“I don’t think Ryan has a secret identity,” I say. “I don’t think he has time to have a secret identity. He practically lives in the hospital.”
“Maybe he’s getting drugs from the nursing home,” Nina suggests. “Ooh, maybe he uses the cake to smuggle drugs!”
I roll my eyes. “You think Ryan is a drug addict?”
“Maybe he just sells them,” she says. “You have to admit, there’s quite a market at County.”
She’s right about that last part. But I can’t imagine Ryan selling drugs. He’s worked too hard to get where he is to screw it up like that. Anyway, it’s not like he lives large. His only attire is scrubs, and as far as I can tell, he seems to subsist solely on beef jerky and pizza.
“Well,” Nina says. “What do you think it is?”
I’ve put a lot of thought into this. And there’s only one really reasonable explanation that occurs to me.
“I think the cake really was for his dad,” I say. “I think maybe his dad has some menial job at the nursing home, like a janitor or something, and… he’s ashamed.”
It makes a lot of sense. Ryan acts like he’s such hot shit, and he wouldn’t want anyone to know if his dad had a job that was any less important than his own.
“Maybe,” Nina says thoughtfully. “That or he’s smuggling drugs.”
I stick out my tongue at her, and she throws a pillow in my direction, giggling. “We should have a pillow fight,” she says.
“A what?” I must have heard wrong.
“A pillow fight!” Nina whacks me in the shoulder with a pillow and I shield myself. “Come on, it will be fun.”
“I’m sorry, but no,” I say. “I think that we are at the age where the only place it would be appropriate to have a pillow fight would be in pornography.”
Nina flops down against my bed, pouting. “Well, what are we supposed to do then? Come on, this is our golden weekend. I don’t want to waste it.”
In most hospitals, a golden weekend refers to the one weekend of the month where you get both days off. In other words, a golden weekend is just a normal weekend to most people. However, the way the call schedule is set up at our hospital, having both days off is impossible. So the golden weekend just means you get one of the two weekend days off. This is actually a rare enough event that it’s worth celebrating. But just for the record, our golden weekend isn’t even as good as a normal weekend to most people.
“It’s not really a golden weekend,” I point out. “It’s more like… a silver weekend.”
“It’s a day that I’m not in the hospital,” Nina says. “Which makes it pretty damn special.”
Our conversation is interrupted by banging on my door. I struggle to my feet and go to answer it. Naturally, it’s my roommate, Julia. Her hair is still in that uber-tight ponytail and she does not look happy.
“You have an unauthorized visitor,” Julia says, glaring across my room at Nina.
“It’s just Nina,” I say.
“I didn’t give my approval,” Julia says. “Plus you have to give me 24 hours’ notice.”
“Are you shitting me?” Nina says.
Nina and Julia are glowering at each other. I feel compelled to at least attempt to make some sort of peace between the two of them.
“Come on, Julia,” I say. “It’s our day off. Why don’t you come join us?”
Nina seems horrified, but for a moment, Julia actually looks like she’s considering it. But then she stiffens and shakes her head.
“I’m busy studying,” she says. She looks me up and down critically. “You should be studying too. I overheard Alyssa complaining to another resident that you never do any reading and have no idea what you’re doing.”
Why am I not surprised?
“We’re going out now anyway,” Nina says, jutting her chin out in Julia’s direction. “I just came by to have a look at how disgusting your bathroom was.”
Okay, yes, I did tell Nina about the Bathroom Manifesto. And Julia looks pretty wounded at the mention of her bathroom being any less than spotless. But I have to say, she kind of had this coming. I actually feel a twinge of satisfaction as we brush past her on our way out the door.
I’m locking the door to the suite when I hear Nina gasp slightly. I look up and there he is: Sexy Surgeon. Wearing real clothes: jeans and a T-shirt. His hair is sticking up slightly and he looks pretty tired, but of course, still sexy. “Ryan,” I murmur.
Ryan glances at Nina, then back at me. “Jane, can we talk?”
