Foreign Threat

by Mitchell Goldstein

  The intern showed Steve where the blood-drawing cart was and instructed him to draw labs on fifteen patients. Steve had never drawn blood before, but he didn’t have a chance to tell the intern. As a result, his first day on surgery was spent teaching himself how to draw blood.

  In the second day on the service, things only got worse. During rounds, Dr. Levinsky inquired about a patient who had been admitted on their service during the night. She was a 32-year-old with right lower quadrant pain.

  The chief resident turned to Steve and asked, “Stephen, what is your differential diagnosis?”

  Steve was humiliated by some stranger calling him Stephen, but he responded, “The woman could have appendicitis.”

  “That’s all?” screamed Dr. Levinsky.

  Steve was still recovering from the Stephen thing when a new wave of redness and heat rushed through his body. Everybody, including the nurses, could hear the conservation, more commonly known as grilling.

  “I thought you medical students would know a little more,”

  Dr. Levinsky shouted. “Maybe you should spend a few hours in

  the library and determine other probable causes for this woman’s problem.”

  Steve walked away from the team like a whimpering puppy with his tail between his legs. His wounds were deep, and the scars were sure not to heal anytime soon. He looked back as he walked away and saw the group smirking and laughing at him. He just hated this rotation and the people who went with it. He had spent the entire day in the library looking up information about right lower quadrant pain. He looked at surgical texts, medical texts, and anatomy books. He was so full of knowledge about the right lower quadrant by the end of his study that he could have given a lecture to fellow students. He was so pissed at his team that he was determined to show them when he met up with them during evening rounds.

  Dr. Levinsky was still set to make his life miserable. “I thought I told you a few hours, not the entire day! Well, did you find out if you can save this woman, or do you need to refer her to a real doctor?”

  Steve refused to let the intimidating remarks of Jeff, the shit head, bother him. “In a normally healthy female, this most likely is appendicitis. It could also be inflammation of the small bowel or infection of the small bowel called terminal ileitis or Crohns Disease. Then it could be Meckels diverticulitis or gastroenteritis. Since she is female, we have to worry about twisted ovaries or cysts on the ovaries. If she is sexually active, she may be pregnant and may have an ectopic pregnancy, which could lead to severe problems. Along the same line, endometriosis could be causing her this pain. Now, in a patient who may be infected with T.B. or H.I.V., there may be a host of other conditions that may account for her symptoms including-”

  “Okay, enough!” shouted Dr. Levinsky.

  The other residents stood with their mouths hanging open. The intern looked down in embarrassment, hoping the chief resident would ignore her instead of revealing her lack of such thorough knowledge on this topic.

  Steve was relieved that the conversation ended there.

  Dr. Levinsky found Steve again after rounds that evening. He put his arm around him and told him he was very impressed with the wealth of knowledge that he offered the team. He invit-

  ed Steve to scrub on a bowel case the next morning.

  Steve was happy as a clam. He spent that night reading at

  home about the case for the next day.

  His learning experience only continued to flourish on that rotation. The chief resident continued to challenge him throughout the clerkship, and he was forced to study a great deal of new material. He became increasingly interested in the field of surgery. By the end, there was no doubt: he would be a surgeon.

  Deagan was just coming to as the bus pulled up to Don’s house. Everyone ran into the house and grabbed a fresh beer. Some ran to the lake, took off their clothes, and jumped into the water. Deagan was among those who proudly whipped off their clothes.

  Steve and Mary laughed at their classmates for being so drunk.

  As the crowd got larger in the lake and smaller on land,

  however, Mary made a bold move. She grabbed Steve’s hand and dragged him to the beach. Without flinching, she began taking off her clothes.

  He guzzled his beer and took his clothes off as well. He ran into the cold water with a sense of apprehension.

  As the moon shed light on the lake, Steve treaded water and watched the others for a while. Then he lay on his back to float. Staring at the moon, he acknowledged what had been his biggest accomplishment yet.

  Chapter 2

  The alarm clock wailed.

  Jake Douglas tried to find it so he could slam it into the garbage. He kept his eyes closed and felt around his bedside table before realizing that no clock was in the vicinity. Instead, he felt a small, hard square.

  “Damn it!” he yelled. He was still in the hospital, still on call, still answering stupid pages that his intern should have been taking. He felt like throwing the pager across the room, but he had tried that once before, and they still found him.

  He tried to muster enough energy to open his eyes so he could see the page. The pager showed the numbers he had grown to despise over the last twenty-four hours – 323-2266…4:10 AM. “Shit, those fuck wads just called ten minutes ago,” he grumbled.

  As he dialed the number, he thought about the incompetent intern he had been assigned over the last two months. The guy was never around, difficult to keep track of, and never managed any of the patients. In other words, he was useless.

  But this was Jake’s last day as a resident. He could tolerate eight more hours of call.

  Then he would start the final year in his surgical training program. He would finally be a chief resident.

  A warm pleasant voice answered the phone, “Hello, Dr. Douglas. This is Sarley Anderson.”

  “What the hell do you want this time? You know there is an intern taking call tonight. You could bother his ass every ten minutes.”

