Third Degree

by Julie Cross

  He shakes his head, and then I notice his teeth chattering. I gently guide him onto his back, moving my fingers over his stomach. “Abdomen is swollen.”

  “Bridget,” I say to my intern. “Go schedule a CT—”

  “Wait.” A nurse shuffles up with her clipboard. “You need a blood panel and history before you do a CT. And before that, I need some information to admit him.”

  I blow out a frustrated breath, remove Marshall’s wallet from the pocket of his jeans, and slap it into the nurse’s hand. “Information.” I point to Jesse. “Brother.”

  Dad gives her a nod, and she walks away scowling and dragging Jesse with her. I try not to think about the fact that it’s really not a good idea to get on the nurses’ bad side. They’re basically the spokes on this hospital’s wheel. But this is Marshall …

  “So, yes to the CT … or should I do the IV and blood work?” Bridget asks.

  “Yes to the CT,” I practically growl at her. “Damn, I should not have to repeat myself.”

  Dad is now pressing on Marshall’s stomach while Marshall covers his face, probably not wanting any grown men to see him hurting. I push the sweaty hair off Marshall’s forehead, lean over, and say in a whisper, “I’m going to get an IV started, okay?”

  He drops his hands and looks at me, holding my gaze for a long moment. “I missed you.”

  I sigh and nod at the same time, quickly swiping away a loose tear before anyone sees. “Me too.”

  It takes me only a minute to get his IV started. Dad’s listening to his chest and abdomen with a stethoscope. Marshall rolls his face toward me. “I can’t drink the contrast. Last time they made me—”

  I attach a bag of fluids to the IV line and then squeeze his hand. “I know. It’s okay. We’ll inject you.”

  He closes his eyes and nods. “Thank you.”

  Bridget skids back into the trauma room. “CT says they need blood work first.”

  “Tell them to go screw themselves.”

  “Isabel,” Dad warns.

  I bite back anger. “Fine. Tell them we’re coming anyway.” There’s a new nurse beside me now. I turn to her and say quietly, “Go ahead and book an OR.”

  She looks at me like I’ve gone crazy, and I can tell she’s sifting through nurse protocol in her head, trying to decide how best to handle crazy residents. “Who exactly is performing this surgery?”

  “I don’t know yet,” I snap. “But I can tell you we’re going to end up there, and we might as well get the room prepped.”

  “You haven’t even taken the patient’s history—”

  “I already know his history!”

  “Isabel Jenkins, what the hell are you doing?” Dr. Rinehart has just walked up behind the nurse, still sporting blood from the last patient. The nurse turns around and begins the process of stripping Rinehart of her bloody covers and gloves and replacing them with new ones.

  “Thank you!” I lift my hands up. “See? We have a surgeon.”

  “Since when do you book CTs, let alone operating rooms, without admitting the patient and getting a history?” She snaps her fingers at Bridget. “List the possible causes of acute abdominal pain.”

  “Appendicitis,” she says.

  “It’s a small bowel obstruction,” I interrupt. We don’t have time and I don’t have the patience for a lesson. I grab the chart from the nurse and begin scribbling all the information I know about Marshall’s medical history, which is pretty much everything. This is normally a nurse’s job, but I’m faster than any of them would be.

  Rinehart rolls her eyes, but she doesn’t ignore my claim, either, and I’m guessing that’s partially because Dad is here and hasn’t uttered a word of protest. “Marshall, what’s your pain level?”

  She’s busy examining his stomach, so I lean in and touch my mouth to his ear. “Don’t be Superman, okay?”

  “Nine,” he says with a groan. “No … ten.”

  Rinehart takes the chart from my hands and reads it quickly. “Dr. Jenkins, how do you know this isn’t just pain from a flare-up?”

  “I’ve seen him during a flare-up, and this is fifty times worse. Trust me, please,” I plead with her.

  She exchanges looks with Dad as if they’ve discussed me when I wasn’t around. “The boyfriend?” she mouths with her back to Marshall. And Dad nods.

