by Barbara Ebel
Annabel blushed and Wilbur smiled at the compliment.
“Glad to hear it,” the chief of the hospital medical staff said. “We older docs want to pass the wand to bright individuals for the future of medicine. You have both made a fine impression so your job market potential here for later on is off to a good start.”
-----
Annabel took out a surgery book and then hurled her overnight bag up on the top bunk while Bob sat on the other upper bed, his feet dangling off the side.
“It’s been an atypical and lively day so far,” she said.
“How would I know?” he asked. “Where have you been all day … so far, anyway?”
She saw how carefree he looked so she decided to climb up to her own bed as well. “First, I happened to catch crossfire in the hallway when Mr. Simmons’ brother showed up with a reporter and hurled accusations at Dr. Burk,” she said, planting her back against the wall. “Then I went to a meeting with Dr. Burk because some bigwig hierarchy thinks my suspicions linking the muscle relaxants to patients’ deaths have merit.”
“That’s crazy,” he said. “It’s been ODTAA the whole time with you.”
“Am I supposed to know what that means?”
“I guess not. One damn thing after another.”
A large noise sounded as if the building had been pounded by a giant. A moment later, Da’wan and Ginny came into the room.
“The thunder is nasty and it’s darker than night outside,” Da’wan said.
“I can think of better places to be right now,” Bob said.
“I don’t mind we’re staying overnight,” Da’wan said. “Hospitals are safe places; they even have back-up generators.”
“I’d rather be home with my daughter.” Ginny said. “Get ready, too, because Dr. Burk said patients are coming into the ER now because they’re afraid if their conditions worsen they won’t want to drive in later.”
“We’re in for a ride,” Annabel said. “Who’s up first?”
-----
Annabel studied from her bunk and watched as Bob and Ginny both went off to the ER. Her pager finally beeped at 10 p.m. and she dreaded going down there; her admission would be with Dr. Mack.
Her new patient was only twenty-five years old. Marlin had been in and out to see her behind the blue curtains but had not yet written a note on the chart; the ER doctor had scrawled his own notes, asking for the surgery department; and Robby had written sparse orders saying ‘Admit to Surgery’ and ‘NPO for surgery.’
Behind the drapes, Annabel found a trim, nervous young woman with large blue eyes and narrow shoulders.
“Josephine Waters?” Annabel asked.
“You can call me ‘Joe,’” she said.
“Okay. I’m Dr. Tilson, a medical student on the surgery team that will be taking care of you.”
“I’m finishing up my own studies, doing my master’s. So I don’t mind a student helping out.”
“Good. Thank you. Can you tell me why you’re here?”
“I’ve told your Dr. Burk and Dr. Mack, so I hate to repeat it. But I know the routine. Talking to a woman might be easier anyway.” She pushed down at the adhesive strip holding her IV.
“You see,” she said, “a week ago I had another laparoscopy so they could remove all the adhesions down there.”
“Down there?” Annabel asked.
“Yes, that covers it. My bowel, rectum, and ovaries. They did the surgery with a laser. So it appears I am suffering from the less than two-percent chance that I could develop an abnormal passage or postop fistula.”
Annabel frowned at her uncomfortable situation. “But why did you develop adhesions in the first place?”
The lady put her hand over her face and talked through her fingers. “For years and years, I have had severe endometriosis.”
“That’s not good,” Annabel said and paused. “Did Dr. Burk explain to you what he’s going to do?”
“Yes,” she said, removing her hand and looking straight at Annabel. “A colostomy! At my age. Can you believe the horror? The only good thing that’s going to get me through this is that it’s supposed to be temporary.”
Annabel hoped that would be the case. She finished up her H&P and, before she left, she patted Joe’s hand. “I’ll be in surgery with you and Dr. Burk does a very fine job. I’m sorry you have to go through all of this.”
She exited the little area and wrote up a thorough and succinct H&P, the best she’d done so far. Sitting around the chaos of the ER and hearing the outside storm, she realized that on more than one recent occasion she had wallowed in self-pity over her own troubles. This woman - only a year or two older than her - was about to wear a colostomy bag under her clothing, something even rare for a patient in their seventies.
Annabel was learning the same lesson again: Challenges come in degrees for different people and the important part was how to handle them. One person’s problem may be another person’s sunshine. Things could always be worse.
-----
Annabel hated standing next to Dr. Mack for Ms. Waters’ surgery. However, she liked being across from Robby where she could watch him focus on his work and appreciate his soft manner.
Wilbur was not on call so Annabel didn’t know the anesthesia resident. But she politely asked what the batch numbers were for the aminosteroids on her cart; after checking with her notepad, she felt secure the bad drugs were not available. She scrubbed and gowned, then looked up at the clock to see it was midnight.
“That was thoughtful of you, Dr. Tilson,” Robby said, pausing with a blade in his hand. “To check about the available muscle relaxants.”
“Why would you do that?” Marlin asked, looking sideways at Annabel.
“Because some of them have been recalled by the FDA,” Robby answered.
“Why wouldn’t an upper-level doctor on the team know about this?” Marlin asked. “In other words, why wasn’t I told?”
