by Barbara Ebel
Annabel couldn’t fathom what would warrant a stat call in psychiatry unless a patient was huddled on a chair next to an open window and ready to jump. She sensed the urgency, however, and the two women had to ignore someone seeking help with directions. When they arrived at the in-patient ward, a woman at the desk pointed down the hallway. “They’re in the recreation room,” she said.
Inside the room, a stocky orderly encouraged Victor to keep backing away from his mother. The frail woman coughed while trying to overcome her shortness of breath. A nurse crouched down attempting to unwind the long nasal cannula tubing she’d freed up from the end of the wheelchair.
“What happened?” Dr. Keeton asked as she sidled beside them and helped put the tubing prongs back into Marilyn’s nostrils. The nurse handed Annabel the other end so she pushed it on the valve of the oxygen tank. Selina changed her mind for the moment, and put her hand up for the nurse not to tell her anything yet.
The nurse rose and Annabel squatted down.
“Are you okay?” Annabel asked Marilyn. The woman took her hand and slightly squeezed. Her eyes stayed wide open and, while her wheezing came in long spurts, she shook her head that she couldn’t talk.
The orderly took one more step straight in front of Victor, forcing him to sit down on the bench. Dr. Keeton, aware that her patient was under control at the moment, focused on Marilyn. “Mrs. Blake, I’m Dr. Keeton and this is a student doctor, Annabel Tilson. Do you think you need to see a pulmonary doctor right now? I realize you must have COPD.”
Marilyn again shook her head. Finally, in a small voice, she said, “No. This will pass in a few minutes.”
Dr. Keeton faced the nurse. “Okay. What on earth?” she asked.
“While down at this end of the hallway, I heard faint cries for help. When I ran in, he was wrapping this all around Mrs. Blake’s foot and shoe pedal, and tightening it like his life depended upon it. It was awful. I thought Mrs. Blake was going to have a heart attack!”
“Please send someone over to the medicine ward and grab a pulse oximeter to put on Mrs. Blake’s finger so we can check her oxygen status,” Dr. Keeton asked. “And stay here with her while we get Mr. Blake back to his room.”
The nurse used the intercom to relay Selina’s order and then went back to Marilyn as Dr. Keeton and Annabel went to their patient and, with the orderly, escorted him out the door.
“What were you doing back there to your mother?” Dr. Keeton asked.
Victor thudded his steps as if defiant to walk with them and scowled at the question. “Killing that snake, of course.”
“I neglected to see it,” Selina said.
He looked at her like she had three heads. “Climbing up my mother. They told me to strangle it.”
“Who did?”
He clammed shut and stayed that way even after they secured him in his room. After giving him a mild sedative, Dr. Keeton and Annabel left the room.
“I suppose if the risperidone is going to work, it will take time?” Annabel asked.
“He only had an initial dose of 2 mgs today,” Dr. Keeton said, “and the target dose is usually 4 to 8 mg per day. Plus, as you should know by now, it can take three oral doses for a patient to have a therapeutic level of a drug.”
“I hope we picked the correct choice,” Annabel said.
“So do I. There’s nothing better than watching a psychotic patient simmer down to normal behavior and go about a halfway normal life after being placed on the right drug and the right dose.”
Selina smiled. “Now, why don’t you go interview his mother for your H&P and rotation report? Obtain a thorough family history and perhaps some insight into Victor Blake’s past. After you’re finished, I’ll talk to Mrs. Blake about her son’s diagnosis.”
-----
Carrying the portable pulse oximeter with her, Annabel went back to see Mrs. Blake. The woman seemed more fatigued than before but without the acute shortness of breath. At least she had her oxygen back on and did not have her foot tied to the chair.
“Are you feeling better?” Annabel asked while placing the probe on her finger.
Marilyn nodded and gave her a warm smile. The oximeter registered 94% and she patted Annabel’s hand. “That’s normal for me,” she said.
“Good. Then you’re at your baseline.” She turned to the nurse nearby. “It’s okay to leave now. I’m going to ask her some questions.”
The nurse left and Annabel seized the opportunity to learn more about her patient. Perhaps his mother would reveal a strange childhood or perhaps the boy had been as average as any child on the playground. But she read the previous night that a family history of schizophrenia was a significant risk factor for a patient to acquire the illness.
“May I turn you around a bit so I can sit down,” Annabel asked.
“Yes, dearie. That would be fine.”
Annabel rolled the chair forty-five degrees, sat down, and took out her notepad. “Dr. Keeton will be in to talk to you about your son. She has a lot to tell you. He will be in the hospital at least a few days until we can get him therapeutic on a medicine we started him on. I understand you both live together. Has he been acting unusual lately?”
