“Wow,” Dr. Stephens says with a nod. “Impressive.”
Jex smiles. “It’s not my first time.”
“I’m sure it’s not. Come on,” Dr. Stephens says as she rises to go. “We don’t want to keep the patient waiting.”
Jex hesitates for just a moment and then stands to follow Dr. Stephens. “Ok,” she says slowly through her teeth, a nervous twinkle in her eyes. “Let’s do it.” Jex’s walk turns briefly into a jog as she catches up with Dr. Stephens, whose gait is fast and purposeful. The two walk out of the café, chins up and eyes determined.
* * *
The examination room is cold and sterile. Ms. Basira Awad sits on the examination table in a niqab, her eyes visible but she is otherwise completely covered. Her husband, Ammar, sits in a chair next to her. The two are silent. The discomfort in the air is tangible.
Dr. Stephens walks purposefully into the room and Jex follows behind, wearing her nervousness on her sleeve. She is surprised by the sight of Ms. Awad in her niqab. Jex momentarily panics but quickly regains her composure, kicking herself in her mind for letting something so irrelevant and natural throw her off kilter, even momentarily. She looks on steely as Dr. Stephens goes through a brief introductory statement.
“Ms. Awad, it is good to see you again.”
“Thank you, Dr. Stephens,” the woman says. “It is good to see you, too.” Jex senses that maybe she is smiling behind the cloth, but she can’t say for sure. Dr. Stephens turns to the man next to Ms. Awad and greets him, as well.
“And Mr. Awad. It is also good to see you.”
“Dr. Cohen,” says Mr. Awad, nodding his head in a respectful way. “Thank you very much for seeing us. We very much appreciate it.”
Dr. Stephens smiles. “It is not a problem at all.” Dr. Stephens turns to Jex with a slight wave. “Ms. Awad,” Dr. Stephens continues. As I mentioned to you before, this is Jex Blackwell. She is a volunteer at the hospital who is preparing to enter college and will likely focus her curriculum on pre-med. I have asked for your consent to allow Ms. Blackwell to participate in the examination today, and you have agreed to that. This is done with the understanding that I will be in the examination and will lead the examination, even though Ms. Blackwell may be conducting portions of it. Of course, there may be elements of the exam that I may do a second time, so this may extend the time of the exam slightly, but not much. You are free to withdraw your consent to Ms. Blackwell’s participation at any time, just by letting us know and I will take over from there, or begin the exam again, depending on what you would like. I would be grateful if you could confirm that consent.”
“Yes,” Mr. Awad states firmly, looking at Dr. Stephens and Jex in a manner that seems curious but also sad in some understated way. “We have spoken and we consent to the procedure you describe.”
Dr. Stephens eyes Mr. Awad politely, but responds just as firmly. “Thank you, Mr. Awad. But, your wife is the patient and I really do need to confirm consent with her directly.”
Mr. Awad awkwardly nods again, and says, just respectfully as before, “Of course. My apologies.”
“Not a problem, Mr. Awad,” Dr. Stephens smiles. “Just following procedure.” She turns to Ms. Awad and asks her, “So, Ms. Awad. I would be grateful if you confirm your consent as previously described.”
“Yes,” Ms. Awad says. “I most certainly do.” Again, Jex senses that Ms. Award is smiling.
“Very good,” Dr. Stephens says with a nod. “Ms. Awad, we are going to ask you to disrobe. Your husband is welcome to stay if you like and you consent that, but if you would like to be examined alone, that is completely your choice and right to do so.”
Mr. Awad seems to turn red, and speaks his words quietly. “With all respect, Dr. Stephens, I have every confidence that you and your young colleague are quite competent to conduct this examination without myself being present. My wife and I have discussed this and, if it is all the same, I will wait outside and return once the examination is completed.”
“Of course, Mr. Awad. Thank you very much.”
Mr. Awad moves towards the door but pauses a moment next to his wife. He reaches out her hand and she reaches back, touching hands slightly. “I will be right outside, my dear. You will be fine.”
“Thank you, Ammar. I will ask them to bring you back in once the physical examination is complete.”
“Thank you, my dear.” He turns and walks towards the door and says, “Thank you again, Dr. Stephens.”
“Thank you, Mr. Awad,” Dr. Stephens repeats.
“And thank you, Ms. Blackwell.” He speaks to Jex while looking straight in her. He speaks to her like an adult. “I am quite confident that you will see that my dear wife receives excellent treatment.”
