by Barbara Ebel
Caleb shook his head. Annabel nodded to the door and they both left, closing the door behind them. Roosevelt opened the bag and pulled out a blueberry donut. “My favorite flavor.” He placed it on a napkin, called the department’s main office, and asked for the chairman.
Roosevelt cleared his throat as Dr. Roger Winstead picked up the phone. “Roger,” Dr. Harvey said, “it’s Roosevelt. We have a situation with resident Ling Watson. We must pull her from her clinical duties and seek out immediate help for what appears to be physician burnout.”
“Although I trust your judgment, let’s sit down about this,” came the response.
“Exactly. I’ve sent her over. It’ll take me a few hours here to fill in. Any way we can jockey around schedules for an upper level resident to fill in?”
“I absolutely don’t think that’s possible.”
Roosevelt knew what he had gotten himself into. This was the rare circumstance where an attending must sacrifice outside duties to be fully available for the university teaching team. Work like a resident. His other partners in his private office would need to step up and split up his private patients.
Dr. Harvey grimaced. “Holler if that situation changes.”
“You’ll be the first to know. I’ll see you when you get here. Don’t worry about Dr. Watson. She can crack open a novel to read while waiting. I bet she hasn’t done that in a long time.”
Dr. Winstead hung up. He huffed out a big breath. He needed to follow the recommended department protocol to deal with her. However, it always killed him that not too long ago, residents and students got through their training years with longer work hours and stress than the current trainees … who moaned about and broke down about everything. He understood both sides of the spectrum, but he felt like an army sergeant witnessing his men wanting clean sheets and pillows while taking cover in a bunker.
Roosevelt stayed put and enjoyed every morsel of the blueberry donut. Since he’d be working like a resident today and in the near future, he might as well eat like one too.
-----
Annabel and Caleb waited in the ICU for Dr. Harvey.
“I’m way too worried about Ling,” Caleb said. He sat on the edge of the counter while Annabel pulled up Bonnie Barker’s ABG result on the computer.
“I’m more worried about what’s going to happen to us. It’s about time we started functioning like a real rotation. I’m not here to stick my head in an obstetric textbook. I’m here to learn from patients and upper level doctors.” She jotted down Bonnie’s arterial blood gases on her index card, but Caleb wasn’t listening. “Are you worried about your relationship with Ling?”
Caleb sighed. “I can’t figure her out these days. She sure was nasty to me this morning. Recently, I thought about throwing in the towel. This morning may have been the last straw.”
“Relationships are complex. You’ll know when to end it, and I agree. From what I’ve seen and heard, there is often some event that breaks the camel’s back and one party throws in the towel. You must do what you have to do. Was it serious between the two of you?”
Caleb slid a little closer. He considered the question before answering. “No. Not serious. ‘Light’ would be more like it. And I think it started because I was kind of struck by her status as a chief resident.”
“Oh my God, that sounds familiar. I was crazy, insanely hooked on my chief resident in surgery.”
“Really?”
“Yeah, but don’t repeat what I said. However, not only was I infatuated by his chief-residentness, but he was my type. Handsome, smart, slim athletic build, charismatic, a damn talented surgeon and teacher, and the list goes on. To my heart’s delight, after some time, he asked me out, but the dates were a set of misfortunes.”
“Wow.” Caleb laughed. “Chief-resident-ness?”
“Yeah. I just made that up.”
“I like that, but sorry, the dates didn’t work out. At least you had a resolution to your crush on him. But, hey, where is our attending?”
“You shouldn’t have left him the donut!”
“Actually, I should have bought more.”
“Speak of the devil,” Annabel said as the doors snapped open. Dr. Harvey walked slowly towards them, too busy tucking in his shirt, and stopped across from them at the desk.
“Ms. Barker’s ABG is back,” Annabel mentioned. She rattled of the numbers: the arterial blood pH, oxygen saturation, and partial pressure of carbon dioxide.
