Code Blues

by Melissa Yi

  No wonder half our orientation had been devoted to filling out paperwork. Forms, stabbing ourselves to test our glucose, and a tutorial on how to do pelvic exams in a room with no running water. I steamed as I filled out the physiotherapy form. This one had extra sections for medical problems, medications, allergies, and all that fun stuff.

  Tori broke the silence. "Want to go to lunch?"

  "Sure." Maybe I was doing some Asian stereotyping myself, but she seemed so much quieter and self-contained than me. Then I realized that if we did lunch, I wouldn't get a chance at Dr. Radshaw's office.

  "Good," she said. "I'm almost done. Are you?"

  "Uh, nah. I have a lot to do. Maybe you should go to the cafeteria and I'll meet you there." I checked my watch. It was 12:21. I started in the emerg on the hour. "On second thought, I might not make it at all. You have fun."

  She gave me a level look. "You have to eat."

  "Yeah. I brought my lunch." I pointed at my backpack. I should have stuck my lunch in the fridge, but there was only one food-worthy refrigerator for the entire FMC building. On the second floor, naturally. "It's cool. I can fill out forms with one hand and eat with the other."

  She shook her head. "I'll keep you company." She pushed her charts to one side and lifted her black shoulder bag on to the table. "I brought my lunch, too." She ripped open the Velcro of her purple cloth lunch bag. "Don't mind me."

  I couldn't exactly ask for privacy because I had a room to search. "You know what? It's too hot in here." I waved at the windows. "You don't have to suffer with me. Seriously. I feel bad."

  She smiled. "I'm fine. Finish your forms. We'll go outside to eat." She began unwrapping a pita.

  My stomach rumbled.

  She quirked her eyebrows at me. Now I couldn't even pretend not to be hungry. "I might be trapped here waiting for the physio."

  She shook her head. "Leave another message with your pager number. She probably won't get back to you until you're back in the emerg."

  "How did you know I was doing emerg?"

  A smile danced around the corners of her mouth. "I saw it on the master schedule. Dr. Callendar also mentioned working with you there."

  Goody.

  She paused. "You'll get used to Dr. Callendar."

  I glanced at her sidelong. "I heard he has a small penis."

  She smiled. "Maybe. Stan would know better than the rest of us."

  I laughed. She was sharp. She'd figured out how Stan had cheered me up. There was no way I could escape to search Dr. Radshaw's office in the next twenty minute anyway. I left a message for the physio, scribbled the last of the paperwork, and stood up. "Shall we go?"

  As we descended the stairs, I wondered how to bring up Dr. Radshaw and Mireille.

  Doctors are not supposed to fraternize with patients. When I was at Western, we sometimes giggled over the inappropriate behavior in Dialogue, the journal of the regulatory College. One woman testified that her doctor did a pelvic exam and spent a long time rubbing her clitoris. "I asked him if he was digging for gold," she was quoted as saying. Then there was a psychiatrist who was supposed to treat eating disorders, but spent more time rubbing his patients' breasts. The cases weren't really funny, of course. One case, about a doctor who abused a mute man in a wheelchair, was just horrendous. I guess we were laughing over how inappropriate the doctors were. In med school, some people argued that you shouldn't even hug a patient. "If he or she comes at you with open arms, step back. Tell them you don't hug. Offer a tap on the arm at the most."

  Someone made up guidelines about dating patients. If you're an emergency room doctor, seeing a patient as a one-off encounter, wait six months before asking him or her out. If you're a psychiatrist, never. Other doctors fell somewhere in between.

  We never talked about relationships between staff physicians and residents or medical students. It's unofficially frowned upon, but you can do it.

  Tori paused outside the main doors of the FMC. A blue Beetle honked at us before it zipped around the corner to park. She pointed to the small deck across the road, between the Annex and the Human Resources building. "Would you like to eat outside?"

  Yes, but not with so many people around. I pointed at the two smokers on the deck. "Maybe somewhere less toxic?"

  She chuckled. "That's a tall order. Everyone smokes in Montreal."

  "Do you?"

