by Barbara Ebel
“That’s not normal,” Danny said. “The team must have just stumbled upon a cluster of extremely sick patients.”
“I don’t know, Dad. My first patient had her gallbladder removed and was found dead the next morning. Then we had this poor, tragic burn patient who died and then a patient came in with a ruptured appendix, only twenty-five years old. And she died.”
“That sounds morbid,” Nancy said.
“I’m sorry to hear that,” Danny said. “That is unusual for such a short time span. Maybe it’s just all a coincidence and those patients, except for the cholecystectomy, may have been wavering on death’s door.”
“You never know when someone surprises you and expires,” Casey said. “My partner, Toni, and I had a simple run early this afternoon. All we were doing was transporting a patient who had surgery this morning to the heart institute across town and she was dead when we got there.”
“Really?” Annabel said. “You must have patients die more than I realized.”
“Usually the deaths we deal with are when we’re at a major road accident. We see and transport patients with severed body parts, things like that, which does not make for good dinner talk. But this woman’s death was totally unexpected.”
“What surgery did the patient have this morning?” Danny asked.
“Just a small follow-up orthopedic procedure – to take pins out of her tibia. Under general anesthesia, the patient had a changed heart rhythm. No ischemia or anything but, instead of waiting, they decided to send her to a cardiologist at the heart hospital. Toni was driving and I was in the back. Everything was fine until the patient went dead still as we arrived. We resuscitated like pros but to no avail.”
“Wait, what did you say?” Annabel asked.
“We resuscitated like pros. She and I are specialists at that,” he added with a smile.
“No, before that.”
“The patient was fine up to when she was dead still.”
Annabel scrunched her forehead. “That’s what I thought you said.”
Chapter 13
Annabel put her fork down. She’d heard ‘dead still’ before; Robby had said it when they were in the ICU and found Dolores Vega. Funny that Casey used the same term, she thought.
“Any clues as to what she died from?” Annabel asked.
“No,” Casey said. We filled out our paramedic reports, the hospital took over, and we left. As far as Toni and I know, the ER docs were clueless, too. Maybe she had a pulmonary embolus from a leg clot after her surgery early this morning.”
“That’s a strong possibility,” Danny said.
“I’ll have to read up on that,” Annabel said, “because that’s what my senior docs said about one of our patients.”
“You’d be prepared,” Sara said and then turned to Casey. “But how old was this patient?”
“Thirty-nine.”
They exchanged glances and shook their heads.
“Remind me not to have pins put in my tibia,” Sara said as the twins began fidgeting in their seats.
“Looks like you two are doing a fine job with your dinner,” Mary said to the youngsters.
“Can I get down and play?” Melissa asked.
“Yes, both of you can.” Mary took their plates away and Casey wiped their hands; they went into the big room near Dakota and their toy blocks.
“They sure are good kids,” Annabel said, watching them thump on the floor. A thought struck her though and she cringed. She wouldn’t want her cousins growing up and doing what she’d recently done … go to bed with a stranger. But how could she have resisted the easiness of it due to a modern social app? What was in store for Melissa and Tommy when they got to be her age?
“Are you going to see David while you’re here?” Sara asked, breaking into her thoughts. Her old boyfriend had suffered a coma after a basketball tragedy and had been under her father’s care. They were still close friends.
“I’m going to see him a little bit tomorrow evening. And I hope you don’t mind if I intermittently study tomorrow.”
“We’re expecting you to,” Danny said. “And if there’s anything we can do …”
-----
Saturday evening, Annabel opened the back of her SUV and let Dakota jump down. She clasped a leash onto his collar and scanned around the park benches for her friend.
“Hey, girl. Good to see you.” David approached her from behind and they both gave each other a hug. His shoulders were not as broad and strong as when she had dated him but he still had the most perfect dimple in his chin. They hugged one more time.
“It sure is nice to see you, too,” she said.
“And how could I forget you?” David crouched down and ruffled Dakota’s ears. The dog’s amber eyes showed recognition and warmth and he leaned his back end into David for an ample massage.
David stood up. “He’s getting gray.”
“That’s what I told my dad.”
“So how are your folks?”
“Good. They say hello.”
David nodded. “Want to walk or sit?” he asked. A walking trail circled around a grassy recreational area and park benches dotted the path.
“Let’s walk. So how is work?”
David shrugged his shoulders. He had graduated from college a year after Annabel due to his medical setback. Now he worked in a sporting goods store as an assistant manager; he had been too burned out to continue with graduate school.
“It’s a job,” he said. “What about you? You’ve been freed from the classroom. Surgery must be so different and exciting. What’s it like?”
They strolled at a medium pace with Dakota between Annabel and the grass. Youngsters played soccer and walkers and runners passed them in both directions.
“It’s not so great. I’ve had nothing but thoughts of quitting.”
“You? No way. You’ve wanted this for years.”
“I know. I guess the grass is always greener and you never know what you’re getting yourself into. But don’t worry, my mother and father have helped me feel less depressed about it.”
“Good. At least give it more time. I mean you just started the wards.”
“You’re right, I know.”