“Maybe if you’d thought about drugs causing our recent rash of morbidity and mortality,” Robby said, “you’d know about it.”
Marlin responded with silence as Robby began evaluating the patient’s large intestine.
“Dr. Tilson,” Marlin said, “do you even know what an ostomy is?”
“I’ve heard of a colostomy, which is what’s on Ms. Waters’ consent, but not an ostomy.”
“It’s the opening we’re making from the inside of an organ to the outside. So, in particular, a ‘colostomy’ is the opening from the large intestine to the abdominal wall so feces can bypass the anal canal.”
Robby eyed Marlin, surprised at his useful teaching. “And a stoma,” Robby said, “is the part of the ostomy we’re creating attached to the skin. Our patient here will have a stoma ‘bag.’”
Annabel hung her head. “Yes, and she’s aware of it. I feel so bad for her. I mean, she’s going to have a bag for feces underneath her clothing. At twenty-five years old, that’s going to kill her social life.”
“No different than the social life of some medical students I know,” Marlin sneered.
“Or an upper-level doctor on a surgical team who doesn’t get along with females,” Annabel quipped without mincing her words.
She thought Marlin would stab her with the scalpel he held and, as she peered at Robby, she could swear he wore a smile under his mask.
-----
In the PACU, Annabel groggily looked up at Joe’s vital signs which appeared normal and robust. She felt a hand pat her shoulder as she sat on the hard chair she’d pulled over.
“Dr. Tilson,” Robby said. “It’s almost 3 a.m. If you go back to the call room now, you may get a good two hours of sleep.”
“It’s just that I want to make sure she’s okay.”
Robby left his hand on her shoulder. “The PACU nurses are skilled in what they do and they also know to pay particular attention to our patients these days. Go to bed.”
“Yes, I suppose so. I have a doctor’s appointment tomorrow after call and I do
n’t want to be totally useless.”
“You will be if you don’t get going. Now get …”
Annabel left but the lightning outside the concourse windows leading to the call rooms made her more alert. Although the storm seemed to be subsiding along with the admissions they had been hit with on their watch, she wished she was going back to Robby’s room where she could nestle in his arms … and more. The thought of it made her shiver with desire and she admonished herself for even considering it.
-----
Annabel had puffy, tired eyes and wore a faint smile when she did her solo rounds a few hours later.
“I think we’re sending you home today,” she told Gustavo Blair. “The IV antibiotic you’ve been getting has been the perfect choice based on lab results and I think Dr. Mack will switch you to a take-home oral antibiotic.”
“The dressing changes are going to be a pain in the arse,” he scowled, “no pun intended. But that’s not your problem. You’ve been a peach.”
“Thanks. I try.”
“Keep your head up, honey. You’ll make a fine doctor someday.”
Annabel left, anxious to see Josephine Waters who was lying only slightly elevated in her bed, the sheets up to her chest.
“Good morning,” Annabel said, relieved to see that Joe had made it safely out of the PACU. “Are you okay?”
“I can’t make myself do it yet,” her patient answered, holding back tears.
“Do what?”
“Look under the covers at the awful colostomy bag.”
Annabel yanked a plastic chair over and sat. “I know it’s easy for me to say but, after living with it for a week or two and learning how to take care of it, it won’t seem that bad. Especially if you have the empathetic support of family and friends. Plus, the plan right now is that it’s temporary.”
Joe wiped her eyes and took a deep breath. “I hope you’re right.” She slightly raised the sheet and peered under for a few seconds. “It’s gross but at least it doesn’t have anything in it … so far.”
“Why don’t you name it?” Annabel said. “Either a good or a bad name, depending on how you see it.”
“Hmm…I’ll think about that.”
-----
With relief, team rounds went smoothly even though Dr. Pittman assumed the wall position twice. Their last patient to see was Ms. Waters and, as they left her room, Joe said, “Dr. Tilson, I’ve named it ‘Mickey.’”
Annabel smiled and looked back. “So you name it a ‘he,’” she said.
“For right now. But I’ll let you know if I change my mind.”
“What was that all about?” Robby asked.
“Just trying to make her feel better by having her assign a name to her colostomy bag.”
Robby laughed. “Good thinking,” he nodded. “Okay, then. Everyone off to finish any incomplete chart work and you students are out of here.” He left with Dr. Pittman, their heads already down in discussion.
“Annabel,” Marlin said, “since Ms. Waters has identified with you and your empathy, I’d like you to go back in there with the nurse who is showing her how to care for her poop bag. You need to learn that, too, but the patient will obviously do better if you’re there.”
The other students were out of sight around a corner as she stood with a dropped jaw. Dismayed what to do, she looked for Robby and found him at the nurse’s station as Dr. Pittman was leaving.
“Dr. Burk,” she said, “I was just given a directive by Dr. Mack to go into Ms. Waters’ room and sit in on colostomy bag teaching. I would be happy to, but I have an important doctor’s appointment. I’ll be lucky if I make it right now.”
“You mentioned your appointment yesterday,” he said. “I hope it turns out fine. Now get out of here.”
