by Barbara Ebel
Annabel visited Sharon Douglas and, luckily, she didn’t launch into a medley of complaints that could be construed as surgical in nature. After she finished all of Dr. Mack’s commands, a look of disappointment stretched across her face; it was so late, she could not go home before her doctor’s appointment. Instead, she would have to leave immediately to make it on time.
She grabbed her belongings, drove over, and showed up still in scrubs. When they called her to a back room, the nurse handed her a gown and left. Annabel changed and waited on the exam table. In a way, her appointment was a waste of her time. She was only coming for a yearly check-up and pap exam so she could get another year’s prescription for birth control pills. She hadn’t had sexual relations in a long time so why was she even bothering? First, she hadn’t dated in ages and secondly, medical school devoured her time and ability to meet men.
One trend with peers her own age, especially not in medical school, was to discover companionship on social dating sites. She had downloaded the most popular app, Findar, but dreaded using it. It wasn’t unheard of to get creepy messages, users to bluntly ask if you could hook up for sex, or end up on a date with some insulting suitor. And swiping right or left on the app for whether you were interested or disinterested in someone seemed so callous. She knew girls who dreaded being swiped left.
Her thoughts wandered to Robby Burk. He’d probably never register on a site like that. But then again, those sites narrow down people’s interests and maybe bring like-minded individuals together. The app slowly dissipated from her mind as she thought more about him. The surgery rotation had become a big problem. There was Robby who she couldn’t stop thinking about and, opposite him, was Marlin Mack who she wished would fall into a bottomless sinkhole.
But at least the other medical students rotating with her were a good group. They certainly weren’t having the trouble she was and she bet all their effort and concentration was on learning the highlights of surgery and the illnesses which bring patients to the OR. She wondered if she’d even be able to pass the two exams given during the rotation. As she fiddled with the strings on her paper-thin gown, the door opened and the OB/GYN doctor came in with a nurse.
“How is medical school coming along?” Dr. Swenson asked.
“Not too good at the moment,” Annabel replied. “I’m on my first hospital rotation and I’ve been up all night.”
“Ouch. Then promise me you’re going home after this and going to bed.”
“It’s a promise. As long as one of the team residents doesn’t call me and parade me back to the hospital.”
“Then it’s time to turn off your cell phone,” she said while waving her hand for Annabel to lie down on the table. As they talked, she did a breast exam.
“No lumps or bumps,” she said. “But lie a moment to your side.” She pointed to the back of Annabel’s upper arm. “How long has this mole been here?”
Annabel tried to glance over. “I can’t see behind me. I didn’t know I had one.”
“I’ll give you the name of a dermatologist before you leave. This bump is all by itself and, since it may be relatively new, it wouldn’t hurt to have it seen.”
“Okay,” Annabel said and scooted to the end of the table for a pelvic exam.
“No problems with your present birth control pills?” the doctor asked.
“No,” Annabel replied and frowned. “Except that I’m not getting any use out of them.”
“When it comes to sex, sometimes its feast or famine with some of the women I talk to. But you have more on your plate than most, so don’t worry about it.”
“That’s an understatement,” Annabel said. She got dressed when they left and picked up the skin doctor’s name on the way out.
-----
On the drive home through the crowded, boring interstate major artery, Annabel could barely keep her eyes open. She cranked up the music and was grateful that she didn’t live further away. The tedious part came near home. Circling blocks for a parking space was no fun. After she entered her apartment, she knew how high the humidity was. Her hair was botched up in curls and she reverted to her habit of running her finger in it behind her ears.
Her eyelids felt like they were wearing lead as she dropped her things and called the dermatologist’s office. Her appointment scheduled, she drank a glass of water, and opened a large container of yogurt. She skipped spooning any of it into a bowl and ate it straight from the plastic tub. When she finished at least two servings, she went to bed and lay down in the scrubs she’d put on that morning.
Curled on her side under the sheet, she realized she’d been up thirty-six hours. Those pressure-packed hours had taken a toll on her emotional and mental well-being. Never before in her life had she been so pumped up and enthused about starting something. She had worked so hard to get to the clinical years of training but her first one, so far, was a major disappointment.
Within a few minutes, tears gathered in the corner of her eyes and she couldn’t stop them from sliding off her cheeks and onto her pillow. Her sobbing started slowly but soon it was rocking her into more of a fetal position. Damn him, she thought, knowing most of her troubles had been due to one person. Her short, sudden breaths intensified as she wept her way into more anguishing thoughts; were the rest of clinical rotations going to be sheer hell? If this was the toll it took, what was the irony of that? How could doctors take care of others when they themselves suffer from emotional and physical strain? How did heartthrob Robby Burk and others like him make it to where they were?
She didn’t have the answers; all she had were questions. But she did know someone who might be able to help … her father. There was no one she admired more than him. His steadfastness and love of neurosurgery and family. And secondarily, her mother. What a smart and loving woman to have gone through the family crises she’d put up with. On top of them, Annabel had the closest aunt and uncle; as good as parents to her. Family does matter, she thought. When the chips were down, she could count on them to provide solace and support. She continued her profound searching until the tears dried up and deep sleep engulfed her.