  "Never." She pointed to a strip of grass in the sun, beside the human resources building and across from the emerg entrance. "Is that okay?"

  The grass patch was empty. A second picnic table, next to the human resources entrance, had a group of people chatting and one lighting up, but if we kept our voices low, no one had to hear. "Sure."

  She sat right down on the curb without fussing about dirtying her light khaki pants. I sat on the grass and stretched my feet out, kicking my sandals off. I enjoy lying barefoot in summer grass. One of the things I missed most in medicine was not having a proper summer. We did for the first two years, but clerkship meant that we'd often rise before the sun and come home after it had set. While my other friends spent their glamorous twenties making money or setting their own schedules in graduate school, I was doing surgery and OB/gyn.

  Don't get me wrong, I felt lucky to be there. But I was conscious of the sacrifice. I was a SSINK. Actually, a SSINK-NB: Shitty Single Income, No Kids, No Boyfriend. But the last part might change. And I found joy in smaller pleasures, like eating barefoot in the sun with Tori.

  Some smoke drifted by from the picnic table. I waved it away and took a bite of my dry peanut butter sandwich.

  I needed a subtle way to bring up Kurt and Mireille. Tact wasn't one of my strengths. I decided to start off bland. "So how long have you been in Montreal?"

  She held up four fingers and swallowed her pita.

  "Why did you stay here instead of going back to Alberta?"

  She shrugged. "I liked it here. How about you?"

  "Well..." I didn't really want to get into my messy love life. On the other hand, if I played True Confessions, maybe she would, too. "I got into med school at Western. My boyfriend at the time—" I swallowed hard. Ryan's face flashed into my mind, with its pointed chin and the darkest brown eyes I'd ever seen up close. I remembered how we used to play tennis together. He'd beat me but never gloat as I vowed to do better next time. "—couldn't handle the long-distance thing. I liked London, but I didn't plan to stay seven hours away from my family. Ottawa—well. I wanted to try something different. Montreal's only two hours away. My mother can live with that. So here I am."

  "I see." Her quiet voice and sympathetic eyes made me feel like she understood.

  "So." I tried to lighten up. "How are the men here?"

  She smiled. "Not bad. Not bad at all."

  "Oh?" I would have nudged her if she'd been one of my Western friends. "You've got one?"

  She laughed. It was the first time I'd heard her laugh out loud, a low-pitched rumble. "No. But I've dated."

  "How do you meet them?"

  She shrugged. "It's hard, you know, with our schedules. But I went out with an RT I met when I was on surgery." I nodded. I've met some fine-looking respiratory therapists. Too bad half of them are female. "And sometimes I meet someone when I go out. But it's not a priority for me."

  "Do you go out with other doctors?"

  "Like Alex?" She looked straight at me.

  I found myself blushing. So not cool. "Well, sure."

  She shook her head. "I did date a few guys from our class, or other years, when I first came to Montreal. But it was too incestuous."

  That word again. "What do you mean?"

  She brushed a crumb from the corner of her mouth and stared at the brick wall of the hospital across from us. "For example, if I were to go out with Alex, it would be awkward because I know Mireille."

  Slam. Bang. "They used to be together?"

  She eyed me. "He didn't tell you?"

  "No. Well, not straight out." Inside, I was seething. What exactly ha
d he said? Not my type. And she said they didn't have an "understanding." Not exactly lying, if they'd broken up, but certainly not wholly accurate and aboveboard. Why hide it?

  A toast to truth. Yeah, right.

  Tori touched my wrist. "I'm sorry. I've upset you."

  I looked down and noticed that I'd pinched the end of my sandwich so hard that my fingers were nearly meeting through a thin layer of bread. I took a deep breath. "It's okay." But it wasn't. Why would Alex want me to play detective and then hide things from me? Why did Mireille come over and warn me off Alex, only to sic me on him? Was any of this a clue to Dr. Kurt's death?

  Tori said, "I am sorry. But you would have found out, sooner or later."

  "Yeah." I took another deep breath. "It's fine. I'd rather have it out in the open."

  She pushed the last piece of pita in her mouth. The sun passed behind a cloud, as if it was depressed, too.

