by Barbara Ebel
Outside May’s room, Donn put up his hand. “We discussed Mrs. Oliver in the cafeteria yesterday,” he said. “Dr. Tilson, give us an update.”
“Mrs. Oliver is the patient who came in with hemoptysis,” she reminded the other students, “which seems to be under better control with cough suppressants and rest. However, her chest x-ray confirms a right lung mass.”
“Which doesn’t surprise us,” Donn said. “That film continues to support the primary working diagnosis we came up with. So think ahead, Dr. Tilson. What is your next move to establish the histology of that mass and whether or not it’s malignant?”
Annabel gave Melody a smile. “Fiber-optic bronchoscopy.”
“You two discussed your patient. Exactly. We need a tissue sample.” He chugged down the last sip of his coffee and squished the cup with his hand. “That suspicious neoplasm doesn’t belong there. After rounds, Dr. Burg, write the order for a pulmonary consult. A lung doctor can do the procedure and assist us with their expertise.”
He led the group into May’s room. Her tray table was beside her as she sat in an oversized armchair. Half-finished breakfast and paper wrappings were scattered on top.
“Good morning, Mrs. Oliver,” Donn said. “I see you chugged down your coffee like me.” He showed her his cup and dropped it into the wastebasket. “May I?” he asked as he moved the table further to the side.
Mrs. Oliver sniffled and darted her glance at Annabel. Her chest began heaving up and down as she started to weep. “My boyfriend, Jeff, just called me. He called a lawyer a little while ago, got a bit of advice, and I’m going to hire him.” She held out her attenuated fingers to clasp Annabel’s hand.
Annabel crouched down beside her chair and the bed, took May’s hand, and glanced at her group. “Mrs. Oliver’s dog died yesterday while it was boarded in day care.”
May reached into the pocket of her robe and pulled out her cell. She opened up pictures and passed them her phone. “Here’s my Misty. She was the sweetest thing in the world.”
“She must have been a great companion,” Annabel said, looking at the furry brown dog. “Do you plan on taking legal action against the facility?”
“For sure. I don’t want to, but what happened to Misty was negligence. That worker shouldn’t have walked through there with her nasty dog.” She wiped a tear away and laced Annabel’s hand with a firmer grip.
“We’re sorry about your dog,” Dr. Schott said. He paused, hoping her tears would dry up. “Please don’t be surprised if pulmonary doctors come by to talk to you today. We are asking them for their input because an abnormality showed up on your chest films.”
“So that may explain this bloody cough I’m experiencing?”
“Most likely. We’ll get to the bottom of it.”
She let go of Annabel. “Is there anything we can do for you?” Annabel asked.
May only shook her head and looked at Misty’s picture. The team started out the door and then the chief resident paused. “We’re leaving the hospital since we’ve been here all night,” he said. “Another team will be covering for us, but we’ll be by tomorrow morning.” His remark fell on deaf ears.
“Annabel and Dr. Burg did a physical exam on Mrs. Oliver,” Donn said outside the doorway, “but did the rest of you appreciate her fingers?”
“I was so wrapped up in her sorrow,” Bob said, “but nevertheless, I couldn’t miss it. Was that finger clubbing?”
“Unmistakable,” Jordan mumbled.
“Dr. Maldonado, would you like to expand on that?” Donn asked.
“Clubbing is an enlargement of the terminal digital phalanges,” the student said, practically puffing out his chest, “and also the nail bed angle diminishes.”
“In non-medical terms,” Donn said practically in Jordan’s face, “chunky fingertips. Not bad coming from a student. Tell them why I brought it up, Dr. Burg.”
Melody demonstrated with her own hands. “Clubbing of the fingers can be seen in some chronic pulmonary conditions, but it’s most commonly seen in patients with lung cancer.”
“That gives us one more thing pointing to our working diagnosis,” their chief said. “And here’s another ominous tidbit. We said that the majority of lung cancers are linked to smoking, but of the 15% not related to smoking, the majority are found in women.”