“Thank you, Mr. Awad,” Jex says, mimicking Dr. Stephens.
Mr. Awad leaves the examination room. Dr. Stephens turns to Ms. Awad. “OK, Ms. Awad. You’ve come today because your left ankle continues to ache, even though the injury occurred over a year ago. Is that correct?”
“Yes, ma’am.”
“And, also, you have noticed pain in your right knee, is that fair to say?”
“Yes, ma’am.”
“OK, well. Ms. Awad. We are going to conduct an examination of your knees and ankles today and see what’s going on, is that OK?”
“Yes, ma’am.”
“And we’ve done these kind of examinations in the past, right?”
“That is correct, ma’am.”
“And so you know that in order to conduct this examination properly, you will have to disrobe down to your undergarments. Is that OK?”
“Yes, ma’am.”
“OK, well, Ms. Blackwell and I will step out of the room so that you can disrobe privately. We’ll come in about five minutes or so. Is that OK?”
“Yes, ma’am. Thank you.” Jex and Dr. Stephens walk out of the room and close the door behind them.
“You OK, Jex?”
“Yes,” Jex beams. “I’m doing great.” She does seem to be beaming.
Dr. Stephens touches Jex’s shoulder lightly. “You ready to conduct the exam?”
Jex does not hesitate. “Yes, for sure. I’m totally ready. Totally.”
Dr. Stephens smiles. “Good, Jex. You’re going to do great. Just keep focused and stay calm.”
Jex smiles back. “I promise. I will.”
The two stand in silence as the minutes click away. After about five minutes, Dr. Stephens says, “You ready?”
“Ready,” Jex confirms. “Let’s go.”
The two walk into the exam room. Ms. Awad is standing in the middle room, wearing only her bra and underwear, unashamed and unapologetic. She is middle-age and overweight. Her face is beautiful and her eyes sparkle like a young girl. “Well, hello there you two. I thought you would never come back.”
“Hello again,” Dr. Stephens says cheerily. Jex chimes in as well, “Hello.”
“Well,” Dr. Stephens continues, “as we discussed, Ms. Blackwell is going to be performing some exams today, and I will be supervising. If you have any questions, please let us know. With that, I will hand you over to Ms. Blackwell.”
Ms. Awad nods to Dr. Stephens and turns to Jex with a look that blends expectation and perhaps some level of amused, vicarious pride. “Ms. Blackwell, I look forward to your exam.”
“Thank you, Ms. Awad,” Jex says, her chin up and her eyes locked with her patient. “As Dr. Stephens said, my name is Jex Blackwell and I am not a doctor but a volunteer at this hospital. I have been trained for the examinations that are going to be conducted, that will focus on your knees and your ankles, and I would like to confirm that you consent to those exams.”
With a smile, Ms. Awad confirms, “Yes, you do, ma’am.”
“Great. Dr. Stephens will be supervising and if you have any questions or want me stop at any time, I will. Just let us know. Is that OK?”
“Yes, ma’am.”
“Great. So, the first thing we are going to do is just ask you to walk fr
om the edge of the exam table to that wall and back again. Just walk normally, not fast or slow – just the way you would typically walk.”
Ms. Awad complies with the request as Jex watches with unrelenting focus. She observes the height of her steps, her ankle movement, the position of the foot and placement of the arches as she steps. She cocks her head a bit as she watches Ms. Awad walk, which can be described somewhat as a stilted gait. As she turns around and walks back towards Jex, Jex nods her head approvingly, saying, “Great. Very good. Now, can you just stand here for a minute. I’m going to examine your knees and legs and ankles for any swelling or scars or things like that, ok?”
“Yes, ma’am.”
Jex bends down into a squatting position and looks carefully at each of Ms. Awad’s legs and ankles, feeling here and there, each time prefaced with something like, “I’m going to squeeze below your knee for a moment, ok?” or, “I’m going to touch you right at the ankle for a moment, is that all right?” Each time, Ms. Awad affirms her consent with a “yes, ma’am.” Jex studies each portion of Ms. Awad’s legs fastidiously. Dr. Stephens observes each step with a sharp eye. Jex stands and, in a manner that belies her mere sixteen years of age, says, “Great. You’re doing great,” and speaks to Ms. Awad while looking her directly in the eye. Ms. Awad smiles back.
