by Barbara Ebel
“What time is it?” she asked. “I must have dozed.”
“Time for late-day rounds. I have you covered with info which I can share on the way. Are you feeling better?”
She looked down at him. His concerned expression turned into a slight smile while he patted one of the ladder steps.
“Just a little bit, thanks to you.” She rubbed her eyes. “Yes, tell me what you think I need to know. If I don’t go on rounds, I may get into more trouble.”
“Here’s a list of any new lab or X-ray reports on your patients that you may get asked about. But, in a nutshell, nothing major has happened this afternoon and we’ve had no admissions. It appears the hospital is on diversion so I think we’ll have a lucky night. Maybe it’ll mean we can sleep and then get some good study time tomorrow before our test on Wednesday.”
They started walking out as Annabel skimmed over the paper he handed her. “Anything more about Mr. Simmons’ death?”
“We haven’t seen Robby. He left word that we’d round at 6 p.m. unless we heard otherwise.”
Annabel nodded. She gathered her strength and set her mind to being quiet and inconspicuous on rounds. The earlier day’s event, she believed, was still too fresh to bring up. If it was mentioned, the only thing that would come of it would be accusations over who did what, what could have been done, and what wasn’t done. And the stirrer of the pot would be Marlin Mack.
The team gathered in the office at around the same time and Robby only had one announcement.
“Dr. Pittman will be joining us early in the morning for rounds, so be ready for that. And I will try to get you all out expeditiously so you can prepare for Wednesday’s surgical exam over in the department’s conference room. We’ll have rounds and patient care first; the test is scheduled for 11 a.m.” With that, he walked out and everyone scrambled to keep up with him.
Perhaps they all felt on edge, Annabel thought, because no one muttered a word about Mr. Simmons. She also noticed that Robby seemed to avoid looking her way. Marlin Mack moaned like he was going to complain about one of her patient updates, but, luckily, he voiced no complaint. Da’wan rattled off a differential diagnosis of blood in urine, Ginny managed to peek at her iPhone, and Bob sneaked Annabel a chocolate espresso bean. It was Brandy Wallace who spoke the most and Annabel wondered if she even knew what was going on behind the scenes.
-----
Except for phone calls from the floor, Robby’s entire team had a peaceful night. Two ambulance runs were diverted to another hospital since they were full so the students had the biggest break. In the morning, Dr. Pittman joined them and never backed up against the wall. If there was a backlash about Mr. Simmons’ death, the attending and chief resident weren’t talking about it. It was as if it hadn’t happened, at least in front of the students.
Annabel made sure she avoided Dr. Mack as she and Bob left the office nonchalantly, then hurried to the call room to retrieve their things and leave. In the parking lot, Bob turned to her.
“If you need any company today or want to study together any time, just give me a ring.” He scribbled his home number on a piece of note paper and handed it to her.
“Thanks, Bob. I’ll call you if I think of any surgery questions that I don’t have answers for.”
As Annabel began walking to her car, she turned and shielded her eyes from the sun. “Bob,” she said loudly, “thanks.”
“What for?”
“For everything,” she said and waved good-bye.
-----
On the drive home, Annabel realized she had a tremendous amount of studying to do. The test the next day compromised forty percent of their written grade; the final exam would be sixty percent. The two written exams’ final score was then eighty percent of their surgery rotation’s grade. Twenty percent would be the clinical score given by the chief resident and attending doctor. The way things were going right now, she figured she was already failing the clinical score. All the more reason to try and ace tomorrow’s test.
She parked her SUV across the street from her place, gathered her things from the back, and headed upstairs. Inside, she dumped everything. The air was a bit musty as she had set the air conditioning to a warmer setting while she had been on call. Annabel lowered it and walked back to the counter where the phone blinked with a message. She pressed the ‘play’ button:
“Ms. Tilson, this is Susan from Midstate Dermatology. Please give me a call.”
Her biopsy results must be back, she thought. No big deal. She’d better respond now before becoming engrossed in her surgery book.
She called the office number. “This is Annabel Tilson returning Susan’s call.”
The woman got on quickly. “Ms. Tilson, we have your path reports back. That lesion biopsied from behind your neck is a benign actinic keratosis.”
Annabel picked up a banana from the fruit bowl with her left hand. She figured that and hadn’t even given the biopsy another thought. It had been a waste of her time.
After pausing, Susan continued. “However, the spot on the back of your arm is not benign. It’s a malignant melanoma.”
Chapter 17
Cancer. That word pulsated through her head like a firecracker exploding between her temples. At twenty-three years old, she had skin cancer. The woman on the other end of the phone, whose name she could not now recall, spoke some more but whatever she said passed by Annabel like a feather in a breeze. When she hung up, she had an appointment to see the doctor again on another post-call day.