  At least I didn’t have to say it out loud—or, worse, say that he’s my ex-boyfriend. Only he doesn’t feel like an ex-anything right now.

  We all wait in anticipation until finally Rinehart turns to the nurse. “Draw blood.” Then she says to Bridget, “Tell CT to wake their asses up because we’re coming. And we’ll probably move quicker than the lab. And book an OR.”

  Marshall hears all this, and his face goes even paler. But he says nothing. I squeeze his hand again. “Hey … I’m gonna have Kelsey call your parents, okay? Jesse’s going to be tied up answering a lot of questions, and he’s probably not had a chance.”

  He blows air out of his cheeks. “Yeah, okay.”

  Two transport staff show up right then and quickly wheel Marshall away to get his CT scan. I start to follow, but Dad grabs my shoulders and forces me to sit down in a chair. The second I do, the rush of adrenaline shifts and I’m seeing spots in front of my eyes.

  “Take a second and catch your breath, okay?” he says. “In a little while you’ll be grateful you did.”

  I rest my elbows on my knees and drop my head into my hands. I see Kelsey’s feet approach.

  “So call his parents?” she asks. “He really didn’t want us to earlier, so Jesse held off. He thought maybe he’d get some pain meds and be fine.”

  My body has already begun to stabilize, to adjust itself back to normal. I lift my head and try to keep the fear out of my face. “He’s not fine. I know he’ll need surgery. We’re just going through the motions now.”

  Kelsey sits down beside me and rubs my back with one hand. “We were at a club downtown and he was miserable, but it was just like you said—he never wants to ruin anyone’s fun.”

  I look at her and try to say I’m sorry for everything. I don’t even know if there’s anything to be sorry for except not telling her I was leaving school. But instead I say, “Thank you for bringing him here. If I had to drive all the way up to the military hospital and sit back and watch them take their sweet time figuring out what’s wrong with him, I would have gone nuts.”

  “You’re welcome,” she says, standing up and holding her phone in one hand. “Me and Carson will go make that call, and we’ll wait for his parents and Jesse, okay? And you go make sure they don’t kill him.”

  I sniff and wipe away a few more tears, laughing at the same time. “That I can do.”

  “I’ll hang out around here,” Dad says. “I can translate when his parents get here.”

  When I get to the CT area, Rinehart is talking with the technicians, and Marshall is in the holding area. I move toward him, and relief washes over him the second he sees me. I brush more sweat from his forehead with my sleeve. “So you’ve done this before? You know how the machine works?”

  He nods. “What’s wrong with me? I’ve been quiet because I didn’t want to interfere. You know what you’re doing. But seriously … explain.”

  I rest my hand on his cheek like I’d wanted to do before he even walked through the doors. “There’s a blockage in your small intestine. It’s keeping anything from passing through and it’s stretching and pulling—that’s why you’re in so much pain. But I know how you handle pain, so this might be a little bit more than a blockage. Maybe there’s also a tear in your intestine. There’s a lump on your abdomen and that gives a sense of the location, but I don’t know what caused the blockage. It could be adhesions from your previous surgeries or from inflammation.”

  “I’m trying to be cool about this, but I’m seriously freaked out.” He reaches up and brushes a tear off my cheek that I hadn’t even felt. I seem to be doing a lot more crying ever since I started therapy. “And y
ou’re crying, so that’s freaking me out even more.”

  I pull my face together and straighten up. “I’m sorry. I’m just happy to see you, but not happy to see you like this. I’m sorry.”

  “Hey, it’s all right. I’ve been going crazy being away from you, not talking.”

  I let the technicians take him inside the CT room. I head over to Rinehart and we both stand there for several minutes waiting for images to pop up.

  When they do, she swears under her breath and I hold mine, feeling the fear and light-headedness all over again. “Good call, Dr. Jenkins. We’re going to the OR like five minutes ago.”

  I grab her sleeve, shaking off the shock. “Can I scrub in?”

  She pauses. “Think you can handle it?”

  “Yes,” I lie.

