by Barbara Ebel
After further preparation inside the OR, Annabel scrubbed and Robby got the okay from anesthesia to begin. He made a 1 ½-inch incision in the left groin as Marlin and Annabel both stood across from him.
“Dr. Tilson,” Robby said, “you must have already read up on open inguinal hernia repairs. This is a nice calm elective procedure today and this will only take an hour.” For emphasis, he rested his hands on the blue drapes and laughed. “I hope you paid attention. I just slapped you with another top ten OR saying.”
She trembled from his attention and her heart pounded as his glance held. “That this is a nice calm elective procedure or that it will only take an hour?” she asked.
Robby laughed and the OR tech said, “Honey, it’ll only take an hour. We don’t listen to surgeons when they tell us that.”
“She’s right,” Robby said. “So, Dr. Tilson, what are we worried about with this type of hernia and why is it performed?” His eyes went from the skin incision to looking at her.
“The hernia allows an opening for what’s underneath to pucker up and get caught in it.”
“Dr. Tilson, you’d be the butt of mockery if you became a surgeon and said that while doing a consult,” Marlin said, diverting his eyes to smile at the instrument tech.
“They wouldn’t ask you to see their patients no more,” the tech chimed in, making fun of Annabel.
“Gang up on the medical student,” Robby said.
“Wouldn’t think of it,” Marlin said. “Around here, people only get what they deserve.” As Robby concentrated below, Marlin threw her a sneering look.
Robby prodded for the defect in the patient’s groin, the creased region between the thigh and lower abdomen. After identifying it, he explored with his fingers to carefully determine its size.
“So, Dr. Tilson,” Robby continued, “why is that a problem if a portion of bowel or internal organ gets pinched in the hernia?”
She wasn’t sure about the correct answer and already felt incompetent. “The organ can’t function correctly?”
“But why? In other words, you must think like an M.D. Get to the etiology, the cause and effect, the pathology and ramifications. If you think of absolute basics, if you know how something works or happens, then you will understand medicine and surgery that much more. That will allow you to be a better diagnostician and, ultimately, treat patients more successfully.”
Annabel thought about his question and advice. Wilbur Gill even nodded at her from the other side of the draped barrier. “I’m not sure of the answer,” Annabel said.
“Nice to hear some straightforward honesty,” Robby said. “Any tissue caught in the defect, if left long enough, can strangulate because its blood supply will be cut off. Imagine…the tissue or organ can actually die. You can see why a little problem like a small hernia can end up being a major problem for the GI track.”
“I see,” Annabel said. “Thank you.”
Robby handed a gauze to Marlin to pat the small amount of blood at the site, giving him better visibility. “You’re welcome,” he said. “I should be letting you do this case,” he said to Marlin, “but I’ll let you close.”
“Next comes the use of mesh,” Robby said. “It’s what almost every hernia is repaired with these days.” He showed Annabel the woven type of material or sort of plastic. “It’s durable and causes less post-op pain than the older materials we used to use.”
Robby glanced over at the clock. “Just a few more minutes and you can finish up, Dr. Mack. And you can turn up the music,” he said to the circulator. When he finished more of the case, he waved Marlin over to his side of the table and stepped away.
“You take over what I was doing,” Marlin said to Annabel and handed her a fresh sponge from the tray table. But in the next minute, he changed his mind, and yanked it out of her hand.
“And Dr. Tilson,” Robby said, “you just heard another OR saying … ‘turn up the music.’” He went through the double doors while humming along with the Nashville country superstar.
Chapter 11
Marlin mimicked several lyrics of the country song when Robby was gone. Since he was also satisfied with Robby’s mesh repair, he began closing. The scrub tech was about to do a count of surgical sponges for wound closure when another tech came in to relieve her.
“I can give you a break if you go now,” the new arrival said. “I have this covered and will get your skin closure count for surgical items.”
“Okay,” the first woman said, rattling off the number of items she’d started with.