Nina’s eyes widen—she gets the hint immediately. “I’ve got to go give Val her shot now, actually,” she says. “Um, I’ll see you later, Jane.”
Nina scurries down the hallway, and Ryan watches her go. He frowns. “Who’s Val?”
“Her cat.” I add, “He has diabetes.”
“Right,” Ryan murmurs. He couldn’t care less. He jerks his head in the direction of my door. “Can we go inside?”
I hesitate. Julia said not to, but I’m hoping she’s gotten the crazy out of her system for the day. Anyway, I saw Ryan yelling at her in the hallway the other day for an inappropriate consult, so I suspect she’s a little bit afraid of him right now. I don’t think she’ll bother us.
“Sure,” I say.
Inside my room, we both settle down on my bed. But it’s clear that there isn’t going to be any sexy time right now. Ryan sits about three feet away from me, and he does not appear to be in an amorous mood. His usually ramrod-straight spine is slumped over and he’s staring down at his hands. I don’t say anything. I’m afraid that if I say the wrong thing, he might change his mind about telling me.
“My father isn’t a nursing home lawyer,” he finally says.
Yeah, no kidding.
“I’m sorry I lied to you,” he adds.
“It’s okay,” I say. I want to reach over and take his hand, but he’s just a little too far away. “Whatever he does for a living, there’s no shame in that.”
Ryan lifts his head. His brow is furrowed. “What do you mean?”
“I mean,” I say, “there’s no shame in cleaning toilets or… or, you know, whatever it is your father does.”
He shakes his head. “Jane, my father isn’t a janitor at the nursing home.” He averts his eyes again. “He’s a resident.”
“Oh,” I say.
That’s odd. I did think of that, of course, but immediately rejected the idea, because Ryan’s father is probably only…
“He’s 64,” Ryan says, completing my thought.
“Oh,” I say again. Apparently, that’s the only thing I’m capable of saying anymore.
“Jane,” he says. “You can’t tell anyone about this, okay? You swear, right?”
“Of course,” I say.
He inspects my face for a minute and I try to look as truthful as possible.
Finally, he says, “He has Huntington’s Disease.”
In medical school, you end up learning a few facts about practically every disease there is. Like there’s this disease where your urine smells like maple syrup. For real. I’ve never seen anyone with that disease and surely never will, but I could name at least three facts about patients with maple syrup urine disease.
Huntington’s Disease is relatively rare and not something I’ve ever seen before. But I learned about it and could recite three facts about it. First, it’s a severe neurodegenerative disease where you get something called chorea, meaning large, involuntary movements of the extremities. Second, the patients usually get a cognitive decline that evolves into dementia starting at around age 40, which I guess is why Ryan’s father is in a nursing home. And third…
“Ryan,” I say, “isn’t Huntington’s disease…?”
He nods. “Autosomal dominant.”
The mutation that causes Huntington’s Disease occurs on a single gene. Every person has two copies of every gene, one from each parent. If a disease is “autosomal recessive,” that means you need two copies of the gene in order to be affected. I
f the disease is “autosomal dominant,” however, that means you need only one abnormal copy.
In practical terms, what that means is that if your parent has an autosomal dominant disease, you have a 50% chance of getting it yourself.
Oh my God.
“Do…” My voice comes out squeaky. I clear my throat. “Do you have the gene?”
Ryan shakes his head. “I don’t know.”
I cock my head at him. “I thought you could be tested for it?”
“Yeah, you can,” he confirms. “But I’m not interested. I don’t want to know.”
“Seriously?” I stare at him. “But… isn’t it driving you crazy not to know? I mean, what if you don’t have it?”
“Jane,” he sighs. “Listen, I’ve thought about it. A lot. But here’s the thing. My sister got tested and she was negative. She’s happy now, has a job, a husband, and two kids. A great life.” He looks back down at his hands. “My brother got tested and was positive. He’s now an alcoholic, and he lives in his car. That’s if his car hasn’t been impounded.”
I see what he’s saying, I suppose. But to me, it seems worth the risk. How could you go through life without knowing?