  I hated Alex lying to me. After Ryan, I never wanted another guy to hurt me. So I went on a few dates, but I kept it light, never got involved. But after two years, the clamshell act was getting old. A new city, a fresh start, time to take some chances. I felt a real spark with Alex. I didn't have to fake interest in his pet wombat or try to ignore his abnormally prominent gums. I liked him right away.

  Which just went to show what a sucker I was. A little zing and I was ready to commit break and entry for him.

  Well, screw that.

  I'd still consider B&E into Dr. Kurt's office, but not for Alex.

  Even though I never really knew Dr. Kurt alive, I still respected him and wanted him to be at peace. This sounds gross, but I remember when my dissection partner said he wouldn't be donating his body to medical school. "Look at them," he said, pointing at the cadavers around the room. "They're not at peace."

  Dr. Kurt's mottled face and glassy eyes popped into my head. He wasn't at peace, either. I hadn't been able to bring him back to life. But maybe I could make sure he hadn't died in vain.

  Chapter 11

  When I hit the ER, my mind was not on work, but on escaping the walk-in side ASAP.

  It was almost like a clinic. I picked up the chart for a middle-aged guy who said his knee hurt. I did a full exam, stressing all his knee ligaments. Then I reported to Dr. Trigiani, a female physician who bustled around the ER in real clothes. Not greens. A full-length, stretchy black skirt, a white cotton shirt, even a chunky bead necklace.

  I always wore scrubs. The emerg is a messy place. Blood, vomit, plaster casts. Of course, most of the time, the grossest thing you had to worry about was a stray sneeze, but I wasn't willing to risk that ten percent spew factor while nearly all my wardrobe remained in another province.

  Dr. Trigiani listened to my presentation, her head cocked to one side. "Okay. Did you check his hip and ankle?"

  Oops. I turned red.

  She laughed. "It's a good rule of thumb. Always check the joint above and the joint below. Are you sure there's no history of trauma?"

  "He says no."

  She checked the triage nurse's note. "'Knee pain x 1 month. O trauma.' Okay. We'll X-ray him, and it'll probably be negative."

  By 4:30, I'd seen a few other patients, but I kept checking. No films for my knee man.

  "Yeah. X-ray's really backed up," said Dr. Trigiani. "It's been like that all day."

  I might end up here past five, just to babysit this guy's knee. I didn't want to enter the FMC too late. It might look suspicious if I pretended to need a chart at 7 p.m. I darted around the corner to check the film counter again.

  Dr. Trigiani laughed at me. "It's okay. Go see another patient."

  I smiled weakly. It took me thirty to sixty minutes with each patient. At this rate, I was going to stay past five anyway.

  Luckily, it was a 26-year-old guy with ear pain. I'd seen some kids before with middle ear infections, called otitis media. The trick was to pull on the pinna, the outer ear, to straighten the external ear canal and have a good look at the ear drum. Like I'd been trained, I checked his good ear first. No problem. I pulled on his tender ear.

  "Ow!" He yanked his head away and glared at me.

  "Sorry." I hadn't even managed to insert the otoscope. "I have to take a good look."

  "Well, be careful."

  I don't think anyone is more gentle than I am, but I tried even more gingerly.

  "OW!"

  This time, I got a glimpse inside. His external ear canal, which normally looks like a tunnel of skin, looked like it was covered in weeping wax. I could hardly make out the ear drum.

  I went on to check his mouth, feel the few lymph nodes in his neck, and listen to his chest and heart. Then I wrote up his chart, my ear cocked for Dr. Trigiani. It was 4:48

  She came around the corner, holding a large brown envelope. "Guess what I found!"

  She popped the films on to the light box. "What do you see?"

  I surveyed them. "It looks normal."

  "Name the bones."

  "Femur." I pointed to the big thigh bone, tracing its lines. "Tibia. Fibula. And of course, patella."

  "You wouldn't believe it, but some students don't remember." I let the student reference pass, although I hoped she knew I was a resident. I'd introduced myself as an R1. She went on, "What would you look for in osteoarthritis?"

