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By James S. Newman, FACP, and Elizabeth Wilkinson, and Nathan Woltman
I was sitting in a conference room on 5 Domatilla at St. Mary's Hospital in Rochester, Minn., with medical students Nathan and Lizzie. They looked worried, as it was the beginning of a week-long sub-internship under my somewhat tangential tutelage. Muzak was playing on the speaker system overhead—a saccharine version of “Stairway to Heaven” as background noise.
As we walked towards the elevators, Lizzie mentioned her marathon training. The last marathon I had participated in was a “Planet of the Apes” film marathon. Nathan mentioned my previous article on elevators (ACP Hospitalist, January 2010). I wondered if he was truly interested or was applying the time-honored gluteal osculation maneuver so popular in well-trained academics. The conversation led to a single conclusion—we would spend the week on service “elevator-free.”
James S. Newman, FACP
We headed downstairs for a quick coffee before starting on rounds. It seemed like a great idea. I can never say no to the bean.
But, cups in hand, we realized our mistake. We were now on the main floor, but our patients were high above us. So began our first great ascension: five flights, 22 steps per flight, 15 centimeters per step. I started out strong, the two students behind me talking. I don't think they noticed the sweat on my brow or the elevated respiratory rate. By the fourth floor I met RRT criteria. As we reached our goal, I faked a page, and stood with my back to them, pretending to take a call as my dyspnea abated and my vitals stabilized.
By the end of the first day, 27 total flights up and down, I realized we had committed to a dangerous course of action. As I trudged home, my dogs aching, I knew I needed better shoes, clean socks, and a hearty breakfast to survive the week.
The next morning, we entered the west staircase, where it was always hot and smelled of fresh bread. Between the second and third floor we were passed by a gnarled old man with a cane. He breezed by us on the ascension, despite his obvious infirmity. His skin was mottled green (maybe it was chlorosis?); he was hunched, wrinkled and gnome-like. I grimaced at him as he passed, and then he turned and stared at me.
“Just trying to walk stairs all week,” I said, shrugging my shoulders.
He replied, “There is no try; there is do or not do.” His tread was so light he barely touched the stairs as he headed upwards.
By day 3 we were all feeling more fit. Lizzie had a gleam in her eye and Nathan was laughing to a joke known only to him (as usual). I felt invigorated. I might be able to do this!
Then came the text that changed it all: I had a meeting on the 19th floor of the Mayo Building!
We prepared for the ascent. Nathan carried a water bottle and emergency rations. Lizzie had stolen an oxygen tank from respiratory therapy. I had a bottle of expired nitroglycerin tablets. The first five floors went smoothly. I was using the standard two-step-at-a-time, crossover-grip and making good headway. By the eighth floor fatigue set in. I took 250 mg of acetazolamide, hoping to head off pulmonary edema. I looked behind me. The two students looked fresh, though I noticed Nathan was down to a modified one-step with a right-handed banister grip, a sure sign he was fading.
By the twelfth floor I was hallucinating. I thought I was back in internship trying to get to a code on the psychiatry floor in the old Houston VA hospital, where the elevators were perennially constipated.
I started to lose my grip on the handrail, the sweat on my palms having made them too slippery. Three floors later I almost fell. Standing before me was an image of the old man on the stairs: “DO or not DO; there is no try.” Lizzie grabbed me by the shoulders, supporting my weight as we climbed upwards. Nathan was right behind, taking large whiffs from the oxygen tank, though I was puzzled that it seemed to read N2O, not O2.
Finally we made our goal, the 19th floor. When we entered the room, we discovered the conference had been canceled. Nathan took a small straw from his pocket, Lizzie grabbed a handkerchief, and I spit out my gum. I placed the gum on a window ledge. Nathan jammed the straw into the gum and Lizzie tied the hankie to the top. This small flag would commemorate our great climb.
The week finally drew to a close. I pretended that I had instilled the students with great wisdom. They pretended they had learned something from me. More importantly, we were all in better shape. In that week, we had climbed 74 flights for a total of 1,061 meters. With the same amount of effort we could have ascended the Great Pyramid of Giza (146 m), followed by the Empire State Building (443 m) and the Eiffel Tower (324 m), and finished with three trips up the Statue of Liberty (46 m).
As I left my last meeting with the students, I headed for the staircase. I listened for Muzak, but to my surprise heard Elvis singing, “I'm gonna walk dem golden stairs.” I passed my spiritual stair guide. He looked at me and said, “You were the student, but now you are the stair master.”
Elizabeth Wilkinson and Nathan Woltman are fourth-year medical students at Mayo Medical School, currently recuperating from a week on service with Dr. Newman. Dr. Newman is a hospitalist at the Mayo Clinic in Rochester, Minn., and editorial advisor to ACP Hospitalist.
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ACP Hospitalist Weekly
From the May 22, 2013 edition
- Warfarin better than heparin bridging during cardiac device surgery
- Intensive-dose statins don't confer greater diabetes risk for post-MI elderly than moderate doses
Cartoon Caption Contest
This issue's winning cartoon caption was submitted by Jennifer L. Norris, MD, ACP Member. Thanks to all who voted!
"I had something else in mind when I asked for an outline of the patient's condition."
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