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Visitors stream in and out of the rooms and corridors. There are families to see, questions to answer, a new admission from the ED. It’s one thing after another—randomly, it seems—bouncing from one story to the next. Mr. Gunther, headed for the NIH, leaves with his wife. She gives me a long look as they head toward the elevator. I wish her well; living with Pascal’s wager can’t be easy. Mr. Kinney, a dapper corporate attorney, is also getting out of here after a rough two weeks. His pancreas is totally destroyed, replaced by puddles of necrotic fluid, yet he refuses to accept the fact that his fondness for single-malt scotch is the reason why. His wife gives me a long look, too, then they’re gone. Jim, the Cardiology fellow, shows me the echocardiogram he just did on Mr. Warner, our guy with HIV. Nothing there, Jim says, no vegetation, no sign of endocarditis. We consider what this means, make a plan. Up on 10 Central, Mr. Mukaj’s bladder irrigation backs up painfully again but there’s nowhere else we can put him, no empty beds in the ICU or Step-Down Unit, no place where he can have his own nurse with him all the time. We bounce this around, too, decide to try this, then that, we’ll see. Mr. Harris, our patient with Marfan syndrome, a plastic aorta, and a septic hip joint, spikes a fever again. Not good. We make a plan. And so it goes, on into the evening. On days like this, doctoring feels like pinball: nonstop random events—intercepted here, altered there, prolonged or postponed by this or that, the bells and boinks sounding all around—and sometimes you can’t be sure whether you’re the guy pushing the buttons, manipulating the levers, and bumping the machine, or whether you’re inside the machine, whether you’re the pinball itself.
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Brendan Reilly (One Doctor: Close Calls, Cold Cases, and the Mysteries of Medicine)