Marlin pestered the new woman for more absorbable sutures for closing while she nodded to the first woman to leave.
“I’m glad I made you stop all that dabbing,” Marlin said to Annabel in a huffy tone. He finished his sutures and applied a sterile dressing to the incision as the nurse made the final surgical item count at skin closure.
As Marlin walked away and stripped off his gloves, Annabel watched Wilbur Gill. He pressed on the nerve stimulator, injected drugs and turned off the vaporizer he’d shown her several days ago. When Mr. Simmons started moving and sputtering at the endotracheal tube, he opened his eyes and Wilbur removed the tube.
“You make it look so easy,” Annabel said.
“Comes with training,” he said. “And we must never forget that waking up patients is as important as how you put them to sleep.”
“Annabel,” Dr. Mack snapped, “we’re finished here.”
Annabel and Wilbur exchanged glances. “I guess you’re not Dr. Tilson to him,” Wilbur said softly to her.
“He never calls me Doctor,” she said. “Thanks, and someday, I want to spend more time up there with you all.”
When Annabel left, she went into the female changing room and took off her bonnet and shoe covers. Her stomach growled. Besides her sporty adventure last night, she’d missed breakfast and now felt famished. Realizing that Dr. Mack may sabotage her if he knew she was headed to the cafeteria, she bolted out of the OR area before he came out of the male doctor’s room. She took the staircase and trotted down to the first floor.
Annabel scanned the hot and cold items, settling on a small salad and tuna fish sandwich. After paying, she walked down the outer aisle of tables and chairs. As it was during a normal lunch hour, many tables were taken.
One man sat alone with his back to her and, as she passed, he said, “Dr. Tilson, if you’re looking for a spot, you may sit here.”
She swiveled at the voice she could listen to in her sleep. “Are you sure, Dr. Burk? I wouldn’t want to disturb you.”
Robby patted the top of the table across from him. “You won’t bother me. On the contrary, you can summarize how Mr. Simmons is doing.”
She knew his interest was in their patient and not her but she seized the opportunity and set down her tray.
“Thank you,” she said, opening a salad dressing packet. “As for Mr. Simmons, he has a fresh bandage on his surgical site and is doing fine. I stayed and watched the anesthesia resident wake him up.”
“Good for you.”
She considered his three words a compliment since she’d had a terrible history so far on the rotation.
“Are you and the other students getting enough studying done? The first of your two surgical rotation exams is next week. I take the scores of my students seriously because they are a reflection on me.”
She wished then that she could score the highest but that was an impossibility because Da’wan would secure that spot first. She searched for an answer but he had her mind swirling in different directions.
“Exam next week?” she stuttered. “That’s coming up quickly. I believe everyone is studying whenever they can.”
“What about you?” he asked, noticing her hesitation.
“Well, as long as you don’t test me on those OR sayings.” She laughed a little bit and Robby beamed a big smile.
“So why’s a nice girl like you going into medicine? Is it what you want or are you following in your father’s footsteps?”<
br />
“A little bit of both. I had an older sister who was hell-bent on the medical field so I guess I’m following her lead, too.”
Robby nodded and poured more ketchup on the side of his plate; he dabbed a forkful of meatloaf into it and took a bite, considering what she’d said.
“Is your sister doing something else now instead?”
“She passed away,” Annabel said.
“I’m sorry,” Robby said, looking into her eyes.
Annabel nodded. “Are you going to stay in the department when you finish being a chief resident?” she said, changing the subject. “Will you become an attending doctor like Dr. Pittman?”
“I’m thinking of taking a year off. I’d love to travel to Africa with Global M.D.s”
“Seriously?”
“Yes, seriously.”
“That doesn’t qualify as a year off. Quite the contrary. That is pure dedication and a huge self-sacrifice.” She held her sandwich without taking a bite, her eyes plastered on him. “Think of all the people you would help. Not only that, but you would gain a different perspective of your field without all the gimmicky technology that’s used in the states. It takes a saint to delay getting into their own practice.”
