by Melissa Yi
"That's part of it," agreed Dr. Dupuis. "Brace yourself. But in the meantime, let's work on the patients here and now." He pointed at the computer.
Between Lori Goody and Alyssa Taylor, plus the evening rush, SARKET kindly showed us that our wait time had ballooned up to 14 hours. Some patients would leave when it got too late, or they'd waited too long, but not most of them. It was like the world's worst Disneyworld.
"I need to transfer a psych patient. Stat! She attacked one of our doctors!" Dr. Callendar bellowed.
I shook my head. He loved to throw his weight around. He hadn't bothered until Dr. Dupuis leaned on him and he was raring to go home, but at least now he was doing his job.
"You can lock her up tonight, for all I care," Dr. Callendar shouted. "As long as you get her out of here!"
I moved around him to grab my pen, which I'd forgotten on the other end of the nursing station.
"Yes, it was a resident doctor. You can talk to her directly if you want. The patient tried to strangle her with her own stethoscope and then stab her with a scalpel!"
I winced as I tiptoed to room 12, which was perilously close to room 14.
"We take the health of our staff very seriously. No one deserves to be attacked in her workplace," intoned Dr. Callendar.
Ye gads. What a hypocrite. Next he'd post on Instagram under #metoo.
I checked my phone for the time: 00:25. No messages from Tucker or anyone else.
Alyssa's Taylor's results should be brewing. After I saw a few patients, I'd track down her boyfriend and figure out exactly who had tried to break her face.
7
Bed 12's clipboard chart gave his name, his health card number, birth date, and triage diagnosis, BLOODY DIARRHEA.
I'd forgotten to bring a workstation on wheels, or WOW, so I didn't have the guy's triage history or vital signs. I'd have to wing it and bring my computer next time. WOW's didn't fit into the ambulatory rooms, but the ambulance side's curtains would expand to accommodate them.
"Are you the doctor?" The 23-year-old white guy sat on the edge of his bed, texting on his phone. He didn't look too agonized.
Neither did his buddy, who turned off his own phone and smiled at me. Even sitting down, I could tell that he was taller, broader, and better-looking than the patient, and he knew it.
I flashed them both a generic smile. "Yes, I'm the resident doctor, Dr. Sze. You can pronounce it like the letter C."
"I need the police here now!" said Dr. Callendar.
"Fuck the police!" Lori Goody answered.
I started asking Bed 12 his history in as loud a voice as I could manage, trying to drown out both of them. Of course it was abdominal pain with bloody diarrhea, and the patient had zero interest in a rectal exam.
"What?" he said.
"You know. A finger in the bum to check for bloody stool."
The patient paled and glanced at his friend.
"Bloody poo," I explained. My job is so glamourous.
"You can't do that!" he yelped.
I nodded solemnly. Not only can I do that, but I do it often, although perhaps not well.
"I don't do stuff like that!"
"You don't have to do anything. Either lie on the bed on your side with your knees bent, or drop your pants and underwear and lean over the bed." I demonstrated how to do the latter, legs apart and butt in the air, although less enthusiastically than if he hadn't been a guy a few years younger than me. How embarrassin'.
"I can't," he protested.
His friend guffawed. "It's part of the deal, buddy. That's why you came here, right? To get checked out." He winked at me.
"No way!"
"Oh, man, I'm so glad this is you and not me." His friend literally bent in half, he was laughing so hard.
"I can't. Seriously, I can't. Can't you write that I refused or something?"
"I guess you could give stool specimens," I said. "But if you're actively bleeding right now—"
"I'm not! It was yesterday!"
"Then why did you come in today?" I eyeballed his friend. They were talking like straight guys, but I couldn't assume anything. "Was it after some sexual activity, using toys or body parts?" My neck flushed. That was as tactful as I could get.
"No. Hell, no. Oh, my God. I want to die. Seriously. Just kill me now."
I changed the subject. "Is there a history of Crohn's or Ulcerative Colitis in your family?"