  When I emerge from the operating room a couple of hours later, my thoughts are so heavily focused on all the people waiting anxiously for an update that I head for the family area without cleaning up at all. Everything on my entire body is shaking and weak.

  Both Marshall’s mom and his youngest sister, Allie, scream when they see me. “Oh my God, she’s bloody … oh my God, oh my God,” Tracy mutters over and over again.

  My dad stands up, his eyebrows lifted like he’s been sitting here for hours trying to keep their minds off horrific hypothetical outcomes. I quickly ball up the mask and the bloody cover over my scrubs, handing them off to a nurse nearby. “He’s okay,” I say.

  I give them a second to absorb that and be relieved before explaining the complications. “There was a tear in his intestines, and it leaked bacteria into the abdomen. He lost a lot of blood … and Dr. Rinehart had to perform an ileostomy.”

  Marshall’s mom gasps. “You took his colon?”

  I look to my dad and he immediately jumps into a sympathetic and very thorough explanation of this surgery despite the fact that this isn’t his field of expertise. Jesse stands beside me and squeezes my shoulder.

  “Dude, you were badass,” he says to me. “Do you have ten pairs of balls or something? I was crying like a baby out here.”

  I shake my head. “I don’t think I’ve ever been that scared in my life. I’m seriously ready to fall over.”

  “Wait a minute … you put a hole in his stomach and he’s got a shit bag?” Marshall’s dad says.

  That’s my cue to leave and get the real surgeon. “I’m gonna go see if he’s awake yet.”

  The lights in the recovery room are slightly dimmed in this late hour. I stop when I hear Dr. Rinehart talking quietly and see that Marshall’s eyes are open. “You’re lucky you came here and didn’t go all the way to Great Lakes; I’m not sure you would have survived that long. It would have been a much bigger mess for that naval surgeon to clean up.”

  “So this is the surgery Izzy told me I was probably going to have to have, right? With the reservoir in the intestines or whatever it’s called?” Marshall’s speech is slurred from the anesthesia, but he seems to know what he’s saying. “I can’t believe I’ve got a poop bag on my stomach.”

  “I know it’s a lot to take in, but the surgery was laparoscopic, and we’ve started you on antibiotics to prevent complications from the bacteria that leaked into your abdomen. You’ll have a quick recovery,” Rinehart says. “You can go back to school for the start of the second semester. The bag will fit under your clothes, so no one will see it. And in three months I can reverse this surgery for you—no more bag—and you’ll be feeling better than you have in years. It was a very bad day, but this is a good direction for you now, okay?”

  “No missing a semester? I’ll stay on schedule to graduate next year?”

  “Yes and yes.” She stands up and pats him on the leg. “I’m going to go tell your family the good news and let them know you’re awake.”

  I stop her before she walks out and whisper, “Don’t bring them back right away.”

  “Got it.”

  My forehead is sticky with sweat and I’m a complete mess, but I head toward Marshall anyway. His face brightens when he sees me. “These are some good drugs they gave me. I don’t feel any pain.”

  “Good.” I try to smile, but instead I rest my head on his leg, careful to avoid his midsection.

  “Are you okay?” He shifts a bit, then groans and instead reaches a hand over to touch my hair. “I can’t believe you were in there looking at my insides.”

  I turn my face, pressing it against the blanket, and finally I let myself cry for real, not the stray tears that drip from my eyes now and then.

  “Izzy …?” Marshall continues stroking my hair. Either he’s calm from the drugs or he gets that I just need to cry. I mean, he’s right—I did just look at his insides.

  After a couple of minutes, I lift my head and drag my sleeve over my face. “You almost died.”

  “I know, Dr. Rinehart told me about the infection and the tear and my missing colon.”

  “No … it was so much worse than that. Like blood on the ground and shock paddles … and … I think I decided that I don’t want to be a surgeon right now … and …” I inhale. “And I love you.”

  His eyes are wide, so I know he’s not that drugged up. His mouth falls open but nothing comes out.

  I wipe my eyes again. “Say something.”