Chapter 24
Annabel worried as she sat waiting on the examination table for the dermatologist. When the spry woman came in, she gripped the end of the table and hung on her every word.
“As you might have suspected,” the dermatologist said, “this lesion on the back of your upper arm now needs to be removed with wide margins and needs to be staged. We’ll wait and see what the surgery results are. Hopefully, you won’t need further treatment.”
“I would like that,” Annabel said. “Since I’m on the wards and have a bulky schedule ahead of me, I don’t want to worry about other scary treatments. So I’d like to take this one step at a time.”
“Okay, then that’s the plan. Who do you want to do the surgery? For this, I recommend a general surgeon; they’ll have to check if lymph nodes are involved.”
Annabel considered the question.
“I can recommend someone if you’d like,” the dermatologist added.
Annabel gave her a small smile. “I think I know the right person. I’ll ask him.”
“Okay, let me know so I can send him your dermatology records. The sooner the better.”
-----
Since the storm the night before last, the humidity had dropped as well as the temperature. Annabel headed for the hospital’s lobby where she knew she’d be disappointed to leave the fresh air. She also knew, by going into this field, her time outdoors would be limited but there wasn’t anything she could do about it until she was out of training. Later on, if she felt strongly enough, she could always scale down too many hours by working part-time, going into a non-demanding specialty, or sharing a full-time position with another doctor. Like some other jobs in America, it was possible to sculpt a workweek to your own specifications.
Annabel squinted while looking ahead and then quickened her pace to catch up to Robby Burk.
“Dr. Burk,” she hollered.
Robby turned around and waited with a smile.
“Good morning,” she said. “You sure are early today.”
“Yes, I have been neglecting some paperwork sitting on my desk. Preliminary forms to fill out for my position next year. There’s a lot involved.”
“I bet, but I’m glad to see you already. I need to have a little general surgery and I was wondering if you would do it.”
“Really?” he said and stepped aside for her to go through the sliding doors first. “What kind of surgery?”
She hung her head down as if embarrassed and said, “It’s a malignant melanoma removal and staging from the back of my arm.”
For a moment, Robby’s leisurely gait turned into a two-step shuffle. “I’m sorry to hear that. I never like hearing about any students or residents falling ill or acquiring one of our patient’s problems. Certainly not you.”
He paused in front of the coffee bar. “Let me buy you a coffee.”
Annabel ordered and Robby said, “Make that two.” Then he focused on looking at her. “If you are sure you want your chief resident to be your surgeon, I would be honored. I am assuming you must go prone so you’ll probably need your trachea intubated and a general anesthetic. Although this should get taken care of right away, are you sure you’re up to it during the tail end of this rotation?”
“Yes, waiting would be worse for my state of mind. I want to get it over with.”
“Okay. We’ll get you on the schedule for Monday morning.”
“I’ll give the dermatologist your name; she’ll fax over my records and then she’ll want to talk to you.”
Robby paid and handed Annabel the mocha she’d ordered. “I’ll be waiting,” he said.
“Thank you,” Annabel said, “for both things.” She raised the coffee cup.
“My pleasure,” Robby said.
His small gesture did more to warm her heart than the beautiful weather outside.
-----
Upstairs, Annabel left a voicemail message at the dermatologist’s office with the needed information and then pulled out her index card with patients’ names she needed to see. Hoping he’d have good follow-up in the surgery clinic, she crossed off Gustavo Blair since he’d been discharged and pulled out Josephine Waters’ chart from the rack to check that her post-op labs and reports
looked good. She threw her empty cup in the wastebasket and, with everything in order, entered Joe’s room.
The curtains were already pulled open with sunlight streaming in as Joe walked gingerly across the ceramic tile to brush her teeth at the sink.
“Good morning,” Annabel said. “Wow, you’re managing baby steps.”
“Not easy,” she said shrugging her shoulders. “My insides feel like a boat bumped into me.”
“You deserve to feel that way. So tell me about the name Mickey.”
Joe managed a smile as she picked up her toothbrush. “It’s the name of an old boyfriend who was a p-i-t-a. Pain in the ass.”
“Ouch,” Annabel said. “I guess you’re getting the ultimate name-calling on him.”
“Yes. And it makes me feel good to do it.”
“Sometimes little therapy-like things can help people get through difficult times. Did you ever stick his picture in the freezer? That’s a little helpful gesture I heard mentioned by a therapist.”
“No, but naming my colostomy bag after him should suffice for putting twenty pictures of him in my ice maker.”
They both looked at each other and laughed, causing Joe to put her free hand on her belly because of the discomfort.
“Sorry,” Annabel said. “Did the nursing staff train you adequately yesterday on how to care for your stoma and bag?”
“Yes, but it took hours for my denial of its existence to go away.”
“I can understand that. I’d feel the same.”
-----
Robby spent some time on medical mail and then went over to the team’s office. As Brandy and the students gathered, he asked them to wait for Dr. Pittman at the nurse’s station. Dr. Mack had not arrived yet and the fax machine had also begun spitting out papers. He grabbed two sheets from the dermatologist’s office addressed to him and found the doctor’s information and complete pathology report on Annabel.