by SA Magnusson
“Help him how?” Gramps asked.
“I don’t exactly know. It’s not like my magic works the same way as yours. There was a spell on him and I started to peel it away before realizing that it had been placed by the council.” I didn’t want to meet their eyes, but I needed to. “He was a dark mage and his magic had been burned off. I think that’s why the council showed up.”
“Oh.”
I looked up. “Didn’t they?”
Gran stared at the glass of wine as if it might give her answers. “No one from the council has come to the cities before today. There’s no reason. You wouldn’t have been able to peel away the spell used on someone like that. And that’s even if the council had been burning off magic—which they haven’t.”
It was the same thing Aron had claimed, but I knew what I’d felt. “Are you sure?”
“Quite. It’s difficult enough to burn magic off a dark mage, Katie. There would be no reason unless they were actively using it.”
I had a hard time imagining Tony using significant magic. “This guy sure seemed like he was from the council.”
She took a drink of wine. “Damn,” she whispered.
“Gran?”
“We were wondering why you were attacked last night,” Gran said.
“Then what is it?”
“It seems, Katie, you have drawn the attention of the rest of the Dark Council,” Gramps said.
“You stopped Lexy before she could report back to the rest of the Dark Council. That’s what you said.”
“That’s what we thought. And maybe we were right, but if we were wrong, we need to keep you safe. They’re dangerous,” Gran said.
I thought it had been bad enough when I thought I was a dark mage. Now to go from worrying about being the child of a demon to fearing that a dark mage council would be after me was worse. “You might want to keep me safe, but if I don’t get to work, I might lose my job.”
8
My entire body felt as if I’d been in a car accident. Considering I had been in an accident before, this was a feeling I knew all too well. It was fatigue and I knew that—I’d lived through medical school and now residency, so I knew what fatigue felt like—but that didn’t change how awful I felt. It left me angry with every person who came into the ER for a minor complaint.
“You have a mild sinus infection,” I said to the man. The way he’d whined, you would have thought him still a boy, despite the fact that his chart clearly told me that he was twenty-six. “I’m going to give you an antibiotic that will clear it up.”
I probably didn’t even need to do that. I’m sure Dr. Givens, my infectious disease attending from a previous rotation, would have a problem with me giving out an antibiotic for a mild sinus infection, especially since he’d only been symptomatic for the last week. Most of the time, it would go away on its own. Under normal circumstances, I wouldn’t have prescribed him, but I needed for him to leave the ER. His complaining made my headache worse.
“Mild? It don’t feel mild. It feels like my forehead is throbbing and my vision starts to blur.”
“I’m sure it’s uncomfortable, Mr. Jacobson. Ibuprofen can help with your discomfort.”
“It’s more than discomfort. My head hurts!”
And now mine hurt worse. I forced a smile, not feeling particularly empathetic with this guy. He really did have mild symptoms. With the way he carried on, he would have me believe he was dying, but then I suspected what he was really after. At least he didn’t come in complaining of tooth pain. Most narcotic seekers used that or back pain. Either complaint was easy enough to fake. A sinus infection wouldn’t be quite as likely to get pain meds with it.
“Ibuprofen has been proven to work just as well as anything more potent when dealing with your symptoms.” I doubted he’d believe me, but one thing he wasn’t getting from me was a prescription for Percocet.
The man glared at me. I waited for the explosion of anger, bracing myself for it.
“I can’t take ibuprofen,” he said.
Yeah. Shocking. “No?”
He patted his stomach. “Heartburn. Got a bleed a year ago from taking too much and ended up here for nearly a week.”
I grunted, letting my surprise show. Had I taken the time to review his chart better, I would have known that. “Why would you need to take so much?”
“Can’t you see it in my record?”
The computer screen beckoned me, but I suspected that any attempt to stare too long at it would leave my head throbbing even worse than it already was. “I can, but thought I’d ask you.”
“Hip dysplasia. I’ve had it since I was a kid. It acts up from time to time, especially when I’m working.”
Shit. Now he had a real diagnosis. “What kind of work do you do?”
“Construction.”
“Why would you work construction with a bad hip?”
“What other job would you have me do?” He huffed, shifting on the cot so he could sit up and stare at me. “These questions make a difference in how much you’re willing to help me?”
“I am here to help you.”
He leaned forward. “I can see the way you’re looking at me. You’re trying to figure out how many pills I’m trying to scam off of you.”
“Are you?” This wasn’t my normal approach when dealing with drug seekers, but this wasn’t the normal kind of seeker. Maybe he really was only after the Percocet, but I had to wonder if he wasn’t telling the truth.
“I’ve dealt with pain my entire life. I can handle a little ache now and again. This—” he tapped his forehead and winced—“just hurts. At least tell me what’s going on.”
Resisting the urge to snap at him, I took a deep breath. “I told you what’s going on. It’s—”
“Yeah. A mild sinus infection. And I’m telling you there’s something else. That’s why I’m here.”
The door opened behind me and Dr. Allen entered. He was youngish, probably mid-thirties but with his floppy brown hair had a boyish quality about him that made him look younger, and one of the smarter attendings in the ER. He also had the terrible habit of interrupting residents as he tried to see each patient.