“Perfect, and you gave me a thorough update of her before. Hand me her chart.”
Annabel gave it to him and he went through it standing up. She was impressed; he took his time and was not distracted by nurses, the sound of monitors, or X-ray equipment rolling past him. He finally grasped it in his hand. “Let’s go in.”
Bonnie was bolt upright in her bed, a tray table and a breakfast tray in front of her. She decided not to put a spoon of oatmeal into her mouth as they sidled up to her bedside.
Bonnie shrugged her shoulders. “I was hungry. My nurse called the kitchen for an early breakfast.”
“Perfect,” Dr. Harvey said. “If anyone deserves extra attention, it’s you. We are so sorry about the last twenty-four hours. Everything is being done so what happened to you never happens again.” With a slight tilt of his head, his eyes reassured her.
“All your labs and vital signs look real good. Having a postpartum hemorrhage and then a setback with a pain medication was no fun, I’m sure. I’m going to transfer you back to your obstetric room and we’ll shoot for tomorrow as far as discharging you. That will also give you more time with your baby in the hospital and a chance for Dr. Thomas to answer any more questions you may have. How does that sound?”
“Maybe Samantha can go home with me.”
“Maybe so. Dr. Thomas must make that decision. Do you mind if I listen to your heart and lungs?”
“Dr. Tilson did that already, but help yourself.”
Roosevelt finished and Bonnie went back to eyeing her oatmeal.
“We’ll see you later on our ward,” he said. The three of them marched out and Dr. Harvey wrote for and informed the staff of her transfer. “After she eats that porridge she’s delighted with,” he added.
Roosevelt left with Caleb and Annabel on either side of him.
“Amazing,” Annabel said, “that she’s taking her situation so well.”
“You and I both gained her trust and we are sincere about her and her baby. She’s no dummy and she picked up on that. I will add her and her baby to my prayers as well.”
Annabel was surprised about his “prayer” remark. But there was no rule against that, she thought. On the contrary, some people were afraid to mention prayer or their religious affiliation whereas others seemed entitled to do so.
“By the way,” Roosevelt said, “the RNs involved with giving Mary Chandler an overdose of magnesium sulfate as well as Melba Fox who made the morphine mistake were both put on leave by the Head of Nursing. And, as you both may have surmised, Ling Watson is going to be placed in a time-out as well. You need only deal with me for the time being.”
Annabel and Caleb managed to lock eyes past Dr. Harvey. Annabel’s lips curled in a slight smile. Their own private attending just for the two of them, she thought. She put vigor in her step as they approached the elevators. She held open the staircase door instead of letting the men push the elevator button.
The three of them were a single file of white coats from one side of the corridor to the other as they strutted down the obstetric wing. “I nabbed you two from the lounge before. Did either of you have a chance to pop in on our patient from late yesterday, Mrs. Wagner, scheduled for an induction?”
“Not me,” Annabel said.
“Nor me,” Caleb said.
“Then what are we waiting for? Let’s check up on her TOLAC!” He looked straight at Annabel.
“Trial of labor after C section,” she said.
“Did one of your residents check if that was a feasible
plan?”
Annabel thought fast. “I believe so … with an ultrasound. Which helped to determine if the previous scar and lower uterine segment seemed adequate enough to support labor.”
Roosevelt popped his index finger in front and wiggled it affirmatively.
They made a right turn at Amy’s doorway and Annabel led the way inside.
CHAPTER 19
Amy Wagner forced a smile when the three doctors walked in. Her husband, Harry, sat on the bed with one leg dangling to the floor and one bent on her sheet.
Dr. Harvey introduced himself as the attending doctor. “How’s Mom and Dad doing this morning? Making progress?”
Amy nodded. “I’m in labor because that oxytocin you gave me is working like rocket fuel.”
Roosevelt scanned the monitor. “Your baby’s heart rate looks good.”
“Baby Bobby is going to be a skier like his mom,” Harry said, “so his heart better be healthy.”