Chapter 9
Robby Burk hit the snooze button and turned sideways.
“Time to get up,” he said, massaging his fiancée’s shoulder.
Faye Garrett grabbed his hand and squeezed it. “You first,” she said. “Surgeons have earlier hours than pulmonologists.”
Faye, like Robby, was nearing the end of her entire residency. She had trained in internal medicine and then went on to a pulmonary fellowship. Since it was her last year, they were both looking forward to being independent physicians in the real world. Although they had met during their residencies and although they were engaged to be married, they had not yet set a date; they figured they’d tie the knot as soon as they ‘graduated.’
Having such bizarre and different schedules, they had decided not to live together either and wait until they were married. That decision resulted in Faye spending nights at Robby’s when they both weren’t on call and when they both weren’t dead tired. If they were lucky, that resulted in one sleepover a week.
Robby gave her hand a reciprocal squeeze, kissed her on the mouth, and swung his legs to the side of the bed. Then he shut the alarm off for good.
“You didn’t say much about your call the night before last,” she said.
Robby furrowed his eyebrows. “That’s because it went downhill and I didn’t want to ruin our time together last night by talking about it.”
“We’re in the same boat,” she said, reaching for his back. “We better share work problems and other important matters or we’ll have two entirely separate lives.”
“There were two deaths during call and one the day before.”
She raised up on her elbow. “I hate to tell you, but you may end up in front of this month’s surgery M&M because of that.”
“I know. I’m bracing for it. I might as well start getting it ready.”
M&M, as m
edical departments knew, were a necessary and useful part of learning. It stood for Morbidity and Mortality which was a monthly mandatory conference for residents, attendings, and students to learn from the most outstanding cases encompassing morbidity for the month. The cases picked didn’t necessarily reflect a team’s negligence or incompetence but sometimes they could.
“Well,” she said, “I hope you won’t be incriminated for a surgery-gone-wrong.”
He glanced back at her, his concern growing. “One was a burn patient that we grafted. Significant burns on patients cause a host of problems, as you know, and the other patient was a ruptured appendix who waited too long to seek help. I’m racking my brain about them and feel somewhat guilty but the deaths are explainable.”
“You need to shake that bad luck,” she said. “I bet you won’t see a cluster of deaths like that or that many sick patients together next spring or summer when you get into private practice. I can’t wait for that for the both of us. Finally, our lives will normalize.” She lay back down and pulled the sheet up. “I, for one, have been living on delayed gratification for too long. I am so looking forward for us to buy a nice house.”
Robby got up and she eyed his toned back and arm muscles. He cracked the blinds to let the rising daylight filter through. “By the way, I’m curious about Global M.D.s. I’ve made some inquiries and have asked them to send me their literature.”
“What? Since when? We just talked about sharing what’s going on in our lives. This is the first I’m hearing about it.”
“I want to look over their material before I consider it any further or talk to you about it.”
She sat up. “But why even consider it when we’re getting married and going into real jobs?”
“You may be right but I can’t get the idea out of my mind. To take a year and go deeply remote to an underprivileged area or country where I can do more good than in my entire career. Like a payback.”
“A payback? You do deserve a payback. You’ve spent years getting to where you are and now deserve to earn a living at what you’ve been doing. I don’t see how you’ve included a wife in your selfish ideas.”
“Selfish?” he asked. “I suppose you’re right. There are two ways to look at this. But right now, we both need to get to our respective hospitals, so let’s not discuss it anymore.”
They both looked at each other a little too long. Robby went into the bathroom, took a quick shower, and dressed while Faye finished twenty minutes on his stationery exercise bike. As he drove to the hospital, he knew sometime during the day he’d go by the main department’s office and put one of his cases on the roster for M&M. But even more, he anticipated getting information from Global M.D.s.
-----
“Did you all study and catch up on sleep after call yesterday?” Robby inquired after the team stopped in the middle of a surgical floor. Even though they blocked half the hallway, Dr. Pittman leaned against the wall. Robby waited for their answers; he was sincere about the question. He wanted oversight over his student’s well-being.
“I was home by noon,” Bob said. “A half hour later, I was asleep like dust under my bed.”
“Good thing no one sneezed,” Robby said.
“My three-year-old has been sick,” Ginny said, “but we both took naps. Thanks for asking, Dr. Burk.”
Annabel looked at the floor. Even Ginny had a decent post-call day. She stifled a yawn and wished she’d made stronger coffee when she woke up.
“You all look no worse for wear,” Dr. Pittman said as he bended his knee and placed his foot on the wall. “Let’s talk about our recent case, Mrs. Vega. You all should have studied yesterday over and above what Dr. Burk taught you about ruptured appendixes. Let’s address her sepsis. Sepsis is caused by an infection in the blood. But what’s the most common type?”
