Out of Order

I went back to work too soon. It made my recovery slower and more painful than it needed to be. But what troubled me more, was walking by Curtain 3 and treating patients there. I had to mentally prepare myself before entering that room. Doing an LP, was damn near impossible. I would hear the voices of Lucy, the patient and myself during that fateful tap on Valentine's Day. Any procedure requiring a scalpel would bring back physically painful memories of the attack. I couldn't escape it. The room was a daily fact of my job.

As the days passed, my dread of entering that room intensified. I tried to talk to Dr. Deraad, hoping he would prescribe something that would make the memories, voices and fears go away. But the fix would not be that easy or come that quick. I resorted to treating myself. I could cope through medicinal means, but since I couldn't prescribe medicine for myself, I'd have to be a bit creative.

I began to look for ways to augment my prescribed medicine. It was easy enough to inconspicuously obtain unused doses of narcotics in traumas. Fentanyl is a powerful pain reliever similar to morphine, but about 100 times more potent. It's fast acting and relieves pain quickly for a short time. We typically use it when traumas require major invasive procedures and to make end stage cancer patients comfortable. Like any other opiate based drug, it offers a sense of relaxation upon entering the system. Perfect, I thought. That's just what I needed.

Fentanyl would get me thru my shifts, but nights were still a major problem. There was no respite from my dreams. In my dreams, I was haunted by the memories from that Valentine's Day. I was tormented by my feelings for Lucy. The guilt and remorse would follow in turn. I would wake up in these cold sweats of fear and panic and dread. I'd end up lying there fully awake wrestling with the mental images that wouldn't leave my mind. Morning would come without sufficient rest, and my body would cry out for mercy.

Then there were days like the one when we received Lucy's match letter in the ER. Since she was my student, I manned up and said I'd handle it. I made the mistake of opening it up, reading it. She would have had a spot up in Psych. It was perfect for her. Lucy blew me away with her perceptiveness into the psyche of patients, into me. It would have been her place to shine. She was cheated out of the opportunity and I felt responsible. Because of me, she would never have the chance to live out her dream when it was right there, so close. I spent the day anguishing over Valentine's Day, my failure to listen to her, to monitor the whole case more closely, and recognize something was wrong in a timely way. My personal feelings of inadequacy permeated into everything I did that day.

I was in a trauma with Deb who was having trouble tubing the patient. She almost had it, a couple seconds more, she would have been in and the patient would have been fine, but I couldn't wait. The monitor signaling the decline in his sats rattled me. The incessant beeping was registering in my brain like the very last gasps of life. I had to restore breathing. I forcefully pulled the tube of the optic scope up and out of his mouth, the head of the scope hitting her in the nose. It probably took longer to do that than just letting her finish. As I was bagging the patient, I physically pushed her to the side and took over the trauma like I could handle it all myself. She and Lily both stood there with these disbelieving looks on their faces. We stabilized the patient and then got into one hell of a fight over it. It was loud enough for Dr. Weaver to come, break it up and send us to our corners. We've never fought like that before or since.

That same day, I was working with Carol. We were treating Pablo, one of our frequent flyers, when he accidently knocked over an instrument tray. The crash as it all came down on the floor sent chills down my spine and the memories of the attack flooded my brain. It surprised me. I wasn't prepared for my reaction. We were in sutures, not the curtain area. I immediately ordered soft restraints. Carol protested loudly, but I pushed Haldol over her objection. Carol exploded. "This is Pablo, they don't come any gentler!" She refused to help with the restraints. Mad as hell once more, I left the room, hurling my gloves to the floor.

We had a chance to air it out a little later. Carol asked me how I was doing. She was concerned about my overreaction to Pablo. I dismissed it as a bad call. How could I explain to her I was reliving that awful day over and over and over and over and it never changed? How could I tell her each cycle brought a more burdensome load of guilt and remorse? How could I tell her what Lucy meant to me, what I lost, for her and for me, what I'd never be able to get back for either of us? I couldn't even share that with Deb. She tried to sympathize, telling me about how life changes and you have to give yourself some time to get used to it. I couldn't say much, but I showed her Lucy's match letter. She said "there's always going to be something, Carter."

I asked her, "What do you do?" I figured, why not ask. What I was doing damn sure wasn't working.

Her answer? "Go back to work." Gee, that was helpful – NOT!

The long, horrible day was finally over and I headed for my locker. Deb was already in the lounge getting ready to leave. I apologized for my brash behavior earlier and the angry words. She looked up at me with so much care and concern in her eyes and said "John, I'm worried about you." I knew she genuinely meant it and I did want to confide in her. It was just hard for me to find the right words. I didn't want anyone thinking I was a psych case with all these morbid thoughts. I was too proud to admit I needed psychiatric counseling. After some mental wrestling, I pulled the envelope from my pocket and showed it to her.

She read it and compassionately looked up at me. In a reassuring voice she said "I didn't know Lucy very long, but I knew her well enough to know she was definitely your MO and I know you well enough to know you still have unresolved feelings for her. I'm sure it's difficult with no way to reconcile them."

I bowed my head, she was completely right. I looked at her nervously and asked "so what do I do?"

She shook her head as she gave it some serious thought. "You know when I found out about Anthony, it was really hard for me to be in the same place he was. When the hospital closed and our residencies got transferred, I made the choice not to go where he was. Coming here, being away from those memories really helped. Have you thought of completing your residency somewhere else?"