She almost took a bite but said, “Oh, I’m sorry, Dr. Burk, it’s not my place to say all of that.”
Robby studied her more closely. If he had a dollar for every young, enthusiastic medical student on his rotations, he’d retire right now. But Annabel was different; what a stark contrast between her and his fiancée. Annabel thought his idea was charitable and important and Faye discouraged him about the whole concept. As he watched her swallow a bite, she put her hand behind her ear and tugged at a curly swath of hair. She was pretty and simply refreshing. But as he and Dr. Pittman were aware, her clinical skills and performance to date left a lot to be desired.
“But,” she went on, “it seems to me that your year of philanthropic surgery service is just what historical greats - like Gandhi or Nelson Mandela – approved of.”
Robby laughed. “Flattery will not get you a higher grade. But I appreciate it. And thank you for your opinion. It actually comes at a good time.” He pushed back his chair and put his napkin on the tray.
“Really?” she said. She could not stop her heart from pattering in her chest as he got up and loomed over the table.
“Really,” he acknowledged. “Now, don’t feel like you need to wolf down the rest of your sandwich. I’ve spared too much time for lunch already.”
As he put his dirty dishes in the used tray rack, Robby agreed more with Annabel’s thinking than Faye’s and was now more determined than ever on doing what he wanted to accomplish.
After Robby left, Annabel went through every detail of their conversation again in her mind. And she actually sat with him for lunch! Her blood felt like it was on a roller coaster zipping through her circulatory system. Sitting right across and alone with him had been amazing; two fantastic events with two men in the last twenty-four hours but for different reasons.
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“I can’t believe it,” Bob said, looking around in the call room the next morning. Although it was quite dark, he could make out the figures in the bunk beds, especially Annabel across from him.
“What is it you can’t believe that you’re keeping us awake for?” Ginny asked.
“You are awake,” Bob said “and we all better be awake because it’s time to get up. But what I can’t believe is that for two hours we’ve all gotten sleep.”
“I was dead tired,” Annabel said. “I’m sure glad I didn’t get a hit last night.”
“You and me both,” Bob said. “We’d make a good couple; we have a lot in common.”
Annabel swung her legs to the side and climbed down. “I’m not going to be the half part of a couple for a long time,” she said. “There are nice options to being single and not committed.”
“Not for me,” Ginny said. “My little girl is the best thing that’s ever happened to me.”
Annabel turned on the overhead light. “I can’t wait for our weekend off. I’m skipping a shower so I won’t be long in the bathroom,” she said.
“I wonder if Dr. Pittman is rounding with us this morning,” Da’wan said.
“I hope not,” Bob said. “He slows things down.”
“But he’s a good teacher,” Da’wan said.
“If he settles against the wall,” Annabel said, “we can kiss getting out early good-bye.”
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Annabel put her bag in the office and bought a large coffee from the downstairs coffee bar. She almost finished it by the time she popped in on her patients and collected information for rounds.
She visited her only surgical patient from yesterday first; Mr. Simmons had a single room and was brushing his teeth in front of the sink.
“Good morning,” Annabel said. “How are you feeling today?” She picked up the bedside chart, scanning his vital signs.
He took the toothbrush out of his mouth and smiled. “Surgery is a medical marvel these days,” he said. “No offense, doc, but it’s mostly the anesthesia that’s so great.”
“I hear you. Any problems overnight?”
“Not one. I slept like a baby and hardly stirred when people came in and out of here. I’m going home, aren’t I?”
“As far as I can tell. But we’ll see you again shortly on rounds so that Dr. Burk can confirm that.”
“Dr. Burk came highly recommended. I can’t tell I even had surgery except for the lumpy bandage in my groin.” He wiped his mouth with a cloth and walked over. “Not only is he the best, but he’s a shining example of professional bedside manner.”
Annabel smiled and had him sit on the bed. She auscultated his lungs and heart and left him to a breakfast tray that had just arrived.
