A Cut Above: A Lakeside Hospital Novel

by Malone, Cara

  “Come on,” Dr. Stevens said, leading them both into a small office behind the nurses’ station. It was a utilitarian room, just a desk, a computer, and three straight-backed chairs. Dr. Stevens didn’t offer a seat to either of them as she closed the office door. Instead, she said, “I want you two to work together this week.”

  “Together?” Ivy asked, her thin brows knit with confusion.

  “You’re very blunt with patients,” Dr. Stevens said, not mincing her words. “You need to learn how to build a little warmth and rapport into your bedside manner so that patients feel comforted instead of just examined. Be a little more like Barnes.”

  A feather could have knocked Chloe over – of all the things she thought this meeting could be about, Dr. Stevens telling Ivy to be more like Chloe was not one of them. She started to smile but Dr. Stevens wasn’t done.

  “You have the opposite problem, Chatty Cathy,” she said, effectively wiping the smile off Chloe’s lips. “This is the Emergency Room, not a family practice. You don’t have to know the complete medical history or become the patient’s best friend in order to treat them. I want the two of you to see patients together this week - see if you can learn something from each other.”

  7

  Ivy

  “That’s not fair,” Ivy said “Why should I have to slow down for her? My diagnoses and outcomes have been excellent.”

  She knew as soon as she spoke that it sounded harsh, but it was too late to take back her words and this was too important to let go.

  “I would expect nothing less,” Dr. Stevens said. “But it’s not all about technical ability. Being a good doctor is about interpersonal skills just as much as it’s about making the proper diagnosis.”

  “I disagree,” Ivy said, and Dr. Stevens gave her a sharp look.

  “It’s just one week, then we’ll revisit the subject,” Dr. Stevens said. “But it’s not up for discussion. Now get back to work - together.”

  She squeezed between the two of them and was out the door before Ivy could further plead her case. Now that it was just her and Chloe, she didn’t particularly want to find out how hurtful her blunt objections had been.

  “I don’t think you’re a bad doctor or anything,” she said by way of apology. “I just can’t reconcile my treatment philosophies with your level of attachment to your patients.”

  “Right,” Chloe said, pursing her lips in irritation or embarrassment – Ivy couldn’t tell which. “Now that you’ve made it abundantly clear that I’ll be holding you back this week, we have nothing left to do but get back out there.”

  She left the office with her head held high and Ivy muttered, “Crap,” before following Chloe back into the department. She really didn’t mean to insult her – Chloe was a great study partner and she was whip smart. Ivy was sure that if Chloe was a little more assertive in class, she could have been ranked higher and she would have been competing alongside Megan and Ivy. She just went about medicine – and life, from what Ivy could tell – in a fundamentally different way.

  Ivy couldn’t help feeling indignant at Dr. Stevens’ suggestion that she wasn’t doing the best she could during this rotation, especially after she’d tried time and again to get feedback to no avail. Ivy didn’t see how the patient-doctor relationship was relevant in emergency medicine. To her, taking time to get to know someone who just needed a few stitches after a minor accident was a senseless waste of time when she could be learning from a wider variety of cases instead.

  But Dr. Stevens had decreed it, so this was what she’d have to do. Ivy’s new goal was to make sure by the end of the week, her chief resident saw enough improvement that she didn’t make them do another week together.

  Ivy found Chloe at the bedside of an elderly woman, holding her trembling hand and trying to soothe her while she repeatedly asked, “Where am I?”

  “You’re in Lakeside Hospital, Mrs. Davidson,” Chloe said, smiling warmly as the woman yanked her hand away. “Do you remember what brought you here?”

  Ivy came to the foot of the bed and picked up the tablet laying on the tray table. Jeanette Davidson, 71 years old, disoriented and combative. Chloe glanced at Ivy – a withering look –then turned back to the patient to repeat her question.

  “Do you know what brought you to the hospital, Mrs. Davidson?”

  “Who are you?” the woman asked instead of answering the question.

