by Barbara Ebel
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Annabel scrutinized Bonnie’s chart and gathered every update she could. Only one more lab was pending, an arterial blood gas ordered by the internal medicine doctor after he took out her endotracheal tube. She waited on writing a progress note until after formal rounds, if that was even going to occur.
After using the staircase back to the OB/GYN floor, she stumbled on Dr. Harvey getting out of the elevator. Her heart pitter-pattered in her chest and she ramped up the nerve to ask to talk to him.
“Dr. Harvey,” she said, “I am terribly uncomfortable with what transpired yesterday. May I talk to you about it further?” She grimaced with her selection of words. He could shut her down with her weak appeal.
“We covered the situation already, Annabel.” He kept walking and she stayed next to him.
“Dr. Harvey, this is extremely important to me. I am a rock-solid student who deserves to be heard. If you don’t mind, sir.”
Roosevelt glanced back over to the lounge where no visitors were in sight. He turned on his heels and wandered over beside a potted plant. “I’m listening.”
“Dr. Harvey, the morphine order did not originate with me. Clearly, the order to give it came from what was handwritten in Bonnie Barker’s chart by the resident. The absolute fact is that every person who looked at the chart had difficulty with interpreting it. Melba Fox interpreted the order her own way and I had little to do with her decision. I questioned her thinking, but she did her job of dispensing medication the way she saw fit. Honestly, Dr. Harvey, if I may be so bold. I’ve been implicated as the fall guy.”
Roosevelt listened more attentively than yesterday. The day was early and burdens had not yet sagged his shoulders or dampened down his toupee. “Hmm. I suppose medical students make good scapegoats. I remember being told to start an IV on an old man. He ended up slapping my hand. He told me he didn’t want no God damn medical school student touching him. I told him that even he had learned to crawl before he walked. I was accused of being disrespectful to him.” He squinted his eyes and repeated his “Hmm.”
Annabel took in a long breath, hoping his comment was because she’d made the situation better and not worse.
“I worry about our patient, how she is doing this morning, and how she is going to react to all of this.”
“I just rounded on her. She is off the ventilator and extubated. Her pulse oximeter registers an oxygen saturation of ninety-nine percent. Her lungs are clear, her heart a normal rhythm. Her CBC and electrolytes are normal and an ABG is pending. After discussing with her the events that happened, she is grateful that nothing worse occurred. She also knows about her baby’s diagnosis from her boyfriend, and wants to focus on her family.”
Dr. Harvey made no attempt to move. “What is her baby’s diagnosis?”
“She has osteogenesis imperfecta. The baby is being handled with special care and attention. Dr. Thomas seems to be an expert about the genetic disease.”
“The baby does have a rare problem. Did you know those babies sweat a lot?”
“I did not know that.”
“Somehow that fact stuck in my mind from doctor lounge talk with pediatricians.” He smiled, surprised he remembered, and added, “It appears you are multi-versed and up-to-date about your patient. And, it also sounds to me like she trusts you.”
Dr. Harvey nodded not once, but twice.
“Bravo, Annabel.”
CHAPTER 18
Ling Watson arrived in the lounge and scoffed at the board on the wall. Two new patients were written there, the black magic marker ink seemingly mocking her in big letters. “At least I don’t need to work them up,” she mumbled while she grabbed her white jacket off the coat hanger.
The ward secretary held a chart and peered into the doorway. “Good morning, Dr. Watson. Here’s this patient’s paper chart to refresh your memory. She was discharged a few days ago, but I’m supposed to tell you that electronic medical records has no discharge summary on her.”
Ling glared at her and pulled the chart out of her hands. “The day hasn’t even started.”
“Make it worthwhile then,” the woman said in a neutral tone.
“Smart-ass,” Ling muttered. She needed to dictate the discharge dictation as soon as possible, she thought, before the records department gave her a demerit like she was in grade school.
The phone rang several times. “Where the hell is everybody?” She yanked the receiver off the wall. “OB.” An ER physician advised her of an admission. “Why didn’t you page me?” she asked.
