by Barbara Ebel
Donn nodded with approval, took off his thick glasses, and rubbed a cleaning cloth on the lenses. “Mid-term test is coming up soon. I don’t expect one bad grade from this bunch.”
“I’ll be ready,” Jordan said.
Donn peered over at Stuart.
“No problem, I hope.”
“I’m not comfortable yet,” Annabel said.
“Annabel always feels that way,” Bob said tentatively, “but she comes through every time.”
“What about you?” Donn asked.
“I squeak by. I can’t compete with Stuart or Jordan.”
“Stuart, maybe,” Donn said. He slid his glasses back on. “Dr. Tilson, any pertinents about May Oliver before we step in?”
“She’ll be transported over to the preop area any minute for her lung surgery.”
“You can break from rounds to watch once she goes into the OR.” He pointed to the room.
Inside, May Oliver twisted her hands together like she was sweating it out at a poker table with high stakes. A man and a woman in their early sixties sat on the bed facing her. They were dressed smartly and stood immediately to greet the group.
“We’re May’s parents,” the man said. “I’m Ken and this is Louise. We came as soon as we could; we’re thankful we’ll be here during her surgery.”
“We only have one child,” Louise said, “so May means the world to us.”
Louise’s cheekbones were prominent and high like her daughter’s; she was an attractive woman with an air of humility. After sitting down, she reached for May’s hand and held it in her own.
Annabel was glad to meet them; she hoped their appearance made up for May’s boyfriend and his cowardly avoidance of her situation.
In a series of efforts, May coughed, trying to clear the irritation coming from her respiratory tract. Stuart handed her the emesis basin from the nightstand. She clenched it close to her mouth and expectorated slimy blood. More came with repeated coughing as Louise and Ken Oliver’s faces registered fear and uncertainty.
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Even though Annabel finished her medical school surgery rotation, it had not included thoracic cases. She realized she would be watching a much more dangerous surgery on a grander technical scale and wished it wasn’t going to be on May Oliver.
In the OR, the anesthesiologist and senior resident busily prepared May for her case as the surgical team waited. She had a soft spot for the importance of the anesthesia care team and watched with diligence as they hooked her up to all the monitors, inserted an arterial line in May’s wrist for constant blood pressure monitoring, and then a central line for better IV access.
“Sweet dreams,” the resident said, as the attending doctor injected a narcotic and sedative-hypnotic to put her to sleep. With a face mask, the resident breathed oxygen into her after she fell asleep and he opened her mouth with a laryngoscope to intubate her. From hearing Dr. Barrett’s previous explanation to Mrs. Oliver, and having talked with the anesthesia resident, she knew this endotracheal tube was different. She stayed out of their way as they inserted a one-sided lung tube, which had to be placed perfectly to ventilate May’s non-operative lung. They checked the placement by sliding down a flexible bronchoscope and taking a look.
With anesthesia satisfied, the OR team, anesthesia, and the surgeons placed May in a lateral position with the operative lung facing up. Dr. Barrett and his resident scrubbed outside at the sink, anesthesia checked placement of the tube one more time since May had been moved, and when the surgical team came back in, they began surgery on May’s lung.
No one asked to turn on music; May’s age and her case were disconcerting to everyone present. Annabel was allowed to stand near the anesthesia team and peer into her chest cavity where she saw the rubbery deflated lung. After Dr. Barrett expressed concern about the whereabouts of the tumor, he isolated it, his scalpel went to work, and blood began seeping into the hollow of her chest cavity.
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“Hold onto me, Mama,” Gloria said to deaf ears as her left arm encircled her mother and her right one jimmied up a clean pair of trousers. The elastic waistband settled on her mother’s waist and Gloria straightened the ends of the adult diaper underneath. She gently lowered Darlene and decided her blue print top was fine for her clinic appointment. She reached for a nylon hairbrush and detangled the back of her mother’s short hair. “Look at you,” Gloria said. “Now you’re the belle of the ball.”
