re nicely tucked in.”
“Well, thanks for the kind compliment. Hurry up so you can get your daytime beauty sleep.”
Jay laughs a little, then looks down at his tablet and slowly scrolls down with one finger. I listen while reviewing the same notes.
“All right, first patient. Christopher Flint, congestive heart failure. I got called by the nurse a little after midnight. Said he was constipated.”
“Wait. What?”
“According to her, the patient had that problem earlier in the day, and even wondered if he should have asked for a laxative then. Maybe he didn’t think it was a big deal at the time. Anyway, it sounds like he decided at the last minute, so late at night, to get that little request over with.”
“So you gave him something.”
“Yeah, a dose of Dulcolax.”
“But vital signs were OK otherwise?”
“Yep. Nothing out of whack with that, or anything else.”
“Cool. Next patient?”
“Uh, let’s see. There was one new admission that I took at around seven last night, so he’s on your list now. But let me get to your existing ones first.”
“OK.”
“Darnell Jackson is fine. I even took a peek at his glucose levels when things weren’t busy. He’s not back to DKA, that’s for sure.”
I nod with satisfaction. Jackson is a type 1 diabetic. He needs insulin every day because his own pancreas cannot make it. Due to chaotic life stressors, he missed an insulin shot at home, so that his blood sugars skyrocketed to the point of diabetic ketoacidosis and paramedics had to rush him to this hospital. The ICU took care of his DKA with an intensive insulin regimen, before transferring him to me on the medicine ward. My job now is to finish controlling his blood sugars and determine the insulin doses that he could continue at home after he is discharged.
“Doris Schafer with pneumonia didn’t prompt any calls,” Jay goes on. “And all the rest… Tony Palacio, Mrs. Green, Mr. Choi… no, nothing happened with any of them. So that leaves the new patient.”
On my tablet, I spot the new name in the list: Donald Chester, a 68-year-old man with a history of liver cirrhosis secondary to long-term alcohol use. I listen to Jay while glancing at his notes.
“Donald Chester came in because of hematemesis. Vomited a lot of blood. Never happened before. He’s also had some indigestion and loss of appetite over the last three days. Obviously, all of this scared him and his wife, especially the bloody vomit. So she drove him to the emergency department here. Doc ordered a CT abdomen, and the radiologist spotted not one but two things: esophageal varices and a suspected gastric tumor.”
Wow. This is the kind of case that could excite a roomful of docs in grand rounds meetings: a clinical presentation with two possible causes. Possibility number one: blood leaving the esophagus, stomach, and intestines flows into the portal vein in the liver, but if the liver is known to be cirrhotic, blood has a tough time passing through. It backs up. Veins in the esophagus stretch wider, what we docs call esophageal varices. If those vessels break, the patient bleeds down into the stomach and could maybe puke it back up. Possibility number two: A stomach tumor results in pooled gastric blood just by growing and poking through little blood vessels nearby. So which is the source of the bleeding here: the esophageal varices, the stomach tumor, or both? Holy crap, this patient might be an alcoholic, yet his case is both mentally stimulating and emotionally intriguing. I can do this one.
“Was he unstable at any point?” I ask.
“Miraculously, he wasn’t. When I spoke to him and did a physical exam, he was a little worried but otherwise awake and asymptomatic. Blood pressure and other vital signs were within normal limits.”
“Maybe his own blood clotting did the trick, whatever the bleeding source is. Obviously, we need a GI consult.”
“Already called for one. Joanne Li is the on-call gastroenterologist. She’ll evaluate Mr. Chester today.”
I nod, making a note to follow up on that. I also need to fit in a surgery consult for the stomach tumor. That would have to come second, because variceal bleeding seems to be the more immediate risk right now. All of this will likely occur in the afternoon.
“Anything else?” I ask, even though I know the answer already.
“You’re all set, buddy, and so am I. Well, almost. I still have to wait for two other docs to do handoffs with.”
At that moment, Jay pulls out a smartphone from his coat pocket and glances at it. Then he smiles.
“What do you know? They just texted me.”
“I’ll let you get to it.”
“I’m almost there. I’ll definitely get some good beauty sleep.”
“Good for you, man. You deserve it.”
“Whoa, hold on. I’m getting another text.”
Almost simultaneously, I feel a vibration. I have two smartphones, one work and one personal. The work phone in my left pants pocket is the one buzzing.
“That’s weird,” I say, pulling it out to check.
“You’re getting it, too?”
“Getting what?”
“A text message from the top, hospital administration. Oh gee, looks like everyone is receiving this.”
I say nothing as I slowly read my screen.
ATTENTION!