“I did,” the man said.
“Not that I’m aware of. I’ll be there when I can.” She hung up, snapped her pager off her pants, looked down, and frowned. She had not turned it on.
A nurse stepped in. “Is it okay if Dr. Fleming does an epidural in Room 4?”
“Wouldn’t I shout from the rooftop or write it all over the board if I didn’t want the patient to get one?”
The nurse didn’t flinch. “Is that a yes?”
“Yes, with a capital ‘Y.’”
“Moron,” Ling said after the RN stepped out. She turned around and glanced at the coffee pot. Empty as a sinkhole waiting for a car. “Damn it. Must I do everything around here?” She opened the cabinet above the counter and saw a bag of house blend sitting on a plate. After wrapping her hand around it and yanking it out, she realized too late why the plate was there. The bag was already cut open and coffee grinds flew everywhere … the counter, the floor, and her blouse and white coat.
She stood staring, the expletive curled on her tongue, ready to explode out of her mouth like she’d spit out putrid milk.
Caleb walked in and approached her from behind. He spoke softly. “I brought you a present since we didn’t wake up together at your or my place.” He held up a Dunkin Donut bag off to her side.
She spun around. “Do I look like some obese pregnant lady who stuffs herself with donuts? Spare me the gift. Decrease my eighty-hour work week instead.” Her voice rose and Caleb was taken aback.
“Unburden me of the exams,” she continued with more potency, “and the research, and the presentations. Get rid of my educational debts, the medicolegal pressures, and the relentless paperwork. Blow up the ineffective electronic medical systems and make the administrative intrusions disappear!”
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Annabel and Dr. Harvey walked toward the lounge. Annabel was ecstatic; she had taken her father’s advice and talked to her attending right away. Now … if the dynamics with the most important person on the team had improved, she hoped she had less to worry about him writing an unflattering clinical review of her at the end of the rotation.
Caleb Gash was ahead of them, strutting along with his canvas bag with books, papers, and whatever snacks he lugged in for the day. In his left hand, he dangled a brown paper bag. Annabel and Roosevelt caught up and he turned into the lounge.
Dr. Harvey stopped at the doorway to smile at the secretary and the RN at the desk. He jolted his head, his ears questioning the loud voice he heard just inside, behind Caleb, whose back faced the door. Annabel realized her attending was listening.
After Ling finished with the part about the obese pregnant ladies eating donuts, the eighty-hour weeks, the exams, and on to blowing up medical records and making intrusions disappear, Dr. Harvey had had enough. He walked in.
“Not to mention,” Dr. Harvey said, startling both Ling and Caleb, “obstetrics is a branch of medicine affected disproportionately by medical malpractice. Insurance premiums of one hundred thousand dollars a year are becoming commonplace nationally. You have that to look forward to. Bad outcomes in obstetrics can lead to multimillion-dollar awards.”
Caleb stood there with a silly grin. Ling moved her head to the side at first with a questioning expression. But then she surmised that her attending really realized how crappy she had it.
“That too,” Ling said.
Roosevelt stared at the coffee grinds splattered on her clothes. Annabel g
lanced at the spillage sprinkled all over the floor. Caleb slid the donut bag on the round table beside him.
“Dr. Watson,” Roosevelt said. “I want you to do these things in order. Write up a medical error incident report on the Motrin order you wrote yesterday for Bonnie Barker. Don’t write down any ‘hearsay,’ only the facts pertaining to your part in it. Then, straight away, go over to the OB/GYN department office. Wait for me there. It may be some time because I need to round on the patients here first. You can leave now.”
Ling’s mouth opened with surprise. Why was he instructing her to leave the ward when there were patients to take care of? Plus, she wanted to make her coffee and then clean up the mess. She hesitated, but Dr. Harvey held his ground. She had a bad feeling about this.
She stepped past them and found the courage to walk out to the desk. She asked the secretary for the necessary papers to fill out her report.