"What's that?"
"It's Inflammatory Bowel Disease."
"Yeah, I think my aunt has that."
I couldn't get too excited yet. "Not Irritable Bowel Syndrome, or IBS. It has to be inflammatory, which is Crohn's Disease or Ulcerative Colitis."
"Um, yeah, I think so. I'm not sure. I'll text my mom."
"You do that." A second degree relative wasn't the be all and end all. It might increase the likelihood that it wasn't only a garden variety infectious diarrhea, although I'd cover those bases with stool cultures.
I gave him a quick physicial exam, sans rectal exam ("Please don't do that. Seriously. I'd rather die"), and headed back to the nursing station to start my interminable charting, reminding myself to type, "Rectal exam refused."
SARKET took a long time to load even simple things like our basic order sets. While its wheels spun, I checked my phone.
Nothing from Tucker.
Ryan's mom, Mrs. Wu, hadn't called back or texted. Her first name was Cheryl, but I'd never called her that, and she'd never invited me to. Ryan and I started dating pre-med, when I wasn't used to calling adults by their first names. Mrs. Wu had suited both of us fine.
Then I remembered my Finding Friends app. After Tucker introduced me to it, Ryan had reluctantly joined, but deleted himself from my Finding Friends list after he blocked my phone numbers, Skype, FaceTime, Facebook, Twitter (I don't even really use Twitter!), Snapchat, Whatsapp, Line, and probably other stuff I didn't even know because Ryan was the engineer and much more techno-adept than me.
I brought up Finding Friends anyway. All I needed was his last location. At least that would show me something.
Tucker was driving west, toward Ottawa.
No Ryan Wu showed up anywhere. Of course.
Ryan's best friend was this guy named Terry Goh. I liked him, but they always talked about things I don't care about, like running, video games, or worst of all, church.
I took a deep breath and texted Terry.
Hey. You seen Ryan lately? His mom's looking for him.
There. That didn't sound too ex-girlfriendy, although it was awfully late to be bugging him.
Screw that. I was awake and hunting for Ryan.
After a minute, I copied and pasted that message to every one of Ryan's friends in my contacts, which was a whopping six of them, but oh, well. He mostly made friends at church, so we didn't have many in common, and when Ryan and I wanted to be alone, we wanted to be Alone, if you know what I mean.
Still, I felt a pang. It made it easier for us to split up that we didn't have friends in common. That was less traumatic, so yay? Except that I still wanted to talk about him, still wanted to remember him, still regretted not having him in my life every day.
After a pause, I decided to call Ryan myself. Even if it was futile and I was a jerk calling after midnight.
It rang straight through to voice mail. Not even half a ring. He'd blocked me.
I texted him.
Where are you? Your mom's worried.
After a pause, I typed,
I love you, Ryan.
You're never supposed to say stuff like that. It makes it harder for your ex to separate from you. You're supposed to rip the other person away, like a Band Aid, because repeated reminders are too cruel.
But he was missing. What if something happened to him? What if it was one of the murderers I'd put away? They could ask a friend to whack him, or hire a hitman. Chances were, they hadn't gotten the memo that I'd switched boyfriends and could easily decide it was a good idea to chomp on Ryan.
; That was crazy talk.
On the other hand, I'd met too many psychopaths to dismiss the possibility.
I finished my orders and called the Ottawa Police.
8
The Ottawa Police number was automated voice mail hell. I could see why they'd invented 911, because otherwise you'd grow old and die before you talked to a human being.
On the upside, I didn't have to feel guilty about calling a machine in the wee hours of the morning.
On the downside, zero people would answer me or take me seriously. I did manage to leave a message, but by the time any human listened to it, I'd be asleep post-shift and/or incoherent with insomnia.
"What've you got for me, Hope?"
I jumped. Dr. Dupuis had rolled up in the chair next to me. Somehow, I always managed to pick the defective chair that sank down to toddler size as soon as I rested my bum on it, so he towered over me even more than usual.