Annabel frowned and shook her head for them all. “This poor woman has two too many ominous occurrences going on now in her life: probable lung cancer and the loss of her beloved dog under gruesome circumstances.”
-----
The team crowded around the bed of Bob’s admission from the night before after he gave them a short rendition of his H&P. A pale old man, Kevin Harty, fumbled with his IV tubing and glared at them. “Take this thing out,” he barked.
“Mr. Harty,” Donn said, “we’ll check your H&H one more time later today. If you have no more bleeding and are stable, we can send you home tomorrow. But are you sure you don’t want me to consult the general surgeons?”
“No,” he snapped. “They cut out part of my inside tubing down there once already. No more surgery and no more sliding that scope up my butt for a colonoscopy. The last time they did it, the source of the bleeding was not determined.
“Also, my family and the head staff at the institution need to stop sending me here every two or three months when I’m bleeding.” His voice trailed off. “Doesn’t anyone understand that you can’t keep someone alive forever? When it’s time, it’s time.”
“But, Mr. Harty,” Donn said, “when you lose blood, there exists the simple remedy of transfusion.”
“That’s what you say and what you think. But you’re not me. I felt my life succumbing to the hereafter when my blood count got real low in the ambulance and they resuscitated me. I am tired. Don’t you understand? I am tired and I don’t want to do this anymore.”
A silence fell on the chief resident’s voice. Annabel wanted to reassure the elderly man. She wondered if her grandfather had felt the same way in the end … if he was “tired,” and wanted to say good-bye to his life. He had gone downhill with dementia and she wished he had not gone that way. It was difficult for him as well as the rest of the family.
“Mr. Harty,” Bob said, “I just told my colleagues in the hallway how you’re eighty-seven. The care you received since yesterday will let you go back home, maybe live a few more months or years, and perhaps let you enjoy another grandchild’s birthday.”
“Where I live is not home. I live in an institution. Do you know what it’s like to be lumped in with old people day in and day out who are either physically incompetent or mentally impaired? Or eat meals that are nothing but lumpy starch?”
Bob frowned like he didn’t believe him.
“You think I’m giving you a bunch of exaggerated horse manure. The last ‘dinner’ I sat down for, which they call the lunchtime meal, was a serving of more than two thousand calories. The plate was piled with hash brown potatoes, chicken fingers, and French fries. I kid you not. That stuff all comes from frozen bags which they then dump into yet another deep fryer, and is not fit for human consumption or any other living being. I can assure that the dieticians and cooks in these type of places work on monthly budgets of less than I used to spend on my dog, so they buy boxes of those frozen chicken pucks and starch for pennies. I forgot to mention that on the side was a tiny plate with about three shriveled-up pieces of lettuce topped with a half cup of thick, creamy dressing.”
Mr. Harty flicked again at the IV tubing like it was a bug.
“I haven’t told you, either, what my routine is when I’m not bleeding … like when I’m sitting around in doctors’ waiting rooms because of aches and pains, infections, or new eye problems. And the supposed highlight of each week is bingo, which they make a big deal about; or on Sunday listening to some minister with a guitar who sings and preaches to us about the Bible while his real goal is to have us put his church in our last will and testament.
“Does any part
of that sound like it’s worth living for?”
Bob held his tongue; he didn’t know what to say.
Mr. Harty looked straight past him to Donn. “It should be mandatory for each of these young naive students to rotate through a nursing home and an assisted living facility. Maybe it would make an impact before they go out to practice like Dr. Kildare wanting to save the world by keeping old farts working like machines when they are meant to be respectfully retired.”
“Students have elective time to select options like that. They can shadow a geriatric doctor for a few weeks and experience first-hand elderly patients in those facilities.”
“Now you’re talking sense,” he said. “Just warn them not to trip over all the wheelchairs lined up in the hallways with slouched-over bodies, the majority of them mumbling gibberish because of strokes.