“Yes. He lives downstairs and I stay on the main floor. It’s just a small house. I usually see him once a day but not always. The last week or two, he’s been a bit scarce. Like taking care of the imaginary pets he’s acquiring.” She rolled her eyes. “Ha,” she added.
“What pets?” Annabel asked.
“Snakes. He said snakes. Collecting them and putting them in cages. He’s going off the deep end, I tell you.”
“Do you go down there?”
“It’s been a long time.”
“Did he say where he purchases them?”
“That changes like the wind. He buys them or finds them. Said he even found a rattler over at Eden Park.”
“He’s not trying to deceive you, Mrs. Blake. He believes what he tells you.”
“Oh. Then he’s gone loco, hasn’t he?”
“Mental illness is a terrible thing. We are going to do everything in our power to make him better.”
Marilyn looked straight into Annabel’s warm brown eyes. “Thank you. Me and him do depend on each other.”
“It’s what we’re here for. Now, tell me, is there any family history of psychiatric illness?”
Mrs. Blake narrowed her eyes in thought and shook her head.
“As far as you know, no one has had schizophrenia?”
“I don’t believe so, but I don’t know what that is. However, I had an uncle who died before the middle years. God rest his soul. He used to do crazy things the older he got. Told my grandmother a voice told him to go escort buffalo across the train tracks. Said the herd had to stomp over to the nearby town and crush the devil. So off he went and parked his pickup on the tracks to stop the locomotive so the non-existent animals could pass. That train came barreling right around the curve and made putty outta my uncle.”
Annabel swallowed hard. A gruesome way to die and it sounded like a psychiatric family history existed. “That sounds suspicious for a mental illness,” Annabel said. “He must have had schizophrenia.”
Marilyn adjusted the prongs in her nose. “So you think Victor believes in these crazy ideas he gets?”
“Yes.” Annabel thought about a study she had read about schizophrenia and genetics. The emotional climate of Victor’s family environment growing up had to have made a difference in his expression of the illness.
“Mrs. Blake, please tell me. Where is your son’s father?”
“Him? He’s the dickiest dick you’ll ever meet. Skipped out when I was pregnant with my second kid. But I lost it, so he needn’t have bothered. But I guess sooner or later he would’ve been gone anyway.”
“Perhaps. But your health hasn’t been kind to you.”
“Dearie, I don’t sugarcoat it. The damn cigarettes caused my lungs to turn into boric acid.”
“I’m glad you r
ecognize the role that tobacco played. And it’s good that your son also didn’t take up the habit. Now, if you think back to his elementary or high school years, do you think he did any bizarre things or heard voices in his head like he does now?”
“I don’t think so. But he’s been on a slow decline for the last two or three years and now he hasn’t worked in the last six months. He’s preoccupied more than ever downstairs. Like a hermit.”
Chapter 5
Annabel and Bob waited in the lounge for Selina or Joshua to dismiss them for the day. The two doctors attended a department meeting so the students buried themselves in textbooks. Since Dr. Keeton wanted Annabel knowledgeable in the significant side effects of the atypical antipsychotics, she used the time to read and study about them.
“I’ll clue you in,” Annabel said.
Bob sat on the opposite end of the couch with his feet propped on the table. He lowered his book.
“Dr. Keeton asked me to recite the major drawbacks tomorrow of the newer drugs that treat psychoses. I would hate for you to not be aware of them when the discussion comes up.”
He flipped to the back index and then turned to a different chapter. “Thanks for the heads up.” Several minutes elapsed and then Annabel wiggled out of her lab jacket.
“As far as I can tell,” Bob said, “the problem with the newer drugs is the possibility of causing a metabolic syndrome.”
“That’s what I read,” she said. “Since we haven’t rotated through internal medicine yet and I vaguely remember it from our first two years of classes, I’m reading about that now.”
Bob slid his feet off the table and sat sideways. “Tell me like you know it,” he said.
She smiled at his idea. “The syndrome consists of these four problems: obesity, dyslipidemia, hypertension, and glucose intolerance.”
“So let’s think of a way to shovel that information into our brains and cement it in.”
Annabel closed her eyes. “Let’s remember Victor Blake when we think about it. He starts taking risperidone and as we follow his progress, we start noticing he’s getting a little chunky, and then we discover his blood pressure is higher than one-forty over ninety, and then his lipoproteins in his lab work go askew, and then he’s becoming like a diabetic and his glucose is creeping up.”
Bob laughed. “I might as well just remember the obesity, dyslipidemia, hypertension, and glucose intolerance.”