  "Narrowing of the joint space. Sclerosis. Bony spurs." I tried to remember the last one and couldn't.

  "That's pretty good." She pulled the films down and wrote "0" and signed her name on the front of the envelope. "How's your guy's ear?"

  "I think he has otitis externa."

  "Has he been swimming?"

  "Yeah, but it was last week. I think that's what it is, though." I described my findings. She waved her hands, her brown eyes snapping. "Sounds good to me. Let's write him a script. Then you're outta here. You're off at five, right?"

  "Right." Wow. A doctor who didn't want me to stay late to prove myself. I liked her more and more. But I was still glad to clock out of there.

  It was twenty past when I crept up the stairs of the FMC. I felt like a burglar. I avoided touching the wooden banister, as if they could date my fingerprints. I noticed the door on each landing had a large pane of glass and windows on either side. Anyone could see me passing. I ducked my head and tiptoed even more quietly.

  Just past the third floor, I heard a door open on the fourth. "Yeah, it's hard to say," said a guy's voice.

  Someone was entering the stairwell! I hurried back down to the third floor and pushed open the door, turning left, down one corner of the U. I had to get away from the windows on the landing.

  I was almost at the end of the hall before I realized I had even less excuse to be on the administrative floor.

  Fortunately, all the room doors were closed and presumably locked. No good bureaucrat would stay past 4 p.m. I took deep breaths. I was not doing anything wrong. I was a resident here. Just lost, sir. Just needed to pee, ma'am. Sorry to bother you.

  I heard footsteps clatter down the stairs and fade to a distant echo.

  My heart thrummed like a rabbit's, but I forced myself to count to twenty before I inched back to the stairwell.

  It looked and sounded deserted. Fine. I took a deep breath. One more floor. I could do this.

  On the fourth floor, the secretary's door was closed and locked.

  I tried to glide past the conference room, which was free and clear except for some charts on the table. The wind picked up and blew the blinds. They banged back against the window.

  I flinched, caught myself, and carried on down the hallway. Nothing to see, Dr. Callendar. I just took a wrong turn on the way out of the conference room...

  I pulled on a pair of non-latex gloves I'd swiped from the emerg and reached for the doorknob of Dr. Kurt's office. It turned easily in my hand.

  I pulled the door closed behind me and scouted the tiny office. If I'd laid down on the worn grey carpet and stretched my arms above my head, I probably could have touched a wall with my fingers and the op
posite wall with my toes.

  Bookshelves stuffed with books, journals, and manila folders lined the walls on either side of his desk, He'd sat with his back to the window, facing the door.

  His chair was an adjustable secretarial model, in ultramarine-blue fabric lining. The seat was slightly compressed, but otherwise it looked quite new. The man cared about his back and his posterior.

  I needed more clues. Where to start?

  The desk was most obvious. There was a square of space along the edge I hadn't noticed before. I tried to recall what had been in it when Stan and I came in, since every surface had been covered in paper.

  Patient charts. All the patient charts were gone.

  Was it possible a patient had killed him and tried to hide the evidence?

  It sounded ridiculous, but I had to keep an open mind. The charts were the only obvious things missing.

  Maybe the police took them. But they should have sealed off the room if they'd searched it. They must still be treating it like a suspicious death, not homicide.

  I sifted through the remaining papers, trying to touch as little as possible. I saw numerous journals like the CMAJ and the Parkhurst Review. Some photocopied articles on renal colic, child vaccinations, and the new hypertensive guidelines. A printed e-mail from bob.clarkson@sjhc.qc.ca to dr-kurt, dated June 27th.

  Hi Kurt,

  I appreciate your suggestions. We all want to make the FMC a better place. Why don't you make an appointment with my secretary to talk about them?

  Bob

  I almost smiled. It sounded like Bob Clarkson. But why had Kurt bothered to print the message out? It sounded pretty innocuous.

  I found a bunch of articles on crystal meth, GHB, heroin and physician addiction in a stack labeled "Grand Rounds." Alex had mentioned Kurt's presentation. Not too useful for me right now, but I kept searching the piles, hoping for something more incriminating.