I reviewed the bloody diarrhea case.
"His heart rate was 110," Dr. Dupuis said, clicking to the triage note and pointing at the vital sign highlighted in red.
Oh, no. Usually, I reviewed vital signs first thing. The lack of electronic record had thrown me off my game. The patient must have been triaged to the ambulance side for tachycardia as a sign of hemorrhage. "He was anxious," I said, because stress also ups your heart rate. "He kept asking me not to do the rectal exam."
"Still, better keep an eye on the CBC."
"I ordered one! And a group and type, INR, and the SMA-7." My face burned. "Usually, I circle any abnormal vitals on the paper chart. Sorry."
Dr. Dupuis nodded. "I noticed that."
Of course he had. God noticed everything. I fumbled with the keyboard, adding a normal saline bolus. I could give him ringer's lactate, but the studies hadn't shown a big difference between the two, especially for young patients with normal kidneys. "I'll give him a litre and see if he responds. If his hemoglobin is low, I'll repeat it—"
"And usually," he continued, "patients don't try to strangle you and stab you with a scalpel. We're having trouble moving that patient from room 14, as you may have heard. You want to go home?"
Confusion exploded in my brain. Of course I wanted to go home and sleep like a normal human being. But was that wimping out? My voice felt a little less hoarse already. I could push through another 7 plus hours.
Dr. Dupuis watched me.
He was the first person who'd showed me compassion. Well, Roxanne had been nice to me. Everyone else thought it was my own fault for wearing my stethoscope.
I rubbed my eyes, willing away any tears. Yes, I wanted to go home and look for Ryan.
No, I couldn't afford to miss any more work. They kept threatening to hold me back a month or two if I missed any more clinical time.
"Look. Take a break." Dr. Dupuis pursed his thin lips. "Even if you go lie down in the back room for a few minutes. I don't want you working right now. You've started this patient, you're bolusing him, the labs won't be back for an hour or two. You're off for at least half an hour, or until I get room 14 cleared. Got that?"
I still hesitated.
"Go."
He was serious. I stood up. The chair seat tried to rebound but couldn't.
Dr. Dupuis gave me a crooked grin and pointed to the resident's room. The hallway to both the sleep rooms, mine and the staff's, hid between bed 9 and 10.
Obediently, I plucked the key from the Plexiglass window's ledge above the secretary's desk. They kept the key attached to a two-foot long stick painted yellow to make sure sleepy residents didn't wander away with it.
"Good job," said Dr. Dupuis, scooping up the next three charts.
He could work faster without me. Having a learner meant stopping to teach. Without me, he could simultaneously blaze through the patients in the waiting room, fix Dr. Callendar's patients, take sign over for Dr. Chia's patients, and handle a shark attack coming through the door. He was like the Olympic gold medallist in emergency medicine.
I sighed to myself. Would I ever be that good? Especially if I was hamstrung by patients trying to murder me every other second?
I passed the mini kitchen on the right, unlocked the resident's room on the left, and dropped into bed, mind blank, too tired to brush my teeth.
God told me to rest, so I should rest. Thus spake the Lord.
But my mind whirled.
Ryan.
Tucker's on him
Tucker.
Tucker's not in danger.
But he had surgery times two, and now he's out driving all night. How smart is that?
I got up and texted Tucker. If you're too tired, pull over and sleep. I don't want to lose you. I love you.
No answer, but he wouldn't answer if he was driving, and Ottawa was a two hour drive away, even if you hadn't worked all day and evening.
Ah, God. I couldn't rest. I sat up.
There was only one thing I could work on right now, and that was Alyssa Taylor's case. Since she refused to talk to me, I'd worm the truth out of her boyfriend, Patrick Warren.
I couldn't let Dr. Dupuis know I was disobeying his direct orders to rest, so I took the back way out. Instead of retreading past his room and the kitchen into the acute area of the emerg and taking a left out the door with the old light boxes, I ducked out the back door of the residents' room, directly into the hall.