Amy grabbed the bedsheet in her hand and squeezed while a tinge of pain passed over her lower abdomen. Her husband wrapped his hand on her forearm and then let go.
Roosevelt let the contraction pass. “Do you mind if I examine you while my team is here?”
“Most certainly, I don’t mind.”
“Even though we teach here, I still like to ask. Occasionally, there is a patient very sensitive to groups and, unless it’s an emergency, we can render a bit more privacy.”
Caleb closed the door and Dr. Harvey pulled on gloves. Amy scooted further down on the bed and spread her legs. Roosevelt quietly examined her and rolled back on his stool. She resumed a more comfortable position and Harry helped cover her up.
The attending snapped off his gloves. “Do you mind if I talk shop to the resident and student?” His tone was soft and reassuring. “Otherwise, I can do it outside.”
Amy and Harry glanced at each other. “Please, I’d love to listen in,” she said.
“Then you’re included.” Roosevelt took a spot facing them all. “Generally, if the cervix is dilated beyond two to three centimeters, the patient has a favorable cervix. Mrs. Wagner is at or passing six centimeters. Dr. Tilson, that means she is making continued progress and has reached the active phase. What labor parameter is next?”
“Second stage of labor?”
“Precisely. Explain, please.”
“Second stage is the complete dilation of the cervix to expulsion of the infant.”
“And normally, in a multiparous woman, how long should that take?”
“I don’t know.”
“Caleb, tell Annabel.”
“Up to two hours; an hour longer if an epidural is in place.”
Roosevelt scanned all their faces.
Harry touched his wife. “Maybe our baby will be here by lunchtime.”
Dr. Harvey laughed. “That may be cutting it a bit close. Hopefully, by dinner time, baby Wagner will be suckling at Mom’s breasts and you two will be blowing out his first-day candles.”
Roosevelt herded Annabel and Caleb out, leaving wide smiles on the faces of Amy and Harry. In the hallway, he closed their door again.
“So,” Roosevelt said, “I want to start with some basics for Annabel about the pelvic exam. The formal teaching of the exam in medical school is fraught with anxiety, especially for the guys. Students are always taught to consider the concerns and fears of the patients, yet I also think about the concerns and fears of the student. Yes, the student!
“The exam of the patient in labor is always a bit easier on both parties because both sets of people know that the woman is going to deliver and all focus is on that part of her body. However, during other physical exams, there is a huge interaction going on between the two individual human beings, each one bringing his or her own knowledge, beliefs, status, attitudes, and experience to the process. The interaction needs to be mastered by the clinician to make the patient relax and feel comfortable and they themselves must do the same. There is a layer of complexity to the clinician’s examination of genitalia and breasts.”
A visitor passed by and Roosevelt quieted.
“Anyway, just know that an obstetric exam and a gynecologic exam is a rare breed. When you perform one, it is an art. At no other time is a woman’s body touched by a stranger or a semi-stranger in that manner. Try to master it with sensitivity for the patients and also be cognizant of your own feelings. Your attitude may also give you clues as to whether the field is something you’d be interested in as a specialty. I also recommend any of the books that address the feelings students may encounter while examining a patient.”
A nurse stopped, waiting to interrupt. Roosevelt seemed to read her mind. “I just examined her. Active phase. Oxytocin working like a charm.”
“Thank you, Dr. Harvey,” she said. “By the way, there is an admission in the ER. Dr. Watson was informed, but no one went to see her yet.”
“I am going to break away,” Roosevelt said. “Caleb, you go see the patient with Annabel. I am a beep, a phone call, or a text away. I’ll be back after going over to the chairman’s office.”
-----
With his usual tranquil manner and confidence, police officer Dustin Lowe entered his favorite diner. He walked in solo, but was meeting another officer he worked most closely with. It was late morning and the place bustled with patrons.
Dustin grinned at Sean as he walked to where he was sitting at a window booth. The older officer had twenty more years on the job than him and as Dustin slid into the booth, he recognized that more space was allotted to Sean’s side. His paunch needed the room.