  He shakes his head. “Sorry, I’m just … I’m … I love you, too, Izzy. I almost called you a thousand times to say that, and I almost texted you those words like a hundred thousand times. But I knew you had some things to work out, and I want you to be okay and happy, and I made it more complicated—”

  I touch my fingers to his lips and then lean in and kiss him. “I could be a PE teacher. I’d make a good PE teacher, I think.”

  He laughs. “No, you would be a terrible PE teacher. But you can stay here with me tonight and we’ll make a list of all the non-surgery-related things you can do for a little while. Or maybe you should just, you know, hang out and be nineteen. Or be a non-serious doctor. Podiatry—what’s so serious about feet? That’s got to be low stress, right?”

  I glance at the heart monitor beside his head and then force his shoulders all the way back against the pillow. “Relax. You need to rest. We’ve got plenty of time to figure everything else out. And I probably will become a surgeon; I’m just in shock. Plus I’m nineteen, so there’s time.”

  He lifts up my palm and kisses it. “Thanks for saving my life.”

  Eight Months Later

  “So there you have it,” I say, turning away from the projection screen and facing the lecture hall full of first-year med students. “After that analysis of holistic treatment versus standard treatment in patients with chronic illness, it’s clear that the holistic approach has a significantly higher success rate and results in less surgical intervention and less need for medication.”

  A hand belonging to a guy in the front row shoots up into the air. I nod, giving him permission to speak. “But you haven’t given us any specifics as to what’s involved in this so-called holistic approach.”

  “Well … that’s what we’ll be spending an entire semester discussing. This is a studentled research and independent study course, so I don’t have all the answers for you,” I say, then add, just because I know they’ve been gossiping already, “And it’s also partly because I’m not even twenty years old, so unlike many of your other professors, I don’t have years of data compiled for you. We’re going to have to work together.”

  Of the sixty or so students signed up for this course, the majority either have blank stares or look completely petrified at the idea of a class that isn’t tightly structured, but I can’t really help them with that issue. A few, the C students most likely, look intrigued by the flexibility and surprises to come.

  “Wait,” a girl in the second row interrupts. “This isn’t some convoluted university ploy to get us all to give up real medicine and go into psych, is it? When you say holistic, is this a mind-body thing?”

  There are many grumbles throughout the room. All I can do
is grin and say, “Guess you’ll just have to wait and see.”

  “You are a real doctor, right?”

  “Technically, I’m a first-year resident—almost a second-year—but I’ve been consulting with diagnostics at Johns Hopkins for the past eight months. I’ve assisted in one hundred and seventy-eight surgeries and performed thirty solo surgeries,” I recite, trying not to yawn. “Does that help?”

  Before I can study any reactions from the room, a door opens in the back of the lecture hall and I see Marshall slide inside and lean against the wall. I catch his eye and smile.

  I clap my hands together. “Any more questions?”

  “Professor Jenkins?”

  My head snaps to the far left side of the lecture hall. I hadn’t really anticipated what it would be like to be called by that title. Weird—that’s how it feels. “Yes?”

  “If you’re teaching, how are you still performing surgeries?”

  “Many of those I did as an intern; now I’m only treating patients a few days a week, not to exceed twenty-five hours.” Per my therapist’s recommendation, but I decide to leave that out considering the already looming fear of a psych invasion in the room.

  The nosy guy in the front with the hyperactive hand speaks up again. “Why is that?”

  I catch Marshall’s eye again and decide to proceed with honesty. We do have to spend an entire semester together discussing the benefits of building patient relationships, so we might as well start the process of getting cozy. “Because I’m nineteen.”

  The guy in front looks like he wants to say more, but I cut him off before he can. “That’s enough for today. On Wednesday we’re meeting in the hospital pediatric wing. I have several patients prepped and ready for your small-group interviews.”

  As soon as they start filing out of the room, I can finally let out the sigh of relief I’ve been looking forward to for the last 120 minutes, ever since class began. I’m not like Marshall; the teaching thing is more unnerving than appealing.

  Speaking of Marshall …