I couldn't imagine being anywhere other than County, but if it would make the memories stop and quiet the voices, it was worth considering. There was one problem though. The match was already over, and if I looked for a spot outside the match, my chances of being chief resident would be reduced to nil.

It was at that point, I took a two pronged approach to my problem. I continued to take the Fentanyl to ease my anxieties about Curtain 3 and treating patients in that room. I also started to take anti-depressants to deal with the voices and memories I couldn't deal with anymore. It was a dangerous cocktail and a very slippery slope. I was well down the road to my own destruction.

The combination of self dosed drug therapies caused radical shifts in my mood. One minute I'd be drag-ass, the next I'd be almost manic, and the next I'd be downright depressed. Deb and I would typically meet for coffee at Doc Magoo's before our shift whenever we worked together. One particular morning, I was having such a tough time getting moving that I called to cancel. We met on our way in the door and she greeted me with a warm hello. I mumbled "well it's morning" as we walked into the lounge.

We were stowing our stuff in our lockers when she mentioned I looked terrible. Weaver happened to be on a rampage that day and came in mad as hell. She gave us an ear lashing about being late. We were to have our asses out there and seeing patients at 7am sharp. She rounded everyone up and ran the board, spitting out rapid fire assignments as she went down the list of patients. I was assigned a patient in Curtain 3. Oh shit! I thought. There was no way in hell I was going to be able to do it with some uppers.

I walked with Dave down the hall, dreading Curtain 3 all the way. He too felt compelled to tell me I looked piss poor. I ducked into the men's room, made sure the coast was clear and reached in my pocket for my stash. It didn't take long before I was feeling more up to the facing the foreboding curtain.

I was working up the patient in Curtain 3 when Weaver sent me another one to handle in the next bed. Instead of finishing up the first patient and then addressing the second, I worked them up at the same time. Mind you, this is not something any doctor with his mental faculties in tact would ever do. Deb walked in and noting the improper history I was taking, offered to help. I told her I was fine as I continued to work up both patients at the same time. Rightfully dubious of what she saw, she kept a careful eye on me as she left the room.

I was bursting with energy and frustrated that Malik hadn't started the IV drip for the patient in Curtain 3 , so I got it started myself. The problem with a tandem workup, especially when one is on uppers, is that it's so easy to get details confused. I started her on a drip of a drug she was allergic to. Her reaction was almost immediate. I panicked. Not only was the patient in physical distress, I was in danger of being busted. I tried to cover my ass by pulling out her IV. I got no help from the patient in the next bed who hit the nurse's call button. Malik and Deb both came running into the room. Puzzled by the blood on the floor, they asked what happened. I had to think fast. I told them the patient pulled her own IV out, but neither one was buying it. I snapped at Deb. It was harsh and defensive. The look on her face was one of horror. I knew I was out of control and a danger to my patients.

I hurried out of there and went directly to the men's room. I locked myself in a stall and cried out of frustration. I was broken, I was out of order. I put a patient in jeopardy. I directly violated rule number one: DO NO HARM! I was sick of myself and I hated it. I hated the memories. I hated the voices. I hated the feelings I couldn't get rid of. I couldn't continue on like this. I had to find another way to deal with it all. I got the uppers out of my pocket and flushed them down the toilet. That was a start I thought. I can beat this, I thought. I took a break. I walked down the street to the convenience store and bought my second pack of cigarettes.

Outside, I lit up. I leaned against the wall and pondered my morning. How long could I keep everything inside before I burn out or blow up or in some way self destruct? Will this keep going until I finally kill someone or can I regain control before that? I was using only prescription drugs. It wasn't like I was a heroin junkie like Chase. My real problem wasn't even the drugs, it was those damn memories, the voices, the feelings. They caused so much pain and anguish. If I could just get rid of them, I'd be fine. I finished my cigarette and returned to the ER.

Around noon, Deb grabbed me and asked me out to lunch. I told her I wasn't hungry and didn't have time. She was very insistent, even leading me by the arm to Doc Magoo's. To make her happy, I ordered lunch. I took a bite or two, but I couldn't manage anything more than that. I felt bad that I yelled at her that morning and apologized. She tried to talk to me about what happened. I genuinely wanted to talk to her, but I couldn't figure out how to articulate what was going on in my head. The memories that brought physical pain and the voices in my head that wouldn't stop were far beyond normal and reasonable. The last thing I wanted to be was a psych case. It was far easier to deflect her concerns. I took out a cigarette and lit up. "What's up with the cigarettes" she asked.

I defended myself, "are you going to give me a problem about smoking now too?"

She reached over the table and put her hand on my arm. "John, I'm really worried about you. Each day you seem to be less and less like yourself."

I tried to assure her that I was working on getting it together. It was tough and I was having to work through some pretty big challenges, but I'd get there. I'd be alright. She didn't seem to be very convinced though. I'm pretty sure she went and talked to Dr. Greene after lunch because later that day, he had a talk with me about getting some psych help. He even gave me a list of doctors I could call. I told him I would, but after he left, I wadded up the list and threw it in the trash. I was not a damn psych case.

I tried even harder to maintain a level demeanor at work in order to avoid such conversations again. I completely withdrew socially for the same reason. Too many people were noticing I was not right. Too many people were trying to tell me I needed help. I still thought I didn't need help. I could handle it on my own.