“I’ve got a 50% shot of having it,” he says. “I can live with that. I can still go through my life, enjoy my job, and do everything I want to do more or less with that 50% chance. If it were 100%... I’m not sure if I could. I can’t take that risk—50% is the most I can deal with.”
“But it’s irresponsible,” I blurt out. “I mean, what about when you get married and have kids?”
He smiles crookedly at me. “Well, I’m not going to do those things, so it’s not a problem.”
“Are you serious?”
He nods. “I can’t. I can’t take the chance of passing it on to another person, so… I’m not going to start a family. No kids. You’re right—it would be irresponsible. Even if I didn’t pass it on, my father started having symptoms in his early forties. That’s too young to lose your father. I should know.”
I can’t believe what I’m hearing.
“If you knew you didn’t have the gene,” I say, “would you get married and have kids then?”
“Yeah,” he says, his voice heavy. “I would. But…” He looks up at me with those deep blue eyes. “I love being a surgeon, Jane. I love my job, I really do. And that’s enough for me.”
“I don’t know,” I say. “I think you should get tested. Imagine how great it would be if you turned out to be negative. Right?”
Ryan frowns. “Seriously, don’t try to talk me into it. I’ve been dealing with this decision for twenty years. I promise you, you’re not going to change my mind.” He slides over a foot on the bed, close enough that he can put his hand on mine. “If you really want to help me, then just promise me you won’t tell anyone else.”
“Of course I won’t.” I raise my eyebrows. “Nobody else knows?”
He shakes his head. “I don’t want people to look at me funny. And I definitely don’t want pity.”
No, he just wants to be the asshole surgeon. But I get it. He doesn’t want to be treated any differently. He wants to earn respect, just like everyone else.
Ryan envelops my fingers in his. “I’m glad I told you, Jane. I’ve been keeping this to myself for so long… it feels really good to finally tell someone. Get it off my chest, you know?”
He starts kissing me, pushing me down onto the bed, his hands lacing into my hair, which is loose for a change. I can’t help but think about the fact that Ryan doesn’t have the luxury of falling in love. No matter how much he cares about a woman, he can never be with her for more than a short term relationship. He’ll never have a family. He’ll never have some little kid looking up to him and calling him Daddy, even though I can see in his eyes that he wants that. He has to give up so damn much.
It’s so unfair.
Ryan pulls away from me, and studies my face. “Jane, are you crying?”
I wipe my eyes. “No. I mean, maybe just a little.”
“What the hell?” he snaps.
I grab a tissue from the box that’s next to my bed. “I just… I feel bad…”
Ryan jumps up off the bed, glaring at me. “You’re kidding me, right? This is exactly why I haven’t told anyone about this.”
“Sorry,” I mumble.
His blue eyes meet mine. “You don’t need to feel sorry for me.”
“I don’t,” I lie.
He knows I’m full of it though. He shakes his head at me, and storms out of my room, slamming the door behind him. I guess that’s the end of me and Sexy Surgeon.
Hours awake: 4
Chance of Sexy Surgeon dying young of a neurodegenerative disease: 50%
Chapter 30
Call #5
As I’m waiting for the elevator to go into the hospital, a mother and her little girl pass by. The girl says to her mom, “Look, Mommy! A doctor!”
She meant me. How cute.
Things go downhill after that.
I discover that on my day off, Mrs. Jefferson developed a fever and her white blood cells are elevated. She was supposed to finally go home tomorrow, but now it looks like that plan is at least temporarily on hold.
Just my luck. I mean, just her luck.
There’s already an admission waiting for us from the night service. I meet Alyssa in the resident lounge to get sign-out from the overnight resident who did the admission. She looks decidedly pissed off when she sees me. But what else is new?
“How come you didn’t do the discharge paperwork on Mrs. Rogers?” she demands to know. “She went home yesterday and I had to write her discharge while covering both your patients and Connie’s.”
“Mrs. Rogers was discharged?” I’m shocked. As of two days ago, she looked like she was practically dead. Well, she smelled dead, at least.