Roosevelt proceeded to address Caleb and Annabel. “You two meet me upstairs in the ICU. Based on Dr. Tilson’s progress report on Ms. Barker this morning, I believe we can transfer her back down here. We’ll start there. I won’t be far behind you.” He grinned, glanced at the brown bag, and back at Caleb. “Mind if I help myself to that donut?”
Caleb shook his head. Annabel nodded to the door and they both left, closing the door behind them. Roosevelt opened the bag and pulled out a blueberry donut. “My favorite flavor.” He placed it on a napkin, called the department’s main office, and asked for the chairman.
Roosevelt cleared his throat as Dr. Roger Winstead picked up the phone. “Roger,” Dr. Harvey said, “it’s Roosevelt. We have a situation with resident Ling Watson. We must pull her from her clinical duties and seek out immediate help for what appears to be physician burnout.”
“Although I trust your judgment, let’s sit down about this,” came the response.
“Exactly. I’ve sent her over. It’ll take me a few hours here to fill in. Any way we can jockey around schedules for an upper level resident to fill in?”
“I absolutely don’t think that’s possible.”
Roosevelt knew what he had gotten himself into. This was the rare circumstance where an attending must sacrifice outside duties to be fully available for the university teaching team. Work like a resident. His other partners in his private office would need to step up and split up his private patients.
Dr. Harvey grimaced. “Holler if that situation changes.”
“You’ll be the first to know. I’ll see you when you get here. Don’t worry about Dr. Watson. She can crack open a novel to read while waiting. I bet she hasn’t done that in a long time.”
Dr. Winstead hung up. He huffed out a big breath. He needed to follow the recommended department protocol to deal with her. However, it always killed him that not too long ago, residents and students got through their training years with longer work hours and stress than the current trainees … who moaned about and broke down about everything. He understood both sides of the spectrum, but he felt like an army sergeant witnessing his men wanting clean sheets and pillows while taking cover in a bunker.
Roosevelt stayed put and enjoyed every morsel of the blueberry donut. Since he’d be working like a resident today and in the near future, he might as well eat like one too.
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Annabel and Caleb waited in the ICU for Dr. Harvey.
“I’m way too worried about Ling,” Caleb said. He sat on the edge of the counter while Annabel pulled up Bonnie Barker’s ABG result on the computer.
“I’m more worried about what’s going to happen to us. It’s about time we started functioning like a real rotation. I’m not here to stick my head in an obstetric textbook. I’m here to learn from patients and upper level doctors.” She jotted down Bonnie’s arterial blood gases on her index card, but Caleb wasn’t listening. “Are you worried about your relationship with Ling?”
Caleb sighed. “I can’t figure her out these days. She sure was nasty to me this morning. Recently, I thought about throwing in the towel. This morning may have been the last straw.”
“Relationships are complex. You’ll know when to end it, and I agree. From what I’ve seen and heard, there is often some event that breaks the camel’s back and one party throws in the towel. You must do what you have to do. Was it serious between the two of you?”
Caleb slid a little closer. He considered the question before answering. “No. Not serious. ‘Light’ would be more like it. And I think it started because I was kind of struck by her status as a chief resident.”
“Oh my God, that sounds familiar. I was crazy, insanely hooked on my chief resident in surgery.”
“Really?”
“Yeah, but don’t repeat what I said. However, not only was I infatuated by his chief-residentness, but he was my type. Handsome, smart, slim athletic build, charismatic, a damn talented surgeon and teacher, and the list goes on. To my heart’s delight, after some time, he asked me out, but the dates were a set of misfortunes.”
“Wow.” Caleb laughed. “Chief-resident-ness?”
“Yeah. I just made that up.”
“I like that, but sorry, the dates didn’t work out. At least you had a resolution to your crush on him. But, hey, where is our attending?”
“You shouldn’t have left him the donut!”
“Actually, I should have bought more.”
“Speak of the devil,” Annabel said as the doors snapped open. Dr. Harvey walked slowly towards them, too busy tucking in his shirt, and stopped across from them at the desk.