“Hey. I’m Dr. Allen, one of the attendings.”
Mr. Jacobson stared at me for a moment. “Two doctors?”
“Well, Dr. Michaels is a resident. A physician in training. I’m her attending.”
Considering how recently Dr. Allen had completed residency, it always surprised me that he could be oblivious to the way his interruption demeaned the relationship with the patient, especially someone like Mr. Jacobson.
I gave my report, filling Dr. Allen in on the symptoms and my exam findings, all with Mr. Jacobson watching.
“Headache and blurred vision?” Dr. Allen asked. Mr. Jacobson nodded. “Cold for a week beforehand?” Another nod. “Any fevers?” He shook his head. “Weight loss?”
Mr. Jacobson grunted. “I’ve worked outside all summer. You lose weight. I’ll pack it on again over the winter.”
Dr. Allen nodded. “It’s probably a sinus infection as Dr. Michaels suggested, but before I send you home, I want to do another test.”
“What test?”
“Just a scan that will help me better evaluate your sinuses.”
A CT for sinusitis? What was Dr. Allen getting at?
Mr. Jacobson leaned back on the bed, grimacing again. “You don’t believe me.”
Dr. Allen nodded to me and I quickly logged onto the computer, fumbling with the password they made us change every sixty days. “It’s because I believe you that I’m ordering it,” he said.
I put in the order for the CT. Now I would get the blame for over-ordering CTs, not Dr. Allen.
“One of us will be back when the test is over,” he said.
I followed Dr. Allen out of the room. “Why the CT?”
He paused as he reached the next room. “A hunch.”
I smiled. “A hunch? That’s not what the algorithms would suggest.”
“Medicine is more than algorithms. The guidelines provide a framework, but sometimes you have to veer off that framework if something doesn’t feel right. It’ll probably be nothing more than frontal sinusitis, but I’ll feel better knowing that.”
He knocked on the door, pausing a moment before sweeping inside.
He’d feel better, but I wouldn’t.
There wasn’t a whole lot that would help me feel better, not without sleep. My mind felt like it was stuck in mud. A few minutes off. That’s all I needed. After leaving the room, I headed toward the lounge. I wasn’t really in the mood to talk to anyone, but I needed to sit and close my eyes for a moment. The ER wasn’t too busy today, so it shouldn’t upset too many people.
Other than Roberts.
He sat up on the couch and smirked at me. Irritation worked through me. The bastard couldn’t even be bothered to get off his ass and work? I had been here for a few hours and hadn’t seen him, which told me he’d probably been sitting back here the entire time. He was great at making it seem like he did work, and he had a way of schmoozing the attendings that I almost envied.
“Michaels. You look like hell.”
“Thanks. You really have a way with women.”
He smiled and rested his head back. “I do well enough.”
I glared at him, but his eyes were already closed. And he wasn’t lying. Jen had always called him the ER Joey, equating everything to Friends, but that wasn’t quite fair. He didn’t have the same sweet charm and wasn’t dumb at all. It might have been easier on me if he were.
“You can’t be bothered seeing patients?” I took a seat on the recliner, much closer to Brad than I wanted.
“Not much action in the morning. Not here, at least.” He sat up and winked. I shook my head and closed my eyes. “I figured I’d let the interns take the easy stuff. You know, for educational purposes.”
“You’re an ass.”
“You have to learn to delegate, Michaels, if you ever want to be an attending.”
God. The idea of Roberts as one of my attendings chafed. Since he was a year ahead of me, it was possible, especially since the other attendings all seemed to think he was the perfect resident. Worse, he’d made it clear he wanted to do a fellowship. That would probably make him even more insufferable, and he’d finish at the same time that I did.
“What makes you think I want to be an attending?”
“You’d rather get out in a community hospital and work?”
“You say that like it’s a bad thing.”
He sat up and fixed me with his deep blue eyes. “It’s not a bad thing. We need good outstate ER docs. You’ve seen some of the shit they send us. Barely able to stabilize before sending them our way, or sending things the dumbest intern could handle. But you’re smart enough to stay within academics.”
I almost didn’t know how to respond. Was Brad complimenting me?
“Yeah, well I don’t have a problem with seeing patients.”
“You know what most smaller ERs end up being?” When I didn’t answer right away, he grunted. “Urgent care. Snotty kids. Tooth pain. Bladder infections.” He shook his head and rested it back. “Give me something good.”
There wasn’t any point in arguing. Wasn’t that my issue with some of the people I’d been seeing in the ER? Most of them needed a primary doctor, not an emergency medicine trained doc. I could handle traumas but too often saw the very things he derided.
“We see enough of those things here.”
“Yeah. We do. The attendings don’t have to. They get to come in for the interesting cases.”
“Dr. Allen seems to think he should come in on all cases.”
“That’s because he’s only a few years out,” Roberts said. “Soon enough he’ll be like Locks.”