  She was clearly suffering from either dementia or delirium and Ivy could already feel herself growing impatient at Chloe’s slow, gentle approach. Ivy was thinking through all the steps they should take to find out the patient’s past history and current state, and she knew that no one who had either dementia or delirium could be relied on to give accurate information about their condition. But Chloe was busy making Mrs. Davidson feel comfortable even though the woman had not a damn clue where she was.

  “Can you tell me what year it is, Mrs. Davidson?” Chloe asked sweetly, and even though a look from those big blue eyes would have melted Ivy’s icy heart, it did nothing to change the patient’s state of confusion.

  “Where’s Melissa?” Mrs. Davidson asked. “It’s her birthday.”

  “Jesus,” Ivy muttered under her breath. She couldn’t take it anymore - this was leading nowhere and Dr. Stevens was wrong about this approach. There was nothing to be gained from being chatty with someone who had no sense of her own surroundings. Ivy scrolled through the tablet and said, “According to the chart, she was brought here by her nephew. I’m going to find him.”

  “But we’re supposed to-” Chloe started to object, probably about to remind her of Dr. Stevens’ order to work together, but Ivy cut her off.

  “We’re supposed to treat the patient,” Ivy said. “That’s what I’m doing.”

  It was a little more snappish than she intended, but the sting of being told she wasn’t good enough to work on her own was still fresh and Ivy was in no mood to pick her words carefully. She walked away before she could say any more harsh things to poor Chloe, who didn’t really deserve it, and marched over to the nurses’ station.

  “I’m looking for bed four’s nephew,” Ivy said to the nurse there. “Have you seen him?”

  “The confused elderly woman, right?” she asked. “I think he went to the cafeteria for a cup of coffee. They’ve been here a couple of hours.”

  “Did you notice any changes in her mental state while she was waiting to be seen?” Ivy asked.

  “Not that I recall,” the nurse said. “Are you treating her? It looks like Dr. Barnes is with her now.”

  “We’re working on it together,” Ivy said through clenched teeth.

  Then she headed to the cafeteria to find the nephew and bring him back. In cases where the patient was mentally compromised, the best source of information was typically past history obtained from a relative or primary care physician, and Ivy wanted to get this information in front of Chloe to prove that her diagnosis method was objectively better. Talking to Mrs. Davidson would be fruitless and probably only serve to upset her more.

  After about five minutes of obtaining the pertinent medical history from the nephew, it was clear that this was a case of delirium rather than dementia and Mrs. Davidson would need to be admitted to determine the underlying cause. Ivy went to inform Dr. Stevens and when she came back, Chloe was standing at the nurses’ station with her arms crossed over her chest.

  “Ready for our next patient?” she asked. “I wouldn’t want to slow down your assembly line approach.”

  “Come on, Chloe,” Ivy said. “I know we would have both arrived at the same diagnosis – I just wanted to get there a little faster.”

  “And I wanted to get there without treating Mrs. Davidson like a piece of meat,” Chloe said. “You pick the next one – who looks most educational to you?”

  “That’s not fair,” Ivy said, but there was an element of truth to Chloe’s words.

  She did look at the patients in the waiting room and evaluate them based on wh
ich one would offer her the best educational experience. Was that really so wrong, though? What were they here for if not to challenge themselves with the widest variety and most educational cases? Chloe was going to be a very compassionate and well-liked physician, but Ivy wanted to be the best. It was something they’d just have to agree to disagree on.

  * * *

  By the end of the day, Chloe was hardly talking to Ivy.

  Even though they spent the last three years studying together, they’d never actually had to work together. Most of their medical school assignments were individual ones and they’d never been on rotation together, but it turned out that Dr. Stevens was right about their clashing styles.

  Chloe couldn’t stop asking the most time-consuming and irrelevant questions and Ivy just kept butting in to ask pointed questions and get them back on track. Chloe got defensive and Ivy got irritated, and neither of them could wait until the end of their shift. Unfortunately, Ivy was on call that night which meant that when the day finally ended, Chloe would get to go home and decompress while Ivy would have to stay at the hospital.