“Ms. Barker’s ABG is back,” Annabel mentioned. She rattled of the numbers: the arterial blood pH, oxygen saturation, and partial pressure of carbon dioxide.
“Perfect, and you gave me a thorough update of her before. Hand me her chart.”
Annabel gave it to him and he went through it standing up. She was impressed; he took his time and was not distracted by nurses, the sound of monitors, or X-ray equipment rolling past him. He finally grasped it in his hand. “Let’s go in.”
Bonnie was bolt upright in her bed, a tray table and a breakfast tray in front of her. She decided not to put a spoon of oatmeal into her mouth as they sidled up to her bedside.
Bonnie shrugged her shoulders. “I was hungry. My nurse called the kitchen for an early breakfast.”
“Perfect,” Dr. Harvey said. “If anyone deserves extra attention, it’s you. We are so sorry about the last twenty-four hours. Everything is being done so what happened to you never happens again.” With a slight tilt of his head, his eyes reassured her.
“All your labs and vital signs look real good. Having a postpartum hemorrhage and then a setback with a pain medication was no fun, I’m sure. I’m going to transfer you back to your obstetric room and we’ll shoot for tomorrow as far as discharging you. That will also give you more time with your baby in the hospital and a chance for Dr. Thomas to answer any more questions you may have. How does that sound?”
“Maybe Samantha can go home with me.”
“Maybe so. Dr. Thomas must make that decision. Do you mind if I listen to your heart and lungs?”
“Dr. Tilson did that already, but help yourself.”
Roosevelt finished and Bonnie went back to eyeing her oatmeal.
“We’ll see you later on our ward,” he said. The three of them marched out and Dr. Harvey wrote for and informed the staff of her transfer. “After she eats that porridge she’s delighted with,” he added.
Roosevelt left with Caleb and Annabel on either side of him.
“Amazing,” Annabel said, “that she’s taking her situation so well.”
“You and I both gained her trust and we are sincere about her and her baby. She’s no dummy and she picked up on that. I will add her and her baby to my prayers as well.”
Annabel was surprised about his “prayer” remark. But there was no rule against that, she thought. On the contrary, some people were afraid to mention prayer or their religious affiliation whereas others seemed entitled t
o do so.
“By the way,” Roosevelt said, “the RNs involved with giving Mary Chandler an overdose of magnesium sulfate as well as Melba Fox who made the morphine mistake were both put on leave by the Head of Nursing. And, as you both may have surmised, Ling Watson is going to be placed in a time-out as well. You need only deal with me for the time being.”
Annabel and Caleb managed to lock eyes past Dr. Harvey. Annabel’s lips curled in a slight smile. Their own private attending just for the two of them, she thought. She put vigor in her step as they approached the elevators. She held open the staircase door instead of letting the men push the elevator button.
The three of them were a single file of white coats from one side of the corridor to the other as they strutted down the obstetric wing. “I nabbed you two from the lounge before. Did either of you have a chance to pop in on our patient from late yesterday, Mrs. Wagner, scheduled for an induction?”
“Not me,” Annabel said.
“Nor me,” Caleb said.
“Then what are we waiting for? Let’s check up on her TOLAC!” He looked straight at Annabel.
“Trial of labor after C section,” she said.
“Did one of your residents check if that was a feasible plan?”
Annabel thought fast. “I believe so … with an ultrasound. Which helped to determine if the previous scar and lower uterine segment seemed adequate enough to support labor.”
Roosevelt popped his index finger in front and wiggled it affirmatively.
They made a right turn at Amy’s doorway and Annabel led the way inside.
CHAPTER 19
Amy Wagner forced a smile when the three doctors walked in. Her husband, Harry, sat on the bed with one leg dangling to the floor and one bent on her sheet.
Dr. Harvey introduced himself as the attending doctor. “How’s Mom and Dad doing this morning? Making progress?”
Amy nodded. “I’m in labor because that oxytocin you gave me is working like rocket fuel.”