I said nothing, leaning back on the recliner and drifting for a little while. With as tired as I was, even a few moments of sleep would do me good. Every time I started to drift off, I kept seeing visions of the attack the night before and I’d wake up, my heart racing. Worse, I even started reaching for my magic without meaning to. It would be just my luck to blast Roberts with my dark magic. How would I explain that?
“Dr. Michaels?”
I stirred and sat up. Roberts was gone, leaving me alone in the lounge until Val interrupted me. The rest had helped, which made me worry about how long I’d been out. “What is it?”
“Your CT is back.”
Rubbing the sleep from my eyes, I glanced at the clock before heading out of the lounge. I’d been asleep for nearly an hour. I didn’t know whether to thank Roberts for letting me sleep or worry that he might use it against me.
I could look at the images in the lounge, but I’d been out long enough that I needed to make an appearance, so went to the nurses’ station to pull them up on the computer. The light hurt my eyes and I cocked my head off to the side, squinting at the screen.
“How did you know?” Val asked.
“Know what?”
I couldn’t see anything on the CT. It was too hard to get my brain focused. With the kind of night I’d had, it would have been better to have just called in sick. That was frowned upon, especially since the residents were the workhorses of the ER, but it would have been better than risking patient safety because of my tiredness.
“To order the CT. How did you know?”
I looked over at Val. I must’ve worn my confusion plain on my face.
“When he came in, I thought you’d send him out with antibiotics, but why scan him?”
It dawned on me that she must have seen the report. Which meant there was something on it that was more than a sinus infection. What had Dr. Allen suspected?
“Scan who?” Dr. Roberts made his way toward us, a smirk spreading across his face when he saw me. “Dr. Michaels has been too preoccupied to be bothered seeing patients.” He mimed resting his head back and snoring.
One of the newer nurses nearby laughed. She probably thought that doing so would get his attention. And it might. Roberts was a pig and had slept his way through enough of them.
“The patient in Room Eight,” Val said.
Brad leaned over my shoulder, staring at the images. He grabbed the mouse and started scrolling, stopping on a particular image and zooming. “Well, shit,” he breathed. “What did he come in with?”
“Headache. It sounded like a sinus infection.”
“And you got a CT?”
“It didn’t fit,” I said. That sounded better than admitting Dr. Allen had wanted the test.
As I stared at the image, I made out what had caught his attention. The tumor in his frontal sinus was likely what caused his headache. Much longer, and it would be pushing into his eyes. That probably explained his blurred vision at times.
“Good thing you stuck to the ABCs of emergency medicine,” Roberts said.
“The ABCs?” the new nurse asked. She was pretty, with dark hair and a little too much makeup. Her sneakers told me she was probably a runner. Roberts would be all over her.
“Yeah. Airway. Breathing. CT.” He shot me a look as he started away, new nurse trailing after him.
“She’d better be careful,” I said.
“She’s young. She’ll learn,” Val said. I arched a brow at her and Val shrugged. “What can I say? I was young. And I learned.”
I shook my head, turning my attention back to the CT before logging off the computer and standing.
“You going to go tell him?”
“He needs to know. Can you call ENT and have them come talk to him too?” I didn’t know the statistics, but a tumor like that had to be rare. The ENT residents would probably be excited to see it, not like the patient I was about to spring it on.
“It was a good catch,” Val said.
I nodded and turned away. I didn’t deserve credit for it, and had Dr. Allen not come by, I would likely have sent the guy out and his tumor would never have been detected.
When I reached the room, voices inside cau
ght my attention. I pushed the door open and saw Dr. Allen with a chair pulled up to the side of the bed, one of his hands holding Mr. Jacobson’s. He was speaking softly, and Mr. Jacobson had tears in his eyes.
I should have gone in, but I didn’t deserve to do so. This was Dr. Allen’s patient now.
Instead I watched.
Somehow, he managed to still find compassion. After a tired day, I had lost mine. What would happen if I had a tired week? A month? Would I end up like all the jaded ER docs I railed against?
When Dr. Allen stepped away, I closed the door and waited in the hall. He nodded to me. “You saw the report?” he asked.
“I saw the images.”
“Good. You looked at them yourself.”
“How did you know?” It had been more than a hunch. Dr. Allen had pieced something together I had missed.
“The symptoms didn’t completely fit, and there were enough red flags for me to justify the CT. Had it only been the cold and frontal pressure, I probably wouldn’t have gotten it. Pay attention to the things you can’t see, Dr. Michaels.”
He headed down the hall, whistling softly under his breath. I could only watch.
Dr. Allen had known there would be something on the CT. He might not have known what he’d find, but he had enough sense to realize there would be something.
Would I ever get to that point?
It wasn’t that I doubted my medical knowledge. I’d graduated near the top of my class, but there were things that books didn’t teach. Watching him with Mr. Jacobson, I don’t know that I would have had the same ability to sit and console the patient. I probably would have told him what we’d found on the CT and that an ENT would come down to evaluate, leaving it at that. I knew I was supposed to have empathy, but time within medicine—especially emergency medicine—had started to steal that from me.
As much as I tried to deny it, I knew it was happening. I could feel it. Every time a drug seeker came into the ER, I felt the lack of empathy. Every time someone came in with back pain, I felt it.