For just a moment, Ms. Awad’s large, middle-aged frame juxtaposes in Jex’s mind with her own slight frame that she was observing carefully just this morning. She remembers feeling gaunt, almost as if she were disintegrating away. Ms. Awad, although overweight, seems vibrant and alive, spry and sprightly, even. It resonates in Jex’s eyes as she feels a sense of comfort in speaking with and examining Ms. Awad. In her eyes is a sense as though she is exactly where she is supposed to be. She smiles back at Ms. Awad and says, “why don’t you just lie down on the examination table, on your back. We’re going to run through just a few simple exercises to see how you’re doing. Is that OK?”
“Yes, ma’am,” Ms. Awad says in her knowing way and complies with Jex’s request. So far, Dr. Stephens has not said a word, but watches carefully.
“Great, can you please extend your knee, fully? Great.” Jex holds Ms. Awad’s left ankle between her elbow and right side. She applies force to the knee with her right hand, towards the left. “Ms. Awad, I’m just applying what’s called valgus force and varus force to your knee, to test your ligaments. To see if there’s any issues there, OK? Does that cause you any pain?”
“No, ma’am. Not really.”
“OK, how about if I go this way,” Jex asks and applies slight force in the opposite direction.
“No,” Ms. Awad says, watching Jex with the same sense of curiosity and amused pride she displayed earlier. “It doesn’t hurt.”
“OK, great. Now, I’m just going to try one other thing.” She flexes the patient’s knee to about ninety degrees, examining it while Ms. Awad’s foot is held in place by the side of Jex’s thigh. “Does that hurt?”
“No, ma’am.”
“No discomfort?”
“No, ma’am.”
“Great. You’re doing fantastic.”
Ms. Awad, smiles. “Thank you, you remind me of my son.”
“Oh, thanks,” Jex responds cheerfully. She does not see Dr. Stephens wince slightly behind her. “How old is he?”
“Well, he would be eighteen, but he died three years ago unfortunately.”
Jex’s body tenses but she otherwise does not show any reaction to this news. Dr. Stephens takes a step forward as though to intervene in some way, but she stops herself before she does. Jex doesn’t seem to miss a beat.
“Oh, Ms. Awad. I am very sorry to hear that. That was three years ago?”
“Yes, ma’am. He unfortunately was involved in a car crash. He did not survive.” She smiles in a way that covers her sadness but does not seem to betray her grief. It is a smile that somehow manages to respect the grief without being overcome by it.
“That’s really sad, Ms. Awad,” Jex says, looking again directly in her eyes. “My father died a few years ago, and it really hurt me badly. He was only forty eight when died. Cancer.”
“That is very young, Ms. Blackwell. I am sorry.”
Jex shrugs. “I still deal with it, I guess, but I had to put it behind me,” she says bluntly. “The first year or so was terrible. I didn’t even really want to get out of bed.”
Ms. Awad smiles. “I know how you feel.”
“That must be very hard on you, still.”
“Yes, my dear,” Ms. Awad says. “It is still very difficult.”
“I am sure,” Jex says. Dr. Stephens watches the interaction closely. Jex has returned to her examination while she is talking, almost without anyone even noticing. As she speaks with Ms. Asad, she peppers the discussion with instructions for the exam.
“Ms. Awad, can you please flex your left knee.” Ms. Awad complies. Jex rotates the foot externally and abducts the upper leg at the hip. She keeps the foot towards the midline, creating a stress at the knee. As Jex guides Ms. Awad’s leg to extend, she listens closely and hears a click. “Is that uncomfortable, Ms. Awad?”
“Yes, ma’am. A little bit.”
Jex rotates the foot the other way, internally, and abducts the leg a little lower on the hip. She listens and hears a click. “Is that uncomfortable, too?”
“Yes, ma’am. A little.”
“I see. OK, well we won’t do that again,” Jex says, with a smile.
“Thank you,” Ms. Awad says with a slight smile, watching Jex closely.
“Yeah,” Jex says, as she continues to prod and examine the knee. “So, I was totally bummed when my dad died, and everyone was like, you gotta get out of bed, you gotta get out of bed. But I didn’t want to. I ended up failing the seventh grade,” Jex chuckles. “I ended up passing though.”
“I am quite sure you did,” Ms. Awad says with a smile.
“Yeah, but they were right, even though I didn’t want to admit it. It wasn’t doing me any good just lying in bed.”
“No,” Ms. Awad says quietly. “I am sure it wouldn’t be.”
“OK, now I’m just going to extend your knee and push what’s called the patella laterally, OK?”