Annabel remained motionless at the counter, her heart thudding in her chest. She knew she had just been dealt the worst diagnosis of all skin cancers. Why had something so insidious turned out to be a treacherous surprise? As long as she could remember, her and her family had never been sun worshipers to warrant damage to their skin. She’d have to check her medical books to learn more but thinking about it at the moment practically sickened her. Looking up symptoms and signs, and medical diseases and diagnoses, was something she did for her patients, not for herself. This was a total shock.
She went into the big room and sat on her comfortable chair. This may change everything. Now, more than likely, she was looking at a shortened life span, perhaps even death in the near future. Who would have thought? She never dwelled on her own longevity because she assumed it would be into her 80s or 90s. Why would she have thought otherwise?
Right now, attending medical school seemed like a moot point. Why put herself through it when she may not graduate from school and residency and have many years to practice? What would be the use? As it was, she suffered day-in and day-out with one incident after the other. Why bother with the likes of Dr. Mack anymore, or fall practically in love with someone who didn’t see her in that way, or put up with the repercussions of patients dying when she had nothing to do with it? As a matter of fact, she was seeing to their well-being and getting in trouble for it.
Annabel contemplated calling her parents but the more she thought about it, the more she oscillated about telling them. They had already picked her up out of the doldrums on her recent visit so maybe she should wait until she had more information from the doctor. Her parents were the best and perhaps she should spare them right now; surely they would worry as much as she if she told them. God knows, her father usually had more troubles professionally and personally than anyone she’d ever known.
Geez, she thought, the apple didn’t fall far from the tree.
-----
Annabel and her student colleagues were all dismissed by Robby at the same time Wednesday morning to go over to the department to take their test. The main concern on her mind was her diagnosis of malignant melanoma. Although she had tried to study for the exam, it had been useless. Her problems took precedence and the more she studied, the more the information pushed through her like passing through a sieve. Her unusual quietness was observed by everyone as well but they assumed it was because of the catastrophic events on the surgery rotation.
In
the small lecture room, there were other students rotating through surgery like themselves. Annabel slipped into a desk chair alongside the aisle and Bob sat behind her. One of the clinically-retired surgeons who worked in the department office stood at the front desk to proctor them.
“You all have fifty minutes,” he said after handing out the tests and glancing at the clock on the wall.
Annabel scanned the three sheets containing twenty-five questions followed by a question for extra credit. She then set the top page down and picked up her pencil. The first question read:
The sign of inspiratory arrest (Murphy’s sign) on physical exam may be seen in the presence of:
Acute appendicitis
Acute cholecystitis
Inguinal hernia pain
None of the above
She sighed with relief as they had emphatically learned that with her patient encounters so she chose b. acute cholecystitis. But questions didn’t stay that easy and she struggled halfway down:
The iliopsoas test may detect:
A testicular tumor
Indirect inguinal hernia
Intra-abdominal inflammation
All of the above
Without a clue, Annabel picked ‘b’, and as she went on, she began to panic. The passing score was seventy-five percent and when she finished in forty minutes, she felt sure that she hadn’t known twenty-five percent or more of the questions. She turned page three over where there was the extra-credit question which made her smile for the first time in about two days.
The questions must have come from Robby or at least he had not been kidding when he told them that all doctors and personnel knew the well-known phrases that went along with working in the OR.
In any case, whoever had written in the extra credit question was being generous. It was worth five points and it read:
There are ten tried-and-true OR sayings. Quote up to five of them for a single point each. Five extra points if you recite five correctly!
Annabel looked at the clock and saw that she had a few minutes to think about her answer. It was an amusing way to let them pull up their grade and she was grateful for the opportunity. She had probably failed no matter what but she needed to rack her brain and remember what she’d heard. Thinking back, Annabel didn’t recall hearing as many as ten but quite a few had been pointed out by Robby and even Marlin.
She figured Marlin didn’t know this would be on the test because it wasn’t in his nature to be helpful: One day he distinctly said to her, “I’ll be there in ten minutes,” and then told her it was an OR idiom.
When she had been drooling over Robby during the ruptured appendix case, he had said to the tech, “Give me what I want, not what I ask for.” He had made a point about saying that.
In the next few minutes, she came up with four more and wrote them down: “See one, do one, teach one;” “It’s on backorder;” “This will only take an hour;” and “Blame it on anesthesia.” She grinned because she’d come up with six instead of five and was sure she had not heard any more. It made her realize she had paid more attention during her time on the wards and in the OR than she thought.
With the fifty minutes up, Annabel laid her test on the front table and despondency set in as she walked out. Without a doubt, she had failed the test and too many situations were not in her favor to continue in medical school … sometimes a person needed to heed what the universe was telling them.
-----
Surgery clinic that afternoon was a drag. Each of the students saw mostly postop patients with the residents closely supervising. Annabel first read over her third patient’s chart, a young woman who had a cancerous small lump removed from her left breast. No lymph nodes had been involved and she was already being followed by a specialist; her postop visit was only to check the surgical site.
As she finished looking over her records, Annabel wondered if this woman was better off than her with the diagnosis and treatment she had received. It was difficult not knowing what was in store for her with the melanoma and also nerve wracking waiting for the next appointment.