  “I’m so sorry. I have one more question. That patient, status post a colon resection from a few days ago, is still having pain, and I wondered if you wanted to give any other pain medicat-

  ion.”

  “Shit, Sarley, you just asked that twenty minutes ago!”

  “Well, actually, it was three hours ago, but you wrote for meds to be given every four hours and, well, it is only three hours and…”

  Before she could finish her sentence, Jake barked, “Just give him the damn Demerol! And next time call Andrew Johnson. He is the intern on call tonight.” He slammed the phone down.

  At 5:30 A.M., the phone rang again.

  “Now what?” Jake screamed.

  “I’m so sorry, Dr. Douglas, but this is the operator, and you wanted to be called now. Is this the wrong time?”

  Jake rolled his eyes. “That’s fine. Thanks.”

  He dragged himself out of bed, brushed his teeth, and splashed water on his face and hair. This was the closest he could get to a shower post-call. He forgot his deodorant, but that wasn’t his problem. The poor intern in the operating room would have to suffer with his smelly armpits. It would serve him right if that intern were the useless Andrew Johnson.

  Jake rushed down to the cafeteria so he could grab a cup of coffee before six o’clock rounds. As he waited in line to pay for the drink, a smile formed on his face. He would scrub on this early morning case and try to get his floor work done by a reasonable time. Then he could get home and plan the next several months as chief resident.

  “Hey, Jake. How you doing? Look like you may need more than that one cup of coffee,” the intern said with a smirk.

  “Fuck you, Johnson. Where the fuck were you all last

  night?” demanded Dr. Douglas.

  “I had an unstable patient in the Intensive Care Unit, someone the other surgery service dumped on me last night. The guy was status post a triple A repair that would not stop

  bleeding. We were afraid that he was going in
to DIC,” Andrew

  replied.

  “Fuck you, Johnson.”

  Jake had a unique way of dealing with people. He treated them as if they were his worst enemy’s pets. Not too many people really cared to be in the presence of Jake Douglas. New medical students who didn’t know any better sometimes dared to hang out with Jake, trying to kiss up to him, but after two or three days, they usually couldn’t take his abusive behavior anymore.

  By the time Jake arrived in the ICU to start rounds, Andrew was already gossiping with the other staff.

  “What are you all smiling about?” asked Jake as he walked up to the group.

  Evidently, no one could muster up a fake answer.

  “Fine. Andrew, you write the notes, and George, you write the orders.”

  This wasn’t Jake’s responsibility, but he was glad to step up. During the last two weeks, Chief Resident Tom Peters had been mentally moving on from residency and preparing for life as a staff surgeon, so he was regularly late for morning rounds.

  Jake didn’t mind. He liked to be in control of the team. Besides, in less than twenty-four hours, this would be his team to command.

  The entire group followed him into the first room. “Good morning, Mrs. Hartman. How are you feeling this morning?”

  After rounds, the team moved to the cafeteria for a quick bite to eat. Here they would delegate all the floor work and

  divide all the tasks amongst the team members.

  Chief Resident Peters finally caught up with the team. He spoke with Jake, who filled in all the pertinent details of all the

  patients on their service. The briefing took five minutes.

  Then Dr. Peters shook Jake’s hand and left.

  Jake returned his attention to the rest of the team. “Tom

  probably won’t be here the rest of the day. George, you organize the management of the patients. Make sure you check the cultures on Mr. Killman, and get the CT scan on room 204. Don’t forget to get Mrs. Hartman extubated and transferred out of the ICU. Andrew, you lazy sack of shit, you get to hold retractors for the next six hours.” Jake left for the operating room.

  The day went by quickly. The staff was content to let Jake do most of the work, and the operations went well. At 4:00, the team met at X-Ray to go over any important films and discuss the patients. This was supposed to be a learning time for the medical students, but as usual, Jake elected not to provide them with any surgical pearls. Jake knew that most students complained to the staff surgeons about his lack of teaching, but no action was ever taken. The resulting perception was that all the staff surgeons were just as much assholes as Jake, except worse.

  After X-ray rounds, the team rushed up to the ICU to begin evening rounds. These were always briefer than the morning rounds. As they left the last patient’s room, they all paused just outside the room. Jake went over all the remaining tasks for the evening with the team. Chores, blood draws, and lab research were delegated again just like in the morning. When all the assignments were divvied, Jake turned around and started for the elevators.

  John Knudson, the most naïve medical student God could ever create, yelled down the hall, “Dr. Douglas, thanks for a great rotation! It’s the last day of the rotation.”

  Everyone stopped in their tracks. Even Jake was stunned. What was this guy doing? Thanking the biggest jerk ever for being the most complete asshole one could ever imagine? Everyone else on the team could not wait for this moment to come. They were all excited to be off the service of Dr. Douglas, and this stupid idiot wanted to give him a big hug and kiss goodbye.

  Jake shook his head from side to side in disbelief and continued his path into the elevator.