“Now that I’ve got that stuff off my chest, I promise not to bleed today. Yank this IV from my hand and I can go back tomorrow to my miserable existence in assisted living where I came from.”
Donn put his hand on Mr. Harty’s shoulder and gave it a squeeze. “The food here may not be great, but it sounds better than what you eat routinely. At least enjoy your meals today. We’ll see you tomorrow.”
Outside, Donn waved them over to the nurses’ station. “You students already took psychiatry. Do you think Mr. Harty is depressed? Do you think he needs a psych consult or for them or us to put him on an anti-depressant?”
Since he was Bob’s patient, everyone looked at him. “I don’t think so and I wouldn’t consider it,” he said. “Mr. Harty doesn’t have the classic signs and symptoms. He gives no report of losing weight and he maintains a desire to eat. He can’t help it if he has no control over the… excuse me … crap he’s being served. He doesn’t lie around sleeping, his affect is appropriate, and he tries to keep mentally stimulated. If we simply prescribe him an anti-depressant or a sedative, we’d be guilty of trying to push him to the side or shutting him up. We don’t want to be guilty of the similar behavior he is presently complaining about from the health care system.”
Annabel agreed with everything Bob said and stood staring at him with admiration. Mr. Harty wasn’t depressed. He told them valid points for why he was mentally and physically near the end of his life. He said it with maturity and conviction; he deserved respect for his opinion about his own life and not pills that would help silence him.
“What does everyone else think?” Dr. Schott asked, his facial expression giving no hint about his own opinion.
“I agree with Bob,” Annabel said. “Based on our limited but well-schooled time on psychiatry, I do not believe Mr. Harty is clinically depressed either.”
“I agree,” Jordan said, “but I bet they don’t like him talking like that where he lives. It may be to his benefit to be on an anti-depressant or some other sedative-like drug.”
Quiet Stuart shook his head. “I agree with Bob for now. However, he may develop depression back at the facility, so I’d monitor him closely.”
“Nice work. You all gave an opinion with a reason. My question was meant to provoke a discussion. There are physicians who would reach for the prescription pad, but not us, not today, and certainly not for Mr. Harty. Who knows, that man may be working on his PhD in geriatric health care delivery.”
As they marched down to see Mrs. Pratt, their Parkinson’s patient, Annabel asked, “Who’s Dr. Kildare?”
CHAPTER 5
With no major developments from their other patients, the team stopped in the ICU kitchen like Dr. Schott had promised. The unit secretary leaned against the counter eating a donut.
“Don’t mind if we clear out this coffeepot,” Donn said. “These poor internal medicine students need delayed gratification for being last night’s caretakers.”
The woman peered over the top of her glasses. “I don’t mind. Your baby-faced students work better when they’re revved up on caffeine.”
“Wanda, us scut monkeys will start another pot when we leave,” Chineka said.
“That’s my girl,” the older black woman said.
Donn split a doughnut hole and popped half of it into his mouth.
“That looks splendid,” Annabel said.
“That coffee you’re pouring will wash it down. Here you go,” he said, offering her the other half.
Annabel waved her hand, declining his offer.
“Annabel has an important post-call day today,” Bob said. “She’s not going to mess it up with a bigger sinking spell than she needs from empty carbs and a sugar blast.”
“You talking about this glazed product? It’s a trademark of the donut maker,” Dr. Schott said, pointing to the patterned box. “Blueberries are in it, or at least the color blue. It can’t be all that bad.”
“I’m stirring up some egg whites in ground turkey when I get home,” Jordan said, “to maintain my brain cells as well as my physique.” He flexed his biceps and stepped to the door. “Mind if I go?”
“No,” Donn said. “You’re all out of here.”
Annabel and Bob trooped down the stairs to retrieve their things. “Jordan’s full of himself,” Annabel said.
“His preoccupation with himself is going to land him in trouble someday.”
“My dad reminds me that medicine and surgery is no longer like the old days. It’s all about team work and there’s no room for egotistical surgeons or other specialists barking at staff.”
