It has been a while since the last story. For a reason. My creativity level went down faster than the european stock market after Brexit. I was sick and tired, but I needed to work. No money, no honey. Freelance downsides baby, here we go. I got offered a contract job again for 3 Sundays in a row in June. 24 hours each. Some 2,5 hours from Berlin. Quick and easy money, so I thought. In the end it was draining me out completely, following and haunting me for weeks.

I took the train on Saturday evening. Because I was sick, I was not able to eat. I had spent a week in the hammock. My energy was down to zero. I tried to survive on an occasional milk shake for at least some calorie boost. Did not work. I had packed a little box of pasta, so I sat down in front of Hannover station on my stop-over and tried hard to shovel it down. Even the sunny summer day could not lighten up the greasy grey tristesse of the city.

On arrival I decided to take on the 30 Minute walk to the apartment, I was appointed. After 10 Minutes I got dizzy, after 20 Minutes I thought I would loose consciousness any second. I walked along a never ending big but completely empty main road, passing by a burger king and several sad elderly homes, one help center for addiction problems and more condom machines than cigarettes. In the end I made it to the neat suburbia family home with a fenced garden and grass cut with scissors.

The landlady opened the door and handed me the keys to their granny annexe. The upper floor, covered entirely with brown carpet, was all mine. The furniture was also held in 50 shades of brown, a mix of heavy oak and cheap veneer. A book on happy family life here. Some plastic flowers and crocheted doilies there. Few roof windows did not let a lot of light through the blinds, but I wanted to sleep anyway. It was this kind of place, where you wonder if someone ever thought, yes, that is exactly how it should be.

Next morning the alarm went off at 6:45h and I had slept surprisingly well. There was a little kitchen with a plastic flower-print cloth on the table, but no coffee. No. Coffee. I got under the shower in pain, put on my white pants and packed my things and belongings to head back along the road in search for caffeine. The further I got, the harder it struck me. There was no place to get a coffee, anywhere. Even burger king was closed, the sort of look-like-a-bakery seemed to not have been in appropriate use for at least 20 years. I had not gone anywhere without a morning coffee in about 20 years, too.

Now, I had arrived at the hospital. It did not look as bad as the rest of the city. It was quiet new, lots of glass and a high and wide lobby entrance. The information desk secretary was busy with her nails on this early Sunday morning and did not seem pleased, when I approached her. After a whole explanation she handed me the envelope with the user name and password for my computer accounts. She could not tell me where to go. I was wondering what exactly her job was.

In the stroke unit doctor’s office was no one yet to find. I put my backpack in a corner, sank down onto a chair and tried to call the duty line. We met and handed over the patients, phone and keys. I fixed my computer account. The specialist came and we did rounds. He was very happy, I was there. Apparently they had a lot of experience with contract doctors not showing up or not speaking any German. Well. He left. Now it was only me, the patients and the phone.

The emergency room had called already. While I was seeing one patient, the phone rang again, all usual things. An epileptic seizure, headaches, dizzyness. Everybody sent home. The phone rang again. On the other side was a doctor from a hospital in the neighbouring town. Something with headache and fever, meningitis maybe, with an accent. I asked her, if he was very sick, meningism, high fever? She seemed to not understand my questions. I said ok, send him here quickly them. I was used to language barriers but not with colleagues.

It went on. A patient on the ward was hemi-paralyzed, apparently since this morning. This was urgent. I struggled with the computer system, I did not use before. Wrong moment. CT revealed old post-ischemia defects, I could not decisively tell if there was something new. But if the nurses said, he had been normal in the morning, I could trust right?! Before we started lysis, I am glad, I called his wife. She said this was the reason she brought him to the hospital in the first place. According to the papers he was admitted because of walking insecurities. No word of paralysis. No word about a stroke. She had told the doctor and she was even there, when the nurses had to help him get dressed in the morning because he could not move. What had happened here?

The patient from the non-communicable colleague arrived. Fortunately he did not look like a fulminant meningitis. They did not bring any laboratory parameters. It took forever, so I did the stroke rounds first. A patient with bradycardia. 25/minute. Potassium levels were almost 7. I called the internal on duty. He again, did not understand me. He would call his supervisor.

I went on to puncture the patient whose lab was finally there. In the meantime there were another two people to see with painful spasms and dizzyness again for a change. The liquor of the meningitis patient showed a pleocytosis. He noticed an erythema too, seemed like actute neuroborreliosis. Treatment, ward. Done.

I went back up to the bradycardia stroke patient. Still nobody from the internal colleagues had come. I went to their office. They had looked at the ecg and the question marks were popping from their eyes. I said, he is a known hemodialysis patient. Oh. More question marks. I thought, have you not even looked at any documentation? He hadn’t, but the ecg. He would call his supervisor again. I was singing “staying alive” from BeeGees in my head already. The patient was still awake. I decided to give him some saline with insulin. The heartbeat raised to 27.

I went down to the E.R. again and finished some paperwork. I was feeling really dizzy. Did I eat? It was 4 p.m. and I had been there for 8 hours. I tried an apple and some bread. The thought of pasta made me feel miserable and noxious already.