Darlene’s face was set in a scowl, like it had been baked in clay. “Mama, on the other hand, I need to crack your face with a hammer to bring back the beautiful expressions you used to wear.”
“Damn,” Darlene scowled; or at least that’s what Gloria thought she said.
Gloria moved the tray table close. She scooped up a teaspoon of left-over yogurt and her mother cooperated by letting it slide down her throat. A portion of the liquid lunch Gloria had prepared was still left so she tipped the bottle up twice to her mother’s lips until the liquid was drained.
Gloria lined up their jackets and hats on the bed and readied her purse. Her mother’s clinic appointment was in an hour and a half. She squeezed sanitizer on her hands, moved the bottle back to the counter, and left a moist trail on every item she subsequently touched. Glancing at the clock, she knew moving her mother out of the house and situating her in the car took longer than the actual drive to the clinic.
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Annabel fretted because May’s thoracotomy extended over the time allotted for it on the schedule. She noted the proficiency of the experts above and below the surgical drapes hanging across May’s neck area to both sides of the arm boards. The senior anesthesia resident swept his eyes over the monitors as a constant ritual, kept his record updated, and adjusted his anesthesia dosages when the need arose. He peered into the lung, watching carefully the amount of blood loss and transfused the second bag of red blood cells. Every thirty minutes, he ducked under the table and noted May’s urine trickling into the Foley catheter. So far, her renal function was fine.
At the end of the surgery, anesthesia had yet more to do. Besides inflating the surgical lung back up, the team then removed the double-sided endotracheal tube and immediately replaced it with a single lumen tube.
“May needs to go to the ICU and patients don’t tolerate the larger tubes well when they’re waking up,” the anesthesiologist said to her, noting her curious expression.
Before they transported May to the unit, Annabel left the OR dazed at the complexity of what she’d seen. Her patient would now be an ICU patient, hooked to a ventilator until the medical specialties deemed she would be able to breathe on her own.
Out in the waiting area, May’s parents approached her with questions.
“What took so long?” Ken asked.
“Is our daughter’s cancer gone forever?” Louise asked.
Annabel wished she was more than a third year medical student but, nevertheless, she tried to appease them.
“The other doctors will be out to talk to you and answer your questions. May, however, is stable and will be going to the ICU. There she will be sleeping off her anesthesia and feeling no pain.”
CHAPTER 20
Gloria pulled her car up below the awning and jumped out. The beauty of bringing her mother into the hospital or clinic was that she didn’t need to bring along Darlene’s wheelchair for the trip. All she had to do was pop into the front door of the facility and grab one of theirs. She wasn’t getting any younger to be hoisting medical equipment into her car, she thought, and realized her birthday was the next day – a whooping thirty-nine years old. She should stage a celebration with her mother. Birthdays deserved a special cake; all the years that Gloria was growing up, her mother saw to it.
Snow flurries swirled around in the unloading zone like they didn’t know where to go and peppered her thick black shoes. She stomped on the mat after she entered the building and grabbed a wheelchair. A considerate elderly volunteer rushed over to help her and followed h
er back out.
“You’ll catch pneumonia out here,” she yelled at him as she opened her car door.
He ignored the remark and heaved Darlene out of the front seat and lowered her into the wheelchair.
“Thank you so much,” Gloria said inside. “I don’t have a shred of help 24/7 when I’m caring for my mom. You don’t know it, but your kind act is like a ray of sunshine on this dreary winter day.”
The man’s eyes smiled with deep wrinkle lines as he pushed Darlene inside and Gloria parked the car. In a little while, both women were riding the elevator upstairs to the outpatient medicine clinic.
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All four students ate lunch together and grabbed refills on their coffee; or in Stuart’s case, a hot chocolate. A buzz of conversation sounded from the waiting room as well as an overhead local news station as the students walked through to the outpatient clinic. “You may need an umbrella later today if it warms up any more,” the newscaster said, “and if this light precipitation hangs around.”
“Warms up?” Bob said when they entered the exam area. “That’ll be a miracle.”