“I don’t think I could bark at anybody.”
“No, Bob, you’re better than that.”
They arrived at the office where Jordan and Stuart were leaving. Bob grabbed both their jackets.
“Here,” he said, handing the lightweight parka to her. “Have a nice time tonight.” He forced a smile.
Annabel nodded. “Thanks.” She slung her backpack over her shoulder and hurried out.
-----
Annabel piled her books and bag into her red SUV and headed down I-75 for her short journey home. It was noon and since most of the young generation in her neighborhood worked downtown, she found a parking spot almost at the front of the three-story house where she rented the top floor. She walked up to the corner coffee shop and café where she ordered a soothing hot tea and vegetarian sandwich. A chef made the bread on the premises and she savored the taste while thinking about poor Mr. Harty’s dilemma with food.
That must be miserable, she thought. Lots of old people lose most of what they love to do and the last thing left for them is the pleasure of eating. Without that, she understood how unappealing daily life must be.
The bulletin board on the wall beside her caught her eye; advertisements for services, real estate, and used items were posted for the Cincinnati area. A letter-sized sheet had a picture of the front façade of a nursing home. The caption said A Place for Mom.
Annabel grimaced. I don’t think so, she thought. Why does society assume that the oldest generation should be partitioned out like putting restaurant scraps in a doggy bag? Which then may sit forgotten in the back of a refrigerator which has a bad door seal, causing a temperature where the bacteria breed faster. She contemplated her analogy; the food, like the old people, turns moldy.
No way, she thought. She and her sister, Nancy, would never plant their mother or father in one of those wayside places. Besides, her aunt and uncle also lived in the large Tilson house and between the four of them, there was a tremendous amount of support. Sooner or later, she would earn a commendable salary and commit herself to getting them at-home care. She snickered at the advertisement. Luckily, those types of scenarios with her folks were a long way off.
She put down the sandwich and slipped out her cell to confirm plans with Dr. Burk.
Are we still on for tonight? she wrote. I’m wiped out but can grab a nap and meet you later.
Her eyes grew heavier by the minute and it was becoming more difficult to stay alert. She checked the message again before sending it. Hitting the “send” button meant it was gone forever, disallowin
g her to take back typos, scrambled words, or ill-conceived messages. After waiting so long to date him, she would never forgive herself if she did something stupid.
“Want some more hot water for your tea?” The young manager from behind the counter stood with an eager expression. They had conversed in there before; he was always pleasant and willing to please his customers. He wore a dark shirt with the top button open and a bulky ring on one hand.
“Sure,” she said.
“You off today?”
“Now I am, but just got off from an all-nighter.”
“Bummer,” he said and poured water for her. “If you grip that phone any tighter, it’s going to explode in your hand.”
“Thanks for the tip. I’m waiting to hear back from someone, but my problem is first-date anxiety with him.”
“Why? Because you think he’s a ten out of a ten and excellent relationship material?”
“Yes, I do.”
“Really that important, huh?”
Annabel nodded and placed the phone on the wooden table.
“Want some advice?”
“Why not?”
“Since you’re thinking he’s Mr. Right, you’re probably setting yourself up to be perfect, which is an impossible task. Be yourself and stay with reality. And quit thinking that you’re on a mission to snag him into being a life partner. Just enjoy the date and learn more about him. You’ll have more fun too.”
“Wow,” she said. “Do you host a relationship website giving advice as a second job?”
He laughed. “No. I’m in my early thirties and dated a lot in my twenties. I’m the manager here now, so this place takes up most of my time and I also see a lot. Watching young couples in here is remarkable; sometimes I think I can figure out who’s compatible and who isn’t.”
Her phone dinged and she startled. “There he is,” the manager said. “You both will probably be sharing the same feelings of anxiety, so there you have it … something in common between the two of you for your first date!”
The message came from Robby. “Thanks,” she said. “I’ll remember what you’ve said.”