  When the time finally came, Chloe didn’t even look at Ivy as she dropped off her tablet at the nurses’ station and headed for the locker room. Ivy watched her go and Dr. Stevens came over to ask, in a rare show of interest, “First day didn’t go so smoothly?”

  Ivy knew she only had her attention for a brief moment – she’d be gone as soon as the next ambulance pulled into the bay outside - so she couldn’t squander this opportunity to plead her case.

  “Dr. Stevens, I have the highest rank in my class,” she said. “I’ve maintained a 4.0 GPA for my entire education, from high school to medical school. I’ve received excellent reviews on all my previous rotations.”

  “It’s not polite to brag, Chan,” Dr. Stevens said.

  “Please don’t punish me for being efficient,” Ivy begged. “I see you working with the same relentless forward motion that I strive for. If you see some deficiency in me, then maybe we could work out some kind of mentorship instead of-”

  “Can you tell me the first name of your last patient?” Dr. Stevens asked.

  “Umm,” Ivy faltered. She used her patients’ names when she was at their bedside but didn’t think much about them after they’d been triaged and sent out of the department for treatment or diagnostic tests. Her last patient had been a man with food poisoning who needed fluids and rest, but as for a name, Ivy came up blank.

  “That’s why I want you to work with Barnes,” Dr. Stevens said. Then the familiar red flashing lights of an ambulance cut through the darkness beyond the ER doors and before she walked away, Dr. Stevens added, “It’s not a punishment – it’s an opportunity to become a well-rounded doctor. Believe it or not, you and Barnes can learn from each other.”

  Ivy sighed and looked around the department. For the moment, there were more than enough doctors to cover the patients waiting in beds. She might as well get some rest before her pager started going off. Things always got busier in the evening and Ivy’s stomach had been growling for at least two hours.

  She left the ER and headed to the hospital cafeteria. It wasn’t the best food in the world, but at least it was fast and there was someone else to cook it. When she arrived, though, the first thing she saw was the wavy blonde ponytail that she’d recognize anywhere.

  “Chloe?”

  She was standing at the dessert bar, frowning at an array of cake and pie slices, and she didn’t look particularly happy to see Ivy. Her posture sagged as if she’d just been caught doing something she shouldn’t and Ivy considered ignoring her – maybe that was what she wanted – but it was a little late for that now.

  “What are you still doing here?” she asked as she walked over to Chloe. “I thought you’d be halfway home by now.”

  “I needed to unwind first,” Chloe said. “When I get home, Megan and Alex will be there and I just wanted to be by myself for a minute.”

  “In a crowded hospital cafeteria?” Ivy asked.

  Chloe shrugged and picked up a slice of chocolate cake wrapped in cling film. She said, mostly to herself, “I shouldn’t eat this. It’s all sugar.”

  “Let me buy it for you,” Ivy said.

  “Why?”

  “I’m really sorry about how today went,” Ivy said.

  She was thinking about Dr. Stevens’ question – what was the name of your last patient? – and she had to admit it was bad that the answer didn’t come to her right away. More than that, though, she felt bad for letting her pride get in her way all day and making Chloe feel inferior as a result. Chloe was the only person in their program who hadn’t been turned off by Ivy’s relentless, single-minded drive to be the best surgeon possible, and even though the only time they were together was spent studying, Ivy had come to think of Chloe as a friend.

  Of course, she couldn’t say that out loud – what kind of friend knows your learning style and your Myers-Briggs personality type but not your favorite band or, until now, your favorite flavor of cake?

  “Come on,” she said, nudging Chloe with her elbow in a way that immediately colored her cheeks. “I’ve been a jerk. Let me buy you a piece of cake.”

  “Fine,” Chloe said. “And I’ll take a coffee to wash it down.”

  “You got it,” Ivy said. She went over to the row of carafes along one wall and poured two cups, adding two sugars to her own and a dash of cream to Chloe’s. After all those café study sessions, she did know Chloe’s coffee order.