Stuart peeked at a chart outside the first door. “This is a new patient, not a follow up. I’ll take her.”
Dr. Burg heard him and stopped filing her nails behind the desk. “Come on, then,” she said. “He should be ready for the A-team.”
“What does that make us?” Jordan asked as they disappeared into Room 1.
“We’re the BTA-team,” Bob said, “better than average. Which can mean A+.”
Annabel shook her head at him and picked up the next chart. “This one’s mine; my Parkinson’s patient for a follow-up.”
“I’ll see another patient in the interim,” Chineka said, plucking out a different chart in the next bin. “You go in there and examine Mrs. Pratt. Evaluate if her Parkinson’s symptoms are stable and not worse than when she left the hospital.”
Annabel turned the knob, grateful for the opportunity. She loved seeing patients by herself. It not only made her feel useful and important, but then she could compare her assessment with her resident’s and realize the things she missed.
“Mrs. Pratt and Mrs. Pratt,” she said when she entered. Darlene sat in the wheelchair and the women’s jackets and hats were lumped on the exam table. Gloria stood, a canvas tote bag brimming with a diaper and toiletries next to her on the floor.
“How is your mom doing?” Annabel asked.
“She’s in her own world but no worse for it. Her motor control hasn’t gotten any worse, thanks to that levodopa and carbidopa.”
“And is the clozapine that the psychiatrist recommended helping with her psychosis?”
Gloria shrugged. “She may be calmer, come to think about it.”
Annabel noted Darlene’s blood pressure was acceptable and then leaned into her patient. She lacked any facial expression, the trunk of her body stayed catatonic, and one hand fidgeted with a tremor. How awful, Annabel thought more seriously than before. Her patient had no pleasant moments as far as she could tell. And unlike some of the psychiatric patients she had taken care of who had thought processes they could not escape but their bodies were fine, this woman’s mind and body were like she was locked up inside plaster without any escape.
Annabel hovered over her with her stethoscope. She appreciated Darlene’s clean clothes as well as the light lavender fragrant smell coming from the woman. Gloria was amazing, she thought, like a Mother Teresa in the Pratt home. She wrapped her stethoscope back around her neck after listening to near normal breath and heart sounds. Her patient’s heart rate and respiratory rate were a tad elevated, but nothing concerning.
“How are you holding up?” Annabel asked Gloria.
“I landed the job that I interviewed for.”
“Congratulations,” Annabel said. “I don’t know how you juggle a job and taking care of your mom.”
“The way I always have. Someone’s at the house when I’m gone. Yesterday was my first day. The personnel office gave me two choices of where I wanted to work and I chose the medical floor. Basically, I had to follow around nurses and other medical assistants, but next time, I’ll be on my own.”
“You’ll be an asset with all your care-giving experience.”
The door opened and Chineka entered. She gave them a greeting and Annabel told her a short update on Mrs. Pratt.
“I’m going to order some labs,” Dr. Watts said, “to make sure your mom doesn’t have a recurrent UTI. After an assistant draws her blood, you may be more comfortable outside in the waiting area.”
“We’ll be fine here,” Gloria said. “Mom will most likely shut her eyes. She’s missing her nap.”
Annabel and Chineka left and Gloria helped herself to an ethyl alcohol wipe next to the sink to kill any new germs on her hands. As her mother soon rattled off some snoring, Gloria also closed her eyes.
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“Only one more hour to go,” Annabel said as she combed the side of her hair with her fingers.
“But then we have rounds on the wards,” Bob said, holding a chart next to her.
“The day is going too slow and I’m anxious to study tonight.”
“Here,” he said. “I have a new box of espresso beans.” He took them out and quickly found Jordan and Stuart hovering behind his shoulder.
“All right. They’re small boxes.” He spilled some into each of their hands as well as his own, crumpled the box, and tossed it underneath in the garbage.
“Bob, this is perfect,” Annabel said letting the chocolate bean melt on her tongue.
A woman from the lab peered at the students’ charts in front of them. “Here,” she said, “this is for Pratt.”