To all staff at Ivory Memorial Hospital:
Our email system has been flooded with numerous spam messages, causing a systemwide slowdown of email communications. It has come to our attention that a form of malware, spreading rapidly via email, is likely responsible, not just in this hospital but also with many incidents elsewhere.
As an urgent cautionary measure, the Division of Information Technology has shut down email servers and disabled all related applications. Technicians are currently working diligently to resolve this matter as soon as possible. Until further notice, please refrain from accessing ANY email (work OR personal), and encourage patients and other staff to communicate with you by alternate means, such as phone and text.
We apologize for this inconvenience. Thank you for your cooperation. Remember, healthcare is a team effort.
Jeffrey Winters, MD
Chief Executive Officer
Ivory Memorial Hospital
“What the hell is going on?” I ask breathlessly.
“Beats me,” Jay says with a frown.
“Has the CEO ever sent a message like this?”
“I’ve been here almost nine years. All I ever heard from him were those emails celebrating hospital milestones and annual holidays.”
“Then something is definitely happening.”
“It’s probably a big news story now.”
“Wait a minute. I heard something about malware this morning on KNX. I should look into this.”
In my cubicle, I open Google Chrome on my desktop computer. I head straight to one of my go-to news sources, The Associated Press. I verbally read the top headline, loud enough for Jay to hear.
“Lucifer’s Worm cripples computer systems worldwide.”
“Whoa. What does the article say?”
I skim the text while reciting the key points.
“It starts with someone getting a weird email message, with the subject line, ‘Here’s something interesting I found.’ The user opens it, only to find a short message in the body: ‘Hahaha! You have just unleashed Lucifer’s Worm! Now face the wrath of the demon itself!’ The opening of the email triggers the malware to replicate and send itself to every email address found on the computer and any connected servers. Address books and mailing lists are major factors in the spread.”
“Oh my god, really?”
“And when this happens, all other network activity slows down. In some cases, even grind to a halt.”
Jay says nothing. But I hear a long exhale come out of him.
“It gets worse,” I continue. “The article talks about some serious consequences of Lucifer’s Worm. At a Bank of America branch in Houston, all of its computers have crashed. And there’s madness in a Cleveland courthouse because everyone’s machine has gone haywire, disrupting case processing there. There’s even the possibility that online retailers like Amazon are going to temporarily shut down their websites, starting today.”
“It’s like we’re going through another pandemic.”
“More like a cyber pandemic. But the idea is the same: cripple one thing so many people depend on, the world goes into chaos.”
“COVID-19 cut off interpersonal contact everywhere. Now Lucifer’s Worm decimates email.”
“Exactly.”
“I sure hope I can still sleep today.”
“What in the world is going to happen next?”
“I don’t want to know.”
Me neither. I take a deep breath. Time to change the topic.
“So, Jay, how are things with that woman you’re dating?”
“No luck. She’s not returning my calls. But it was hard for us to coordinate schedules, the end of her work day with the usual time I wake up in the afternoon.”
“Sorry to hear that.”
“At this point, I’m better off looking for ladies of the night.”
“You don’t mean—”
“No, not that kind, idiot. Someone whose circadian rhythm matches mine. Don’t forget smart and beautiful, too.”
I stifle a laugh. Jay has a funny way of calling me an idiot.
“How about another nocturnist here?” I ask.
“None catch my eye.”
“Are you even looking?”
“Of course I am. At one point, I even thought about getting to know Joanne Li. But she’s married with two kids, you know.”
“Just remember you’re not alone. I’m a bachelor, too.”
“Thanks for the encouragement.”
“Sure. Don’t sweat it. I think you’ll be fine, as long as you—”
All of a sudden, a loud high-pitched squeal pierces my eardrums from above. I freeze and hold my breath, waiting for the voice over the PA system.
“Code Blue, room 832. Code Blue, room 832.”
I glance at the patient list in my tablet. Shit, it’s Christopher Flint, now on the brink of death!
I jump out of my seat and run for the door, nearly crashing into two docs coming into the room, no doubt Jay’s last two handoffs. Out in the hallway, an elevator opens up. No one inside. I dash in and press eight. The doors close. Then I clench my fists, suddenly remembering how goddamn slow these elevators are, even for a three-floor descent. I should’ve rushed down the stairs.
Yeah, I’m a real idiot.
Once the doors open, I dash down the hall in big, careful steps. Past the nurse’s station. Then a right turn. I slow to a quick crawl as I carefully maneuver through the doorway of 832 and a crowd of staff inside. I reach the patient.
Flint’s mouth is open, filled like a bowl of putrid stew.
