Madi Sinha’s first novel deals with a young Indian doctor struggling through her medical residency. Sinha was born in Princeton and raised and schooled in West Windsor, where her father worked at RCA/Sarnoff and Lucent technologies. Now a resident of Moorestown, the writer and practicing physician attended Villanova and Hahnemann Medical School.
She completed her own medical residency at Thomas Jefferson Hospital in Philadelphia and captures that world in the following excerpt from the novel:
Sprinting up the stairs would be easier if my white coat didn’t weigh 15 pounds. Senior residents like to joke that interns carry their lives around in their pockets. Mine are filled with two miniature textbooks, three pens, a stethoscope, a reflex hammer, a hospital ID badge, a penlight, a laminated map of the hospital, and a protein bar. A wearable emergency preparedness kit. Unlike the embarrassingly short medical student’s white coat, which projects nothing but bewilderment and the deflection of responsibility (Me? Oh no, I’m not the doctor I’m a student. I’m just here to observe. Although once they let me catch a baby as it came shooting out of a woman’s birth canal. It was beautiful experience), the long doctor’s coat radiates confidence and capability: “Throw anything at me, I’m ready.”
In a code blue, the first doctor to arrive at the beside gets to “run” the code — be the leader and make treatment decisions — at least until the senior resident or attending arrives. I’ve seen codes run before, but this is my first opportunity to be at the helm. This is my chance, finally, to prove my abilities.
The first thing I lose from my coat pockets is a miniature pharmacopeia, a medication reference book. It bounces away down the stairwell, but I keep going, taking the stairwell, but I keep taking the stairs two at a time I’ll be damned if I can’t beat Stuart Ness from Harvard Medical School to room 512. If I can’t compete with him academically, I’m determined to at least outrun him. I’ve met people like Stuart. There was always one in every class in college and medical school, someone for whom everything seemingly came easy, the curve-breaker, the guy who thought organic chemistry would be great if only it were a little more challenging.
Which is why I’m not entirely surprised when I see a blur of brown, perfectly groomed hair and green scrubs flash past me somewhere between room 485 and room 502. I arrive — perspiring excessively and panting — to see a breathless, ruddy-cheeked nurse standing over an elderly male patient. The nurse chews her lip and adjusts and re-adjusts her reading glasses, while Stuart, at her elbow, stares at the heart monitor above the bed. The tracing shows a heart rate dangerously fast and erratic, and the words “Critical Value” blink angrily on the screen The patient, his skin pale and clammy, his eyes wide with panic, speaks in a soft whimper. “What’s happening?”
“Your heart is beating too fast,” the nurse says, fiddling with the wires taped to the man’s chest. Her movements are confident, but worry ripples through her voice.
“He’s in A-fib,” Stuart announces, anxiously clutching his stethoscope with both hands. “Unstable A-fib. Maybe we should try a medication? Maybe diltiazem?”
The patient’s blood pressure is falling due to his heart arrhythmia. If his heart rate isn’t slowed down, right now, he’ll go into cardiac arrest. Every cardiology textbook I’ve read clearly outlines the appropriate next steps for this exact scenario.
Why are they just standing around?
A crash cart with a defibrillator is next to the bed. I grab the electrical paddles as the heart monitor emits an ear-splitting alarm. The patient’s blood pressure reads 80 over 35 and is falling by the second. The nurse, the patient, and Stuart all turn to me and speak at once.
“Maybe let’s wait for the resident,” Stuart says.
“Are you sure that’s what you want to do?” the nurse says.
“What are those for, Doc?” the patient says his voice barely a whisper. His eyes drift closed.
I shock him. The sound is like a candle being extinguished. “Clear!” I remember to shout, moments too late.
The patient’s limbs jerk and waggle; then he is still, and the heart monitor is silent. No one moves. The nurse clutches her chest, steading herself against a chair.
Oh my god. What have I done? That should have worked. Why didn’t it work?