“Maybe it’s just surgery you don’t like and you’ll find your passion with another specialty.”
“Maybe even anesthesia. There’s a lot going on at the head of the table.”
“Will you rotate with them?”
“That’s the thing. It’s not a regular rotation like internal medicine, or surgery, or pediatrics. I guess I could arrange something as an elective during the weeks that are free for us to be creative and do what we want.”
David nodded and they stopped a moment for Dakota to pee. “You should look into it.”
“I think I will.”
“So are you dating anyone?”
“Besides not having any time, I haven’t really come across any dating material. What about you?”
“I’m seeing someone but it’s not serious and it hasn’t been that long.”
“I’m glad you’re getting out anyway,” she said. “You’re doing better than me.” They completed one loop, walked one more time around, and then stopped by Annabel’s car. “Okay, Dakota, time to go home.” David opened the back door and the Chesapeake jumped up.
Annabel and David embraced again. “Don’t do anything I wouldn’t do,” he said. “See you next time.”
“Thanks, David. You’re my dearest friend.”
She drove away from the park and wished she had such a good friend on her surgery rotation.
-----
Annabel glanced in the rearview mirror on Sunday morning at her parents, Nancy, her aunt and uncle, the twins and Dakota. They had cooked breakfast earlier and now they were sending her off as only her family members could; the longing to see them again already nagged at her. She always hated good-byes yet she knew it was more difficult for them. Her mom always said that when she left, it put a big void in her heart an
d, over weeks, it would only fill halfway. They all had voiced similar remarks except for her sister. However, their relationship was better than it appeared on the surface and, in some ways, Nancy looked up to her just like she had done with her older sister who had passed away.
As Annabel was about to lose sight of them over the hill, her last view was of Dakota who had trotted out to the street and watched as the car disappeared. Although he still maintained his spirit and intelligence, it made her sad to think that in a few years he could be gone; imagining life at the house without Dakota was intolerable.
North of Nashville and depending on traffic, she clicked on cruise control and thought about the next day. Back on call. She had to maintain the positive attitude and confidence she’d gained over the weekend. Plus, she had stuck to her studies and, with a little more cramming, she should be ready for this week’s exam. And if anything happens with Marlin Mack, she thought, she must deal with him emphatically or by seeking help from Robby Burk. And the patient deaths: She bet that was the new students’ bad luck and they probably wouldn’t have another patient expire for the remainder of the rotation.
She passed the Corvette museum on the left and wondered if she’d ever finish medical school and residency and be able to splurge on a sleek car like one of those.
-----
Since she made good time into the hospital on Monday morning, Annabel treated herself to a mocha coffee in the lobby. As she stirred the chocolate syrup with a wooden stick, she felt a pat on her back.
“Good morning,” Bob said. “Did you have a nice weekend?”
“For sure. I needed it.”
“Me, too. But it would have been better if we had studied together.”
“You did do other things besides study. I know you did.”
“Yes. I went drinking with Marlin Mack.”
“Seriously?”
He shook his head and laughed. “No.”
She picked up her overnight bag with one hand but Bob slipped it out of her grasp. “You concentrate on your coffee and I’ll carry this. Chivalry is not dead.”
They walked to the elevator in silence. Her group of fellow students was a varied mix of personalities, she thought, with Bob being the most uplifting and comical of all. She pressed the button to go up and gave him a smile.
“Good morning,” Annabel said to Da’wan upstairs. She finished her coffee and Bob stashed their bags.
Da’wan shot back a response as Ginny came in, head bent while she texted.
“Who’s up for the first admission since we’re on call?” Da’wan asked.
“I think it’s Ginny,” Bob said.
“Unfortunately,” she growled. “I had a love-hate relationship coming in here this morning.”
“You’re probably not alone,” Annabel said.
After the students split up to see any of their patients still hospitalized after the long weekend, they met again in the office. Brandy Wallace sat with a chart and looked up. “Anyone see Dr. Mack yet?”
Marlin hurried in and stopped short. “Now you’ve seen me. I got detained downstairs helping a patient.” He tossed his head as if they should have known that.
“So you students are back for more,” Robby said, strolling in. “Da’wan rounded with us on Saturday morning but, other than that, you four should have had plenty of time to study and a little time for fun.” He leaned on the edge of the desk, crossed his legs, and pushed up his rolled shirtsleeves a bit more.
Annabel had resisted thinking about him the last few days but now - watching the way he moved, his mild manner, his preppy style and good looks – it only reinforced her attraction towards him. No matter what, she couldn’t make him go away.
“We’re on call,” Robby continued. “Let’s get right to work. Come on.” He pushed off the desk and headed out. They all looked at each other quickly. Their chief resident hadn’t had the weekend off but he was zippier than they were.
In the hallway, Bob stepped alongside Annabel and they all walked in silence. Robby stopped at the nurse’s desk.
“Let’s see Mrs. Watkins first,” Robby said. “Dr. Mack, she is your patient as well as Dr. Tilson’s. Maybe you can give us a short synopsis from her admission the end of last week and update her status from over the weekend.”