Annabel walked into the room and gave the woman a warm smile. The patient wore a paper gown to her waist which opened in the front. Attractive and attentive, she paid close attention to Annabel and occasionally glanced at the nurse in the room.
“Ms. Carr, it’s nice to meet you. I am one of the students, Dr. Tilson. I read through your history and operative report. Have there been any problems with the surgical area that you are aware of?”
“No. I don’t think so.”
Annabel first listened to her heart and lungs and then they took off the surgical dressing.
“It does look fine,” Annabel said. “But of course, we’ll make sure with the resident on duty. If you will sit tight, he’ll be here in a moment.”
Annabel left the room and approached Marlin in the clinic’s office where he was alone. She would have preferred presenting to Dr. Wallace but she was in a patient’s room so she had no choice but to go to him.
“My next patient is Ms. Carr,” she said, “a twenty-six-year-old status-post removal of a noninvasive breast cancer seven days ago. She has no complaints and is off any pain medication. Already she has been seen by the cancer center. On physical exam, the area looks slightly red, dry without any drainage, and not swollen. It is not warm to the touch.”
Annabel stopped, waiting for a response or acknowledgement. He finally gave her eye contact. “A third grader can tell me that. It’s up to you to use your brain, if you have one, and tell me what your assessment and plan is.”
The plan that came to her mind immediately was that she wanted to get the hell away. Walk out of the clinic and the surgery rotation for good. But her rising anger told her she had nothing to lose to confront him.
“Just like you should not have said that to me and no one else heard it, I’ll tell you that your skull carries around two things: foul air and a wretched, ratty mentality.”
Marlin’s eyes bulged with disbelief. “What did you say?”
“You heard me.”
Marlin stood up. “You better hope I didn’t.”
“And because you can’t figure it out,” she said, “my assessment is that Ms. Carr is doing well and the plan would be to have one more surgical site check-up and then she can be discharged from the clinic.”
Bob walked down the hallway and straight into the room with a bounce to his step. “I hate to interrupt but I just saw my last patient with Dr. Wallace. She just left and asked me to remind you both that we are all due at M&M soon, especially since Dr. Burk is presenting today.” He finished and stared at them: reddened cheeks and bulging neck veins made him realize he’d interrupted a nasty altercation.
Dr. Mack pushed past Bob. “I’ll see this last patient myself. Get over to M&M, both of you.”
“Let me know later, Dr. Mack,” Annabel said, “if my assessment and plan were factual and correct.”
When he left, Bob stared at Annabel.
“That was bad,” she said.
“I could tell but don’t let him bother you. Let’s go over to conference and hear Robby talk about our complicated appendix patient who died.”
“I’ll go because you’re going. However, there’s no point. I’m sure I failed the surgery test today.”
“No you didn’t. But even if you did, it’s only a portion of our grade. We’ve all made it through tests where we thought the worst.”
As they walked down the stairs to the bigger lecture hall, she thought about what he’d said. She hoped her own personal diagnosis would be surmountable more than her medical rotation test results.
-----
When they arrived at the lecture hall, Robby had already begun; Annabel grabbed the aisle seat right inside the door. Her chief resident rattled off Dolores Vega’s history and physical for the morbidity and mortality conference and began discussing at length her ruptured appendix postop complications. The case served not only to review those types of medic
al emergencies, but to look more closely at any bad turn that could have been avoided.
By now, Annabel knew Dolores Vega’s case by heart and she believed it would serve as a template to always consider that diagnosis under similar circumstances in the future. For a little while, she watched in awe of Robby’s professionalism not to mention his good looks. Whoever his fiancée was, she was a lucky woman.
Annabel pulled her cell phone out of her lab coat pocket to make sure the sound was muted. The chair next to her had remained empty and for that she was glad. She held the phone on her lap and discreetly scrolled to Findar. Finishing the surgery rotation was on the line, as well as her health; she needed to do something for herself, like another sexual fling. There wasn’t anything else she could think of that could give her the thrill, pleasure, or gratification. Some people do drugs or alcohol, but she liked her idea so much better. No hangover or build-up of an opioid or drug tolerance or accidental overdose.
Recently, she had been contacted by three males who had shown interest in her profile but she had had little interaction with them due to clinical duties draining her time. Perhaps she could get something going with one of them for tonight. To hell with everything else. She pulled up the one named Mark with a profile picture worthy of being a computer screen background picture. The region was his ‘territory’ as he was a salesman for medical appliances.
She contemplated her message and decided to make it blunt. How about finally meeting tonight?
After a few minutes, she needed to use the restroom so, while Robby was turned to the power-point screen, she quietly sneaked out. She went to the bathroom down the hall and, when she emerged, she heard another conference going on. Exploring what it could be, she turned the corner and stepped inside an open door to the M&M lecture of the anesthesia department. Interestingly enough, their speaker was also presenting Dolores Vega as their case of the month. Annabel huddled to the side, hidden in the corner against the wall.