When she went back to the office, Robby waited as they all filed in. “We had a lucky night,” he said. “You students should have gotten some sleep. Marlin and Brandy took phone calls but nothing too terrible. Now come on, let’s go round with Dr. Pittman.”
Bob pulled out a wrapper from his lab coat. He popped a chocolate in his mouth and handed Annabel one as they trailed the others.
“Thanks,” she said. “I hope we’re not still here in three hours and need another one.”
“I agree,” he said.
“When rounds split up, I must try to avoid Marlin.”
He raised his eyebrows. “He’ll do his best to sabotage me,” Annabel clarified.
The group stopped when Dr. Pittman joined them.
“Let’s see Mr. Simmons first,” Robby said and Marlin inched forward ready to speak.
“Dr. Tilson,” Robby said, “can you give us his status this morning?”
“Yes,” she said. “Mr. Simmons is post-op day one from an open inguinal hernia repair. He has no complaints, he is afebrile, and his bandage is clean and without drainage. He has been ambulating in his room and his labs are within normal limits this morning.”
“Good,” Robby said and looked around. “Just be aware that many hernias nowadays can also be done on an outpatient basis.”
“He did report discomfort to me this morning,” Marlin said.
“That’s to be expected during the first week after surgery,” Dr. Pittman said. “Now let’s go in.”
As they filed into Mr. Simmons’ room, Bob and Annabel exchanged glances. It appeared like Dr. Pittman wasn’t going to stall the morning.
“Mr. Simmons,” Robby said, “how is your appetite for those scrambled eggs?”
“Not bad, although I think it’s those egg beater things and I like fresh farm eggs myself.”
“I hear you. Dr. Tilson told us you are doing well this morning.” He looked at Marlin. “Does Dr. Mack concur?”
“I believe Mr. Simmons can be discharged,” Marlin said.
“Your dressing can be removed after two days,” Dr. Pittman said, “and having a shower won’t hurt the site. If there’s a lump there, don’t fret bec
ause that’s normal puffiness after surgery and the formation of scar tissue. But if anything looks or feels suspicious, come into the office.”
Mr. Simmons nodded while Robby moved the tray table and inched his gown to the side, checking the bandage. “Yes, we’ll see you in the office in two weeks but come in sooner if need be. You should also be able to go back to work then but I’ll give you my formal decision when I see you again.”
“Sounds good,” Mr. Simmons said. “I have my own landscaping business and can’t afford to be away from it too long.”
“Okay, then,” Robby said. “Dr. Mack will write your orders and just give staff a few short hours to get your paperwork ready.”
Annabel sighed with relief … Robby didn’t say anything to include her in the discharge.
After the team’s patients were all seen, Dr. Pittman wished the students a nice weekend. “But I expect good grades on your mid-term exam.”
“Dr. Mack and Dr. Wallace,” Robby said, “don’t go too far. We’ll talk about the next three days’ schedule.” He turned to the students. “Have a safe weekend,” he said.
Annabel had to pry her eyes off him and leave with the others. She memorized those milk-chocolate brown eyes in her mind and headed to pick up her things.
“We escaped,” Ginny said and immediately started texting her husband.
“See you all on Monday,” Da’wan said and left.
Annabel unplugged her cell phone from the wall and drank the cold remnants of her morning coffee. She dug in her bag looking for her car keys as Bob entered the office.
“Annabel,” he said, “they finished talking but I heard Dr. Mack say he had to see you first before discharging Mr. Simmons. Come on.”
They both hurried out the door. “He’ll be here in a second. Go into the bathroom and I’ll knock when the coast is clear.” She realized Dr. Mack would see her heading down the hallway if she left. Bob’s idea of hiding in the bathroom was the best option so she went in and locked the door.
Bob went back in the office as Dr. Mack appeared. “Where’s Annabel?” Marlin asked.
“Oh, she’s gone,” Bob said.