This way, I could circle outside the ER, secretly making my way to the front doors, the main entrance where a lone security guard usually sat at night. Sure enough, I spotted some beefy white guy who wasn't Patrick Warren, so I migrated back to check the guard by the emerg entrance.
No Patrick. I found the older man, the sixtyish guy who'd attended the Code White.
"Hi," he said. His brown eyes seemed to miss nothing behind his glasses. "Everything okay in there?"
"Not too bad, thanks, uh, Charles." I'd glanced at his security badge, which said CHARLES PACKARD. I tried to call adults by their first names nowadays, but my cheeks reddened. "I was hoping to talk to one of your colleagues, Patrick. Is he going back to the front desk?" The front desk guard seemed to act as hospital locating after hours, meaning that when I tried to page, say, the internal medicine consultant, my own pager started beeping, and I had to dial the guard back to tell him, No, I’m the resident. I’m not trying to phone myself. Call the big guns.
"Patrick? He's doing rounds," said Charles Packard.
I blinked. Guards strolled the hallways, but I'd never consciously realized that they'd be patrolling more often than not. "Oh, okay. I only have a few minutes. Do you know where he is?"
"I can give him a message. Your name is?" He clicked open a ballpoint pen, a piece of paper at the ready.
"No, I need to speak to him directly. Could you talk to him on your radio or something? I can meet him somewhere."
Charles Packard frowned. "He's on duty right now. He shouldn't be interrupted."
"You know what? Never mind." Patrick had missed work to bring Alyssa in. I was probably getting the guy in trouble with his boss right now. It reminded me of my own life, being on probation for missed work. Yet another similarity between us.
It belatedly occurred to me that Alyssa would have Patrick's phone number, and I could contact him through her. No need for the boss to know anything.
Slipping into room 13 meant I'd risk being seen by Dr. Dupuis—and Lori Goody. But I'd have to take that risk.
"You know what? It's fine. I'll see him when I see him. Thanks, Charles."
"No problem, Dr. Sze."
For a second, I wondered how he knew my name. Then I realized I was wearing my badge, and for once, it was facing the right way around. I wasn't the only one sleuthing in this hospital.
I should have felt comforted, since it was his job to be alert and identify wrongdoing, but I couldn't smile.
I hurried back to the ER, trying to figure out the most unobtrusive way to get back in without alerting Dr. Dupuis. The conference room was my best bet, but of course it was locked fr
om the outside. We don't want anyone breaking into the ER from the hallway.
I'd have to sneak in through one of the main doors. I pondered the layout again.
I usually took the doors next to the old light boxes, between the acute and ambulatory side. I liked hitting the buttons to make them open automatically, but it created a ruckus because we brought stretchers through there. People glanced up to see who was coming in.
I could either cut through triage and patient registration and sneak in the hall between the eye room and resus, or cut between the four ambulatory examining rooms, but that would put me back within eyeshot of Charles Packard, and I already felt stupid enough without underlining the fact that I couldn't re-enter the ER without trying twice.
Worse, the ambulatory side increased the risk that I might run into Dr. Dupuis as he shot around the ER, seeing ten million patients at once, like the doctor equivalent of the Indian god with all the arms.
Hmm. Humiliation vs. God's ire. Decisions, decisions.
I marched away from Charles Packard, chose the doors at the light boxes, and took a sharp right to room 13.
There was no sound from Lori Goody. Either she'd been successfully drugged or ported out or both.
My shoulders relaxed. When I glanced down at the stretcher, in the dim light, Alyssa Taylor stared back at me.
"Hi," I whispered.
She blinked in response.
"I'm looking for Patrick. Do you know where he is, or could you text him?"
She held up her phone and typed furiously.
I can't find him.
She couldn't move from her stretcher. Then it clicked in my foggy brain. "Oh. You mean that you've been texting him already?"
She started to nod and stopped herself as the edge of the collar reminded her to stay still. She showed me her phone's messages to him.
HB
CRB