Finally the internal supervisor came. We could try bicarbonate and otherwise dialysis. Apparently they did not do this on intensive care, which was run by anesthesiologists. So I called the doctor from the dialysis practice, on a Sunday evening. We should wait and see.

I sat down in the office and had a coffee. Finally. I hardly finished it while writing some reports and medication orders for the newly admitted, when the phone rang again. Back to the E.R.. Then back to the intermediate care unit to do the rounds again. Not any better heart rate. The other 7 patients were fine. I called the dialysis doctor again. We decided he had to come. At 10 p.m. we started.

I did my final rounds at 12 p.m., 16 hours from the start. I was feeling dizzy, exhausted, tired. My legs barely wanted to move, my brain was feeling just as slow. A bunch of snails in a salad head. They were leaving slimy trails of doubt. Was I still able to take the right decisions?

There was a sort of bed to sleep on. Folding out of a closet in the office, made from similar cheap veneer as I had seen before. The mattress was lined with rubber-plastic, apparently to keep it clean, which it wasn’t anyway. Few holes in the greasy shiny and sticky cover revealed some ocherish pvc foam. It always feels weird enough to sleep at work and to walk through a hospital with sheets and covers. But inside a closet in the middle of an office with a pc running, shining light on a greasy makeshift that is less comfortable than any south indian backpacker’s hostel makes it obvious, that nobody thinks you are supposed to do this.

I put the sheets on the bed and installed the phone in the charging unit next to the bed. My thoughts were slipping on the slimy snake trails that were left through the hours. They got more and confused until they turned dark. The same second I dreamed about a light and a sound and a phone and for a second I had to reorientate, still believing, it might not be true. It was. The blue light on the display was spared for the black letters “E.R.”.

In some countries torture is still a valid method of dealing with convicts. One of the ways to get a confession is to keep the subject awake and wake them each time they start to snooze. Every time this happens to me at work, I think I should call amnesty international. This is war crime. In the middle of Europe, happening every day.

The admitted patient had high fever and pain in his neck. Not to be confused with neck stiffness. I could move his head on the chest easily. His pain was lateral to the shoulder and existed already for a week, since he had worked in his garden. Yesterday he already reached for help because of this. He went to a different hospital where they gave him an intravenous pain killer. Now he got a fever. His history included an artificial heart valve and due to this he was taking a coumarine to prevent his blood from clotting at the valve. Lumbar puncture was thus excluded. In my opinion it was also not necessary. Or was it?

I waited for the lab results. High infection parameters, very high. Very very high. He did not look that sick. Waiting for x-ray, he was half sitting, half lying on his bed, the legs pulled up, one foot on the knee of the other. This could not be meningitis. Didn’t it look like endocarditis maybe? Probably. So I told the colleague from internal medicine, happy that I could go back to bed. 3 a.m..

But my colleague did not think so. He shouted at me that if I did not do a lumbar puncture, he would not take him, as meningitis was not certainly excluded. I told him I could exclude meningitis clinically and puncture was not possible with unclotting blood. He refused. I got furious. Isn’t this about the patient too? It was not. He told me, he worked in this hospital every day and I was not. He knew the rules. What to do? I told him again, this was not a neurologic problem and if he had endocarditis, for which the risk was very high, it was a life threatening problem.

I went back to bed upstairs, when the E.R. called again. What was supposed to happen with the patient? I told them he was an internal patient and I had written everything down in the computer. They said the colleague refused to treat him. I called him again. He would only accept him, if I wrote down on paper, not in the computer but on a paper, that I could exclude meningitis clinically. He seriously made me get out of bed again. 4 a.m..

I got to sleep for two hours until the alarm went off and I had to get out, put on my shoes and coat and do rounds again before presenting all cases to the team. I moved to the coffee slowly and in a different world. My body was aching and the night was turning around in my head, spinning round and round. What if he did have meningitis? He would be dead maybe. Should I just have treated him empirically? Was I biased by my wish to sleep and missed some signs? Did I just want to turf him to this colleague?

The questions kept haunting me all week. I was quiet unexperienced as a young doctor. I did not know the place, the boss, the people. I did not know, what they usually did and if they would support my back if it went wrong. I was solely responsible for this young guy’s life. I was hung-over and tired, still physically and mentally not in a good shape. I got insecure, called everyone to tell my story, just because I wanted to hear from someone that I did it right. I called my mom and colleague friends. And even though I was still supporting my opinion that cardiology was the place to be for this young men, I was self-doubting and wondering what had happened to him again and again and again.

I had to wait until next Sunday, to find out. The first thing I did, starting the day, was looking into the digital files. All 5 blood cultures were positive. Endocarditis. Probably from a contaminated intravenous needle the day before admission. I was content and relieved, not happy. I felt sorry for this guy and really hoped the best for him and his heart. I wanted to kill the colleague. The next shift started. It kept crawling inside me. This and the next week. And the next. And while I write this, I still want to cry.

I know now, I really did not miss 24 hours shifts. I needed a lot of time to get over these, physically and emotionally. I will never ever do them again. Not for any money in the world.