Alyssa just shakes her head at me. “In the future, if you know a patient is going home on your day off, you need to do the discharge summary in advance.”
I also need to develop psychic abilities, apparently.
“Sorry.” I can’t help but ask, “Did you ever figure out why she smelled so bad?”
Alyssa looks horrified by my question. “Excuse me?”
“Well, she had that smell,” I say, “and it was really bad, like the whole hallway smelled horrible, and nobody knew why…” I stop short, aware that Alyssa is glaring at me. “Never mind,” I mumble.
I guess I’ll never find out what that smell was. Damn.
“Also, Mr. Dugan had a headache this morning,” she says. “I wrote an order for some ibuprofen for him.”
“Actually,” I say, “that’s probably not the medication I’d pick, considering he’s got renal insufficiency.”
Alyssa gets quiet for a minute. Finally, she says, “Yes, that’s true. Switch it to Tylenol.”
Score! Alyssa actually admitted I was right about something. This may never happen again. I need to savor it. Ahhh.
I hear a loud whirring noise coming from outside and a large scooter navigates into the lounge. Sitting atop the scooter is a resident named Jim, who was the senior admitting overflow patients last night. Why he’s sitting on a scooter is beyond me. I saw him no less than a week ago darting around the hospital on his own two feet. This is just bizarre.
“Jesus Christ,” I say. “What happened to you?”
Jim’s face lights up, clearly loving the attention of zipping around in a scooter. “You won’t believe this,” he begins. “So you know that big dumpster behind the hospital…”
Alyssa clears her throat loudly. “I’m sorry but we don’t have time to socialize right now. Could you just tell us about the patient, please?”
“Spoilsport,” Jim grumbles as he fumbles through the papers in the basket on his scooter. Seriously, this is so weird. And what did Jim do in that dumpster that landed him in a scooter? “Aha, here we go. The patient is Richard Thurman, 38 years old. At about 4 a.m., he was FOOBA.”
I frown. �
�FOOBA?”
Jim winks at me. “Found On Ortho, Barely Alive. The guy had a severe traumatic brain injury from a motorcycle crash, but orthopedic surgery was keeping him to nail his femur fracture. He was looking pretty puny last night, going in and out of a-fib, his blood pressure all over the place, his blood sugars completely uncontrolled. He’s still pretty sick, so you better keep a close eye on him.”
Alyssa does not look pleased. “Maybe he’d be better off in the ICU if he’s that sick.”
“Nah,” Jim says. “Frankly, his worst problem is that he’s FOS.”
I raise my eyebrows. “FOS?”
“Full of shit.” Jim snickers and my heart skips a beat. Please don’t let me have to do a stool disimpaction. “Don’t worry, Jane. I threw some Mag Citrate at him and I think most of it came out.”
Thank God.
After Jim zips away on his scooter, Alyssa and I go to pay Mr. Thurman a visit. When we see him, it’s pretty clear that his femur fracture is the least of his problems. Whatever happened to his brain was pretty bad. He’s two months out from the injury, and essentially in a minimally conscious state. His eyes look in two different directions and his only actions are to try to pull at his tubes, which is why his arms are in restraints. He has a long scar along the left side of his scalp and underneath a large chunk of his skull seems to be missing.
Per his chart, Mr. Thurman was in a motorcycle accident and he wasn’t wearing a helmet. I’m not a risk taker and I’ve always thought motorcycles were scary dangerous. I mean, cars have a ton of metal protecting you, and then airbags on top of that, but when it’s a motorcycle, there’s nothing but air between you and the other cars (or the ground or a tree). So it seems like the least you could do is protect your skull with a helmet. But not everyone feels that way, apparently.
I’ve heard that motorcycle riders have lobbied against helmet laws, saying it’s a violation of their rights. What I don’t understand is why wouldn’t you want to wear a helmet if you were on a motorcycle? What excuse could you possibly have? It’s uncomfortable? It makes you look uncool?
The Devil Wears Scrubs Page 18