“You order yet?” Dustin asked.
Sean nursed a cup of coffee. “No sense in waiting. I take longer than you.”
A familiar waitress came over. “What’ll ya have, Dustin?”
He scanned other tables. It was fifty-fifty. Half the plates were piled with remnants of waffles, eggs, hash browns, and sausage, and the other half were in front of the afternoon eaters, with cheeseburgers and French fries.
“Do you all ever serve anything that is green?”
“I can put food coloring in a glass of milk for ya.”
“I’m yanking your chain, but that was very funny.”
“Yeah, you must like it here. You bring that girl of yours in here once in a while.”
“Annabel. Annabel Tilson. I think of her when I come in during work. I also think of my former partner.”
“When are you bringing her back in here? You must be taking her out more to fancy restaurants.”
“Sometimes. I see her less than I’d like. Her being in medical school and all.”
“Okay, since she’s not here, order what you want and not what she’ll tell you to eat because she’s concerned about your health.”
“What a fine idea. How about a couple of eggs over easy, bacon, and toast? Don’t forget the coffee.”
“You got it.” Like a salute, she tapped her pink diner cap.
“So what’s the update on her and you?” Sean asked.
Dustin rubbed his chin. He could hear the staff washing dishes. Off to his right, the parking lot was like a pit stop off an interstate. Cars pulling in and out and doors opening and closing. He looked back at Sean.
“Sometimes I don’t know whether to be ecstatic or cautious. She’s getting under my skin.”
“Then what are you cautious about?”
“Her past dating history was a bit indiscriminate. I believe she’s over that. So more than that, I’m afraid our relationship is too good to be true, and the more I see her, the more I like her. She’s barging in on my thoughts all the time. I guess I’m guarded because I don’t know if she feels the same way; I don’t want to press the relationship to another level if she’s not up to it.”
The waitress passed and set down Dustin’s steaming black coffee and Sean’s order.
“What does an old married guy think about that?” Dustin continued.
“Love is a flower. You have to let it grow.”
“Love? I didn’t say I was in love with her.”
“Perhaps you’re not, but from where I’m sitting, you seem pretty close to it.”
Dustin’s heart thumped. He stared out the window. A lanky older teen with straight, combed-back blonde hair got out of a sedan. He yanked the hoody of his jacket up on his head.
“Women,” Dustin said. “How do you find out what they really think about you?”
Sean laughed out loud. “I asked the love of my life to marry me. She said yes, so that’s how I found out.” He chuckled again and reached for the salt and pepper.
“You have to be kidding.”
“Nope. In your case, you better not try it. She might say no and you would not be pleasant to work with after that.”
“You’re preposterous. I’ve known her a little less than a year and we’ve only been dating a couple of months.”
“What difference does that make?”
Dustin shook his head. “That potbelly of yours has gone to your head.”
The waitress set down Dustin’s food, topped off Sean’s coffee, and left. He watched the old kid with the hoodie walk behind a woman coming towards the diner, his right hand jammed into his pocket. The guy looked both ways as if monitoring for traffic crossing an intersection.
Dustin twitched his mouth. In general, it was not cool enough outside for a man that age to really need a thick fleece hoodie, but a bit more suspicious to use it to cover his head while entering a public building.
The front door of the diner opened as Dustin swiveled in the booth to look towards the door. The young man shoved the woman aside and yanked a gun out of his jacket pocket. Without flinching, he aimed the weapon to the side of the cash register and pulled the trigger.
The man at the register grabbed his left bicep in pain as the young man aimed instead at the manager off to his side.
Dustin slid out and stood. The manager was about to be shot, so his hand gripped his firearm and, with no hesitation, he fired.
Dustin’s bullet made contact with the young man before he pulled the trigger again. With a fast rush, Dustin tackled him to the floor and then pinned him down. Sean followed and attached handcuffs to the assailant.