  Ivy went over to the cashier and showed her hospital badge so the money could be deducted from her account, then she handed one of the coffee cups to Chloe and started to walk away.

  “Where are you going?”

  “The call room,” Ivy said.

  “You can join me if you want,” Chloe said.

  “I thought you wanted to be alone.”

  “Look around,” Chloe said, gesturing to the crowded cafeteria. It was dinner time and a lot of hospital staff were trying to squeeze in a quick meal before or after their shifts, plus there were a lot of visitors here to see patients in the early hours after the work day ended. “There’s no such thing as alone.”

  Chloe found a small table in the middle of the room and Ivy sat down across from her. The space was so tight their knees were practically touching beneath the table and Ivy had to make a conscious effort to keep her legs from brushing against Chloe’s. She blew the steam off her cup – the carafes always kept the coffee too hot for her liking – and watched while Chloe carefully unwrapped the cake.

  “Want some?” she asked.

  “Nah,” Ivy said. “Thanks.”

  “Are you sure?” Chloe asked. “I grabbed two forks and it’s really not bad for hospital cake.”

  She produced a couple of plastic forks from the pocket of her white coat and held one out to Ivy, so she took it. She’d been so distracted when they were in line that she’d forgotten the whole reason she came to the cafeteria was to get something to eat - a cup of coffee wasn’t going to sustain her for the next twelve hours, or help her sleep for that matter. Half a slice of chocolate cake wasn’t the best meal, but it was better than nothing.

  “Thanks,” Ivy said, taking a small bite. “Mm, that really is good.”

  “Yeah,” Chloe agreed.

  They ate quietly for a few minutes and Ivy could feel her cheeks getting warmer. She hoped they weren’t turning too pink and she couldn’t quite pinpoint the reason for her embarrassment. At first she thought it had to do with the absurdity of being cruel to Chloe all day and then sharing a slice of cake with her – a beautiful illustration of Chloe’s forgiving nature - but that wasn’t quite it. She’d sat across small café tables from Chloe many times since they met, and in much less crowded spaces. But this time felt more intimate than usual and Ivy didn’t know why.

  When the cake was almost gone and their forks were beginning to meet in the middle of the plate, Chloe said, “I’m sorry about today, too.”

 
“You don’t have any reason-”

  “I was just as upset about Dr. Stevens’ criticism as you were,” Chloe went on. “And I got petty as soon as I realized you thought working with me was a punishment. I could have been more magnanimous about the whole thing.”

  “Well, I guess we have another chance to try again tomorrow,” Ivy said, looking into Chloe’s big blue eyes for the first time since they sat down. Something jittery stirred in her belly and she looked away again. “I’ll do better tomorrow.”

  “Me too,” Chloe said.

  “So what kind of music do you-” Ivy started to ask, but then her hip started vibrating and she had to stop in the middle of her sentence to grab her pager. With an apologetic smile, she set down her fork and said, “Duty calls.”

  “Thanks for the cake,” Chloe said and Ivy nodded, then rushed back to the Emergency Room.

  8

  Chloe

  Chloe finished the last few bites of her chocolate cake, then instead of getting up and letting someone else have the table, she lingered in the cafeteria a while longer. She sipped her coffee and watched the crowd slowly change around her.

  She’d been surprised when Ivy followed her to the cafeteria and pleased when Ivy apologized for the rough day they’d had. But Chloe always knew Ivy had a soft side – she’d seen it right away when they met during their medical school orientation weekend, even though it was clearly something Ivy tried very hard to hide. Megan never could see it despite all of Chloe’s attempts to prove that Ivy wasn’t as prickly as she appeared, and that was probably why they competed so bitterly with each other.

  When she got to the bottom of her cup, Chloe got up and threw away the empty plate and forks, then walked back to her apartment, shivering slightly in the fall air. She’d have to start riding the bus soon, but it wasn’t far and she liked to walk as long as the weather would allow it. As she walked up the sidewalk to her building, Chloe chuckled to herself and wondered, What was that stuff about my musical tastes?