“Sure,” Marlin said. Like his lab coat, he looked like he’d just stumbled out of bed and hadn’t combed his hair or shaved the stubble on his chin. Today his mustache looked more kempt than the rest of him.
“Mrs. Watkins is a fifty-two-year-old Caucasian with a history of hypertension and COPD who came in for a lump on her thyroid gland and symptoms of hoarseness. Following a workup and with help from the endocrine service, she was found to have thyroid cancer. At our request, the pulmonary service has also been following her because of her symptomatic chronic obstructive pulmonary disease. They were giving her breathing treatments and evaluating her pulmonary function tests so we could do her surgery today and take out her thyroid gland.”
Marlin looked at Annabel. “Since Dr. Tilson did see her patients this morning like she’s supposed to, I’ll let her finish our patient’s status since yesterday.”
At first, the request took Annabel by surprise. But before she opened her mouth, she realized his motive. Marlin had only arrived before they started joint team rounds and hadn’t seen Mrs. Watkins or the other folks yet under his care. He was, in essence, clueless about his patients since yesterday morning. By having her give an update, she’d be covering for him. Now was her chance to get back at him, she thought.
Robby nodded his approval and they all looked at Annabel.
She cleared her throat and began. “The pulmonologist reported in the chart late yesterday afternoon that Mrs. Watkins gave a good effort for the PFTs, which I understood to be an important part of the testing.”
“That is true,” Robby said. “It gives more validation to the results.”
“However, not seeing results of spirometry or PFTs before, reading the results and figuring them out left me baffled. The pulmonologist wrote his results with more of a senior doctor in mind for reading them. After all, the outcome tells us if Mrs. Watkins is going to surgery today and I am still confused whether he means to proceed with her or to delay.” She felt good about the coy way she pulled it off … so far.
“Dr. Tilson,” Marlin said with a concerned look on his face, “certainly you know the tone of the consult. Mrs. Watkins needed her lungs to be tuned up. Since admission, has that happened or is she worse than before?”
“Dr. Mack,” she said, “this is my first clinical rotation. I am sure that after I rotate through internal medicine, I will have a better grip on chronic obstructive pulmonary disease and pulmonary function tests.”
Marlin’s jaw dropped and he tugged at his mustache while Robby picked up the patient’s chart off the counter.
“Dr. Tilson has a point,” Robby said. “So please proceed, Dr. Mack. Does the pulmonary service recommend that she go to surgery today or wait?”
Marlin stared blankly for a moment. “Here, I’ll take the chart,” he said extending his hand. “Let me refresh my memory.”
Robby furrowed his eyebrows and held onto the patient’s records. “I’ll refresh it for you.” He went behind the desk and read the pulmonologist’s report. Clearly, the pulmonary service had recommended delaying surgery. He realized Annabel had read the note due to the pulmonologist’s remark about the patient’s effort and she had seen her patient. It appeared she knew that Dr. Mack hadn’t and she had just ensnarled him in a web. What that was about, he didn’t know. But one thing was for certain: his resident had not seen their patient this morning and acted like he had. That was delinquent, dishonest, and negligent behavior from a doctor in charge of patient care.
Robby got up and waved the group to follow him to Mrs. Watkins room. With Dr. Mack to his right, he turned his head toward the rest of the group, especially Annabel. “We’re not taking her to surgery today,” he said. “She need
s more respiratory treatments.”
As they kept going, Annabel overheard Robby’s remark to Marlin. “You’re lucky Dr. Pittman didn’t join us for rounds this morning.”
Chapter 14
As they walked into Mrs. Watkins room, the respiratory therapist smiled as she left. “Dr. Burk, I just gave her a breathing treatment so she’s tuned up for at least a little while,” she said.
“Thanks,” Robby acknowledged.
The patient sat in a chair next to her bed, hooked to the wall oxygen with a nasal cannula in her nostrils. Her gown was loosely tied behind her neck and she tapped the armrest with her fingers. “I was waiting for you, Dr. Burk. This young lady couldn’t tell me if I was going to surgery today and no one else has informed me. They have me fasting just in case.”
Robby sat down on the edge of her bed and put his hand on hers for a moment. “It’s okay. Pulmonary still wants your lungs to be better so we’ll wait another day or two. In the meantime, I’ll tell them to feed you. We’re not that mean around here.” He gave her a warm smile.
“Thanks. And I’m the first one to admit it. It’s those damn cigarettes I’ve been smoking all these years. They’ve made me a crumpled old lady with medical problems way before my time.” She exaggerated and elongated the word ‘way,’ and Robby nodded.
“They do that to people, but you’re far from crumpled or being old.”
Her face lit up and she blushed as Robby’s pager beeped; he took a look and silenced it.
“I need to run to the ER,” he said to her. “Dr. Mack will do a better job next time of keeping you informed.”
As all the white coats left, Marlin gripped his fist.
Bob smiled at Annabel. “Here,” he whispered, handing her an espresso bean. “It’s a good morning so far.”
Grinning back at him, she slipped it into her pocket.
-----
By late morning, the students had caught up with charting and clinical errands. Their team had a light surgery schedule for the afternoon so they made a plan to go stash their things in the call room and then go eat.