The patient’s eyes snap open. “WHHHAAAAAAT THE FUUUUUUCK!!!” He tries to crawl out of the bed.
The nurse struggles to restrain him. “Mr. Leeds, I’m very sorry about that, I —”
It occurs to me that I should have warned him, said something to prepare him, probably, before shocking him. But, with the heart monitor now beeping a jaunty, steady rhythm, I’m giddy with relief. “Look, Mr. Leeds, you’re not in atrial fibrillation anymore!” I smile at him triumphantly. I saved you. I pulled you back from the brink of death.
Mr. Leeds has a wild look in his eyes. “Get away from me! Get her away from me!”
I’m taken aback. Maybe he’s confused. After all, he’s just had a near-death experience. Then I catch Stuart’s eyes. He’s gawking a me, his mouth agape.
A dozen residents and medical students have crowded into the doorway, craning their necks this way and that to peer over one another’s shoulders like a flock of curious, wide-eyed birds. Among them is (her medical school friend) Clark, holding a steaming cup of coffee.
“What’s happening? What’d you guys do?” he asks.
Stuart turns to stare at him, his mouth still hanging open. “Dude. You stopped for coffee?”
A gangly man with a ponytail wearing a long, tattered white coat, his lips pursed as if he’s just tasted something rancid, squeezes into the room, shouting, “You people need to move, now! I need to get in here.” He is followed by a petite young woman in scrubs who has secured her hair around a pencil. Their name badges identify them as general surgery residents.
“Terry! Thank goodness!” The nurse seizes the man’s arm.
Terry pushes his wired glasses up the bridge of his nose while drawing in a deep breath, the whistling sound produced hinting that he likely has either a chronic sinus obstruction or really, really tiny nasal passages. “Tell me what’s going on,” he says.
Mr. Leeds clutches the bed rails. “These people are trying to kill me!”
“That intern just defibrillated the patient.” The nurse’s tone is accusatory. “He was wide awake.”
Honestly, I can’t understand what she’s so upset about. The patient was moments away from death, and now he’s alert and talking. Full of vim and vigor, in fact. Yes, technically, you’re supposed to sedate the patient with something like Valium before shocking them, because having your heart electrocuted while you’re awake is probably as unpleasant as being unexpectedly struck by lightning, but —
“The intern did what?” Terry’s voice becomes increasingly shrill like a teakettle coming to a boil. He turns to me menacingly. “What do you think you’re doing?”
My heart pounds against my ribs as I drop the paddles and cross my arms over my chest. “His heart rhythm was irregular,” I say, unable to quell the tremor in my voice. “And his blood pressure —”
“Are you incompetent?”
“He was unstable —”
“This is my patient!” Terry paces back and forth, seething. “You don’t do anything to my patient! What department are you from?” He grabs my arm and twists it forcefully — not enough to hurt, but enough to knock me slightly off balance — to look at my coat sleeve, where the words Internal Medicine House Staff are embroidered in blue thread near the shoulder. “Internal Medicine! Who’s your senior resident?”
I open my mouth but can’t form any coherent words. Humiliation pricks at the corner of my eyes. Don’t cry in front of the patient.
“That’s me.” A young man in his late twenties with a rakish smile and tousled brown hair saunters past the crowd at the door. Ethan Cantor, a senior resident. I remember him from orientation; he was disarmingly friendly and not nearly as intimidating as he senior residents I’d worked with on clinical rotations in medical school. “What’s the problem, Terrance?” Ethan asks casually.
“You need to supervise your interns, Ethan!” Terry says. “This genius just shocked my patient! Without sedating him!”
I nod nervously. “His blood pressure was really low, eighty over thirty-five.”
“Sir, sorry we had to do that to you.” Ethan places his hand on Mr. Lee’s shoulder. “But the young doctor here probably just saved your life.”
I lift my chin righteously but avoid making eye contact with Terry.
The White Coat Diaries by Madi Sinha, 368 pages, $16, Berkley/Penguin Random House.