“Thanks,” Annabel said, and looked at Darlene’s results. “I’ll be back,” she said and updated Chineka. The two women compared new lab results with old ones.
“Let’s go back in,” Chineka said.
Inside, Darlene’s eyes stayed closed. “I hope my mama hasn’t had too much rest,” Gloria said opening her eyelids. “Otherwise, she’ll be up half the night.”
“We’ll let you get out of here,” Chineka said. “Results are fine except that your mother’s renal function seems to have slipped in the wrong direction, but there’s no UTI. I’m sure it’s not easy for you, but try and make sure she stays hydrated. The creatinine is creeping up and we’ll have to watch for further renal insufficiency. Instead of bringing her back in a month, we’ll schedule you back in two weeks.”
“Okay, doc,” Gloria said. “You know you can count on me.”
Gloria began softly rocking her mother’s shoulder to stimulate her. “Mama, it’s time to wiggle you into your coat so we can go home.”
Outside, Annabel wrote a clinic note on Mrs. Pratt for Chineka to counter-sign. Gloria soon passed, pushing Darlene in the clunky wheelchair, and waved good-bye with the appointment slip in her hand.
However, Gloria thought, there was a scant chance she’d be back in with her mother for that visit … which was sooner than she anticipated.
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Back on the medicine ward, the students and residents hurried to gather any new patient data for rounds. They ached to go home. Tomorrow was a call day.
Dr. Schott pitched in too. “All right, did they expedite Mr. Hogan’s echocardiogram this afternoon?” he asked no one in particular.
Mr. Hogan’s nurse, a young woman named Susan, handed him several sheets, paper-clipped together. “Here are incoming results from today for his chart,” she said.
“Thanks.” He glanced at Bob. “Which means even the eager medical student here hasn’t seen them.”
Bob frowned. “Don’t hold it against me.”
“I would never,” he said and took off his glasses. Instead of wiping his lenses, he rubbed his eyes as if he didn’t want to see Mr. Hogan’s echocardiogram assessment.
Donn read the results with his glasses back on and with Susan still standing by. He shook his head and leaned back. “His ejection
fraction is estimated to be 34 percent. Very bad heart failure. That means the pumping ability of his heart is severely below normal. Among other fatal complications, he is capable at any time of having a life-threatening arrhythmia or having the left and right ventricle pump in an unsynchronized manner.”
Annabel placed her head in her hands on the counter. She liked Mr. Hogan. She could tell that Bob did too; he not only didn’t have a humorous thing to say, he didn’t say anything at all.
“Thanks for letting me listen,” Susan said, “because now I can keep a closer eye on him.”
Donn nodded and she left. “I feel it’s our duty to tell him now,” he said. “Unlike many patients with their illnesses, I think he absorbs and understands what we tell him about his heart failure. And when he doesn’t, he asks more questions.”
“Somewhat like our other patient, Mr. Harty,” Bob said. “He was a really smart old man that I admired. I still feel bad about him”
“I tell you,” Donn said. “Sad cases multiply like leaf piles in the fall.”
Annabel had never seen Dr. Schott with a crestfallen face before, but for a flash, his beard and mustache and demeanor made him appear ten years older. He was not even an attending yet, she thought. Clinical medicine, as well as many other specialties, was not for the faint of heart.
When the team shuffled into Mr. Hogan’s room, he was absorbed with watching the history channel. Old footage of World War II had him on the verge of tears: antiquated-looking airplanes dropping bombs, boys in uniforms wielding rifles, and disheveled families seeking refuge from homelessness.
Dr. Schott cleared his throat and Mr. Hogan flinched.
“Didn’t notice my cavalry came in,” he said. He muted the television and grinned. “What are you going to tell me this time?”
“Your heart function worsened since your last echo.” Donn pursed his lips. Mr. Hogan deserved getting his medical news like whiskey. Straight up.
“Bad, huh?”
“That bad.”
“Thanks for telling me. Of course, you already told me you aren’t going to stick a new heart in me. You better send me home then … ASAP.”