“Bacterial,” Da’wan said.
“Good, that’s correct. What’s it called if it works its way into bone?”
Annabel didn’t know and the other students didn’t speak up either.
Marlin cleared his throat. “It’s osteomyelitis,” he said.
Dr. Pittman nodded. “We talked about what can happen to lungs yesterday with prolonged endotracheal tubes. What are some specific sources of infection that hospitalized patients can pick up?”
“From IV lines,” Bob said.
“From a surgical incision,” Annabel said.
“Not from one of mine, I hope,” Robby said. He smiled at her and she blushed.
“I certainly didn’t mean….”
“No, that’s good,” Robby said. “I’m not taking it personal.”
“Robby never takes anything personal,” Dr. Pittman said. “Not even from his fiancée, I’m sure.”
So, Annabel thought. Robby is ‘taken.’ What a sour note to hear on rounds. Maybe at some level she had recognized that. He is just too handsome, too sincere, too engaging and charismatic to not have a love interest in his life. She could have kept dreaming that it could be her but maybe now this information would help clear her thoughts of him. She fiddled with her hair behind her ear. Well, she could try anyway.
“Don’t forget the dreaded urinary catheters,” Dr. Pittman said, “and the nemesis of nursing homes … bed sores.”
As Dr. Pittman went on, Annabel grew more tired and came to realize he still hadn’t finished lecturing about sepsis - what Dolores Vega had along with her ruptured appendix. Her eyes grew weary but she managed to will them open and could swear she fell asleep standing. Ten minutes later, she shuffled her feet and heard him wrap up.
“You all had a model case of appendicitis and its sequela. It’s always sad we have role models like her for our teaching and learning. Her demise is the ultimate end point we don’t want to see. Anyway, Dr. Burk will present Dolores Vega at M&M.”
Pittman pushed himself off the wall and waved for them to move on along to see patients.
Bob and Annabel brought up the rear. “Here,” he said. He slipped his hand in hers and she took his chocolate-covered espresso beans. Popping one in her mouth, he said, “You need these more than I do.”
Annabel nodded. He looked great this morning, his top layer of hair slightly over his forehead and he wore a sheepish grin. She sucked on the dark chocolate, as tasty as the bean underneath it.
“I’m learning something from rounds,” she said.
Bob cocked his head.
She closed the gap between them. “If Dr. Pittman gets against a wall, it means rounds will be a lot longer. And that means I’m learning to sleep on rounds while standing up.”
“You’re more perceptive than you appear,” he said, tapping her sleeve in jest.
“I’ve been accused of that but certainly not by Dr. Mack.”
-----
When rounds finished, the team went back to the office and Dr. Pittman left.
“I have good news for our team,” Robby said. “This upcoming weekend is a three-day holiday. Because we aren’t a team on-call those three days, Dr. Pittman and I, along with the other chief residents, have come to an agreement. If any of you want to take off and not do rounds those three days, you can do so. Dr. Wallace, Dr. Mack and I will round on all our patients. The opportunity rarely presents itself this way, so take advantage of it. Study, go out of town, or still come in and see patients with us.”
Annabel listened with disbelief. It was an opportunity and one which could help bolster her spirits again by going home.
“Now we’re still on call the night before,” Robby added, “but once you get off that morning, you’re free for those three days.”
“Can we count on you to do our surgery if we have a water-skiing accident due to all that time off?” Bob asked. He maneuvered his arms and legs like he was tethered to a boat.
“Don’t tell him that,” Ginny piped in.
“That’s right,” Marlin said. “We senior doctors will change our minds.”
“All right, that’s enough,” Robby said. “Let’s not rock
the boat or Bob may fall down.”
Annabel glanced at Robby’s soft leather shoes, his brandy-colored pants, and his crisp white shirt and jacket. In a moment, he leaned forward and slipped off his lab coat. She hated when he did that; it meant he’d roll up his sleeves halfway and she’d have to avert looking at his physique. But he draped his jacket over his arm and stepped towards the door. “Any questions?” he added.
After a unanimous “no,” the next thing the students said was, “Thank you, Dr. Burk.”
-----
Even though she had too much scut work for the afternoon, Annabel’s day dragged. Her enthusiasm for the rotation had also waned; just knowing Robby Burk had a fiancée made her gloomy. He’d gone to surgery in the afternoon and it wasn’t one of her patients and she was glad to be free of him. If only she could get him out of her mind.
For a whole hour, she had the office to herself and read everything she could from Robby’s surgery textbook about a ruptured appendix. She now felt saturated with the subject and it bothered her that the team had given Mrs. Vega classic, perfect treatment yet she had still died.
Brandy Wallace walked in and sat with a thump at the desk. She rubbed hand sanitizer around in the palm of her hands while looking at Annabel.
“I just finished a few hours in the surgery clinic,” Brandy said. “Why didn’t you come by?”
“I didn’t know about it. Was I supposed to?”
“Dr. Burk said so for the students not in surgery with him.”