“Yes, ma’am.”
“Please flex that knee for me again, OK?”
“Yes, ma’am.” Jex observes carefully as she does so. “Great, no resistance,” Jex says. “You’re doing great.”
Jex continues her examination, having Ms. Awad turn her knee and ankle this way and that, first the left and then the right, instructing her to flex in various ways as Jex observes every motion. They continue to talk here and there, some about the exam and some about Ms. Awad’s son. There is both sadness and acceptance in her voice as she discusses this.
After some time, Jex stands up and says, “Well, Ms. Awad, you did great. Just great. Thanks very much for being so patient. As I bet you could tell, I’m kind of new to this.”
“Well, Ms. Blackwell, I’m no expert but I think you did pretty great.”
Jex smiles, as Dr. Stephens looks on, with a smirk of satisfaction on her face. “Thanks, Ms. Awad. I really appreciate it. You can go ahead and get dressed. We’ll give you a few minutes and come back and talk about what we found.”
“So,” Ms. Awad says with her grin. “Am I going to make it?”
“Yes, I think you are,” Jex confirms with a grin. “From what I can tell ...”
“Oh, can you just wait a minute,” Ms. Awad interrupts her with a cute little shake of her hand. “I would very much like Mr. Awad to be in her with me, if that is OK? He will get very nervous if he’s not listening in. He dotes on me very much that way.”
“That’s fine,” Jex says and then catches herself. “I mean it’s OK if it’s OK with Dr. Stephens.” The two look over at Dr. Stephens, who has been silent but observant the whole time. She smiles.
“We will of course honor your request to have your husband with you. Jex, are you comfortable giving your diagnosis
in front of a crowd?”
It is Jex’s turn to say “Yes, ma’am,” now. “I am confident I have it right,” she says in a manner that comfortably walks the line between confidence and arrogance.
“Great,” Dr. Stephens says. “Ms. Awad, go ahead and get dressed. We will get your husband and bring him in when we come back in about five minutes.”
Dr. Stephens and Jex leave the room as Ms. Awad begins to get dressed.
[Will Jex properly analyze the symptoms of what is ailing Ms. Awad? Turn to Little Toy Saxophone Diagnosis to read Jex’s diagnosis and the conclusion of the story]
Ana Gnorisis
The library is a sanctuary for Jex Blackwell. The stacks are a womb. The carpet is warm, safe; a reliable comrade in the endless war against everything. The low buzz of the ceiling fans emits the perfect white noise that dulls away all distractions. Every hallway and fire exit. The door on the fifth floor that has a lock that works in a funny way, which if Jex jimmies just so, she can sneak onto the roof and watch the city shuffle by beneath her. The old ladies reading Lilian Jackson Braun while the old men with funny hats pretend to read biographies of Churchill and spend all their time flirting; beautiful clichés. They are all friends to Jex, family in a weird way, whether they’ve ever shared a word with her or not.
And the books. The books. They are everything of course. Joan Didion and Thomas Pynchon; James Joyce and Toni Morrison. Sir Arthur Conan Doyle (her secret favorite) – Jex has read those a hundred times, maybe more. All of them her best friends. Poe and cummings and Virginia Woolf. They represent the one consistency in Jex’s life. And Henry Gray, of course. The hours that Jex has spent in the downtown L.A. Public Library with the words of Mr. Gray and his intellectual colleagues and progeny are too many to contemplate. In this way, the library is not just a safe haven for Jex. For Jex, it is home.
It is, therefore, with an uncomfortable weight that Jex sits on the first floor, in an uncomfortable wooden chair, outside the office of the library manager, Ms. Tubman, preparing to fight uncomfortably for her job as a library assistant. Jex has been absent without leave from the job for weeks now, fighting demons. The demons seem to be at bay, for now, at least. She disappeared without notice from her duties, though, and provided the library more than enough reason to fire her. Jex wouldn’t blame them at all if they didn’t consider her back at all. Jex wouldn’t be surprised if they had already hired someone else. But, if Jex doesn’t have her job at the library, one of the very foundations of her existence will be gone, and there aren’t many left. Jex pulls at the short pony tail that holds her dirty blonde hair back. She straightens and re-straightens her wrinkled gray sweatshirt and ruffled jeans. The uncomfortable weight on Jex’s spirit, as she waits for her chance to advocate for her job back, is a heavy one indeed.
Jex Blackwell Saves the World Page 10