The team meets our new attending today, Dr. Debbie. I worked with her when I was an intern and she was my senior. She is a great leader — smart, decisive, and funny.

This is a good boost for team morale. We need it.

[ … 8:30 AM … ] My intern paged me. He said, “Mr. Auric had 1200 cc of dark red fluid from his nasogastric tube this morning. I think it’s mostly blood. His family is here too ….”

“Give him a unit of blood, and fresh frozen plasma. I don’t want his family to have to decide this second if they want to continue treating him or not. Give him the blood so they have some time to think about it. Then we’ll ask them.”

Mr. Auric is a 32 year old man with end-stage liver disease. He is beyond jaundiced, beyond yellow, or even orange. His skin is now a deep dark bronze/gold color. His abdomen looks 9 months pregnant and today the tube in his stomach shows us that he is now bleeding from his massive varices. There are only a couple of ways that cirrhotics usually die … and this is one of them. His death has begun.

I go to his room and his mother is there as always. She looks near 50 at the oldest. I tell her what I told her last night. He is getting worse despite everything medicine can do. She tells me he called her in the middle of the night and said he was dying, so the family came right in. When a patient like this says that, they are almost always right. This morning he was crying and said he wanted to go home. He told his mom he would get better if he could only go home. Then he went back to babbling incoherently in his hepatotoxin-induced encephalopathy.

The mom says to me, “I just don’t want him to die like this. I don’t want him to hemorrhage to death.” She cries. You can tell a family/patient has been here too long when they start using medical terms correctly. They won’t be here much longer.

[ … 5:20 PM … ] Another CPR called. Another CPR cancelled. What is going on here…?

[ … 6:48 PM … ] Today was “Christmas Dinner Day” in the hospital cafeteria. The food was free, so a lot more people came to eat and they all brought their families with them. There were so many “non-medical” people I felt like I was in the mall on Christmas Eve. I actually felt out of place wearing my whitecoat as if I had dreamt I wore it to the store on accident. There was also this Neil Diamond-wannabe singing tunes on a Mr. Microphone set. He even spoke to the crowd in between oversung Christmas lyrics. I was in Christmas Hell, or at least a bad Saturday Night Live skit.

[ … 12:48 AM … ] One of our new patients has a large scrotal mass. The ultrasound says it might be a tumor so he’s probably going to surgery tomorrow. He thought he would just get some antibiotics and go home. But after tomorrow he will forever be known as The Lone Dangler.

Compared to dying men spewing forth blood and crying to their mothers to go home, this is comedic relief for me.

[ … 3:28 AM … ] “So technically we’re stealing company supplies here,” I tell my student, H.L., as I put a mini soapbar and a mini-shampoo bottle in my pockets. Hopefully I’ll have time to take a shower before the sun comes up in a few hours.

We walk to the elevators both operating at that 3 a.m. “punch-drunk” brontosaurus-in-a-tarpit mode. The only thing that will wake me up at this point is a call on the CPR beeper. At the elevators a nurse who worked with H.L. asks us, “What are you still doing up at 3 a.m.?”

After she leaves, we make up sarcastic answers to the nurse’s question.

“There was nothing on TV and we were bored.”

“Sleep is for kids.”

“Would you believe - stealing soap chips?”

“We were tired of sleeping.”

Okay,… it’s late. Everything is funny until somebody dies. Even then … sometimes.