  Jake spent the ride home thinking about the coming year. It was what each surgical resident eagerly anticipated: the chief resident year. This was the year that the resident would do most of the surgery, spend as little time as possible with patients themselves, and have full control of their surgical service – or at least most of the control. The staff surgeons that were assigned to each service would ultimately be responsible for the patients. This was somewhat of an irony since the staff rarely had any contact with the patients. They might meet them once just before surgery so the patient could put a face to the name on the bill that would arrive in two or three weeks, but otherwise, the staff usually kept their distance.

  Driving down the interstate with the window open to stay awake, Jake planned out the next day. The new surgery interns would have orientation in the morning in order to fill out their W-2 forms and learn the boring details of being a surgery resident. Jake would have to make rounds with the two new junior residents assigned to his team, Sally Jenson and Tom Formin.

  Sally was a fourth year resident and was good at her job.

  Jake had worked with her in the past, and she did everything with great confidence. Most of the staff liked her, which made her a great spokeswoman for his service so that he would not have to deal with those egotistical assholes more than necess-

  ary.

  Tom Formin was a little greener. He had just finished his internship year and had been known to falter under the stress of surgical residency. He would show up to work, but that was about it. No one felt comfortable having him responsible for the patients on the floor recovering from surgery. He would routinely get labs mixed up, forget to order important studies on patients, and take forever to get the work done. He even had to have help getting the history and physicals done when there was too much going on. Still, Jake felt that a little Dr. Douglas guidance would help Tom shape up.

  Jake was not sure which medical students he had been assigned, but he couldn’t care less. He was so removed from the med students that he didn’t know if any particular one was better than the others. As long as they didn’t mind getting up early, going home late, tolerating any dull or obscure assignment he gave, and basically disregarding life outside of surgery for the next two months, Jake didn’t care anything about the students. It was well known that, while on the surgery clerkship, they would eat, sleep, and shit surgery.

  Jake turned off the interstate and pulled into the grocery store near his apartment. He picked up the bare essentials, strode to the checkout line, and asked the clerk to charge the total to his account.

  As she recognized him, she said, “One moment please,

  Dr. Douglas.” She went to the office to get the manager.

  “Well, hello, Dr. Douglas,” said a stern voice.

  Jake turned to the manager of the store. They had met several times over the last four months. “Hello, Joel.”

  “Your account still is not paid, Dr. Douglas. You have told me many times over the last four months that the check is coming. We have yet to receive this payment.”

  “I get paid this Thursday, and I will make this wonderful

  grocery store my first stop. I appreciate the fact that you and your staff have been so patient, and-”

  “Cut the BS, young man. If you don’t pay the bill by the

  end of the week, I will turn your account over to a collection agency,” Joel promised.

  Jake signed for his purchase and left without another word.

  What is one more collection agency? He had promised himself not to go to that market ever again after Joel had given him a hard time six weeks ago. The post-call exhaustion must have caused him to have a minor brain infarct, and he forgot to go to the market on the other side of the interstate. Next time he wouldn’t forget. He’d have to write a reminder to himself and leave it on the steering wheel.

  Jake turned the knob to his apartment. As he opened the door, he could already smell the stench. He switched on the lights and saw the mess he had left behind two days ago. Clothes, clean and dirty, laying over chairs and the sofa. Old pots and pans still on the stove.

  He thought for a moment. He didn’t recall what meal he had cooked prior to this last call shift. In fact, he remembered eating a frozen pizza. The pizza box that lay on the kitchen table with three un
eaten pieces was confirmation. That would also account for the smell in the apartment, or at least part of it.

  He walked over to the refrigerator, closed his eyes for a

  second, and opened the door. Three beers and an apple. What a pitiful way to celebrate the beginning of his chief year. At least he had a few beers. He opened the first can, stared at the pile of dishes in the sink, and turned toward the sofa. He shoved all the clothes over to one side, sat down, and looked at the picture on top of the television.

  It was a photograph of four people at a water park. Jake stood with the beautiful young woman who had been his wife until eight months ago. Between them was a little girl with long brown hair and a golden tan and a little boy who very much resembled his father.

  Jake remembered the picture, the day, the park, and the family vividly. It was one of only a few vacations that his young family could afford. They went to a water park in Wisconsin for just a few days, but the children had a lifetime of entertainment. Soon after that trip, though, he and Claire began to struggle with many issues. They had married when they both were seniors in college. They quickly had Brittany, and Claire decided to stay at home with the baby. They used school loans for living expenses until they were dried up, and credit cards became the next best solution. Soon they were in major debt, and he had not yet finished medical school. By the time Jake started his surgical training, he owed the credit card companies more than $50,000. This put quite a strain on the family, not to mention their relationship. As Jake continued with residency, his long hours, sleepless nights, continued debt, and lack of time spent with his family, the stress on his marriage became just too much. Consequently, Claire decided she could not take it anymore and had asked for a divorce earlier in the year. She won custody of the children, and he got visitation rights one weekend a month as long as he was a resident. Hopefully that would change after he got a real job as a general surgeon.

  While Jake finished his last beer, he continued planning the year. He still had to juggle his finances so he could cover child support and alimony and attempt to pay off some debt. It was a depressing situation but one to which he had grown accustomed. He tried to create a financial plan as he was slowly getting drunk. It did not prove to be a good time to figure this out.