Annabel broke into a big smile. “See. You just remembered it because of our Victor Blake discussion.”
“Nice work,” he said
The door to the room swung all the way open and Selina and Joshua entered. Annabel and Bob closed their books and gathered the cups and wrappers on the couch.
“You can go home, Dr. Washington,” Selina said. “See you in the morning.” She pulled a chair up in front of the coffee table as the resident disappeared out the door.
“Mrs. Blake went home after I explained schizophrenia to her,” Dr. Keeton said. “Poor woman. The day was as traumatic for her as it was for her son. That’s what happens sometimes. People unconsciously choose to ignore growing problems until one fine day the situation goes drastically wrong.”
Annabel nodded. “They both need medical supervision.”
“Mrs. Blake is followed in the pulmonary clinic,” Selina said, “so her condition is maximized as much as possible.” She leaned back and crossed her legs.
Bob scooped up the small garbage pile and tossed it in the can beside the couch. With no more discussion going on, he looked at Dr. Keeton and said, “Is there anything else you need?”
Selina brushed her hair away from her chin while a smile spread across her face. “Very good, Dr. Palmer. Although you said it earlier on the rotation than most.”
The two med students stole a glance at each other without a clue what she was talking about.
“You obviously didn’t know,” Dr. Keeton said. “‘Anything else you need?’ is the number one most used medical student catchphrase to try and go home.”
Bob gulped and Annabel frowned.
“But in answer to your direct question, I don’t need anything; it is you students who need something and that is experience. And secondly, yes, you may go home.”
-----
After Annabel and Bob exited the ward, Annabel giggled. “I thought we knew all the med school catchphrases but you used one we didn’t even know about!”
“Yeah, busted,” Bob said. “I did say it to encourage her to let us go. I guess you can’t fool someone skilled in the human thought process.”
“Maybe next time we should be more direct like ‘May we go home now to study?’”
They walked through the hospital lobby downstairs and out into pure sunshine. On the curb they took turns holding each other’s bags and slipped off their white jackets.
“The subsequent choice of words is up to you,” he said. “You’re spending more time with her than I am.”
“She’s interesting to observe. Do you know she has two sitting styles? A particular one when she’s with patients and another one for everything and everybody else?”
They stepped off the curb. “Are you one of her clones or are you becoming brainier?”
Annabel smiled at him and shrugged her shoulders.
“So are you going to tell me?” he asked. “Now that you’ve hooked the bait.”
“Yes,” she said, stopping at her SUV. She clicked the door opener and turned to face him. “With Mr. Blake or other patients, she sits tall but, in particular, she crosses her legs at the ankles. Otherwise, she throws one leg over the other at the knees.”
“I’ll take your word for it but henceforth I’ll watch her lower body maneuvers.”
“I’m going to start using her style when I’m with a patient. For sure, she’s observing me. Maybe it’ll be good for some brownie points.”
“Don’t concern yourself over extra credit. You’re off to a better start than our first rotation when that resident, Marlin Mack, harassed you.”
“Thanks,” she said with a smile. “See you in the morning.”
-----
Annabel took two steps at a time up to her third floor apartment in the quiet eclectic neighborhood that she’d become fond of and kicked off her shoes. She changed into casual clothes and sneakers and headed back out. Since she wasn’t a serious runner, she ran a moderate-paced two miles on the available paths alongside the Ohio River and then sat on a bench in a small garden park one block from her place. The run invigorated her and she felt pleased she did it. Perhaps as the rotation wore on and she began seriously working on her report, the opportunity would diminish.
As she observed the beauty of the manicured flower garden with a variety of rose bushes and mums of orange and gold, her thoughts roamed to someone whom she could not get out of her mind. She fell hard for the chief resident, Robby Burk, on her surgery rotation. Besides the knowledge that nothing did or could become of her romantic desire for him, thinking about him was like a domino effect: the more she contemplated him, the more she craved him. She imagined his milk chocolate eyes focused on her and remembered his trim and muscular body. Once when they stood at his office doorway he stroked her hair, sending her heart into a gallop.
Annabel wished there could be some resolution of her strong attraction for him. But really, she thought, the conclusion already existed. With the course over and no contact with him, he didn’t know she existed. Besides, she reminded herself, the skilled hunk of a surgeon was leaving the country next spring for one year … going to do philanthropic physician work for Global M.D.s. in Africa. The only opportunity to run into him in the next few months would be by accident around the medical campus or if a meeting was called by several health agencies to wrap up what they’d learned about an anesthetic drug. The new medicine had reared its unpredictable effects during her first rotation.
A boy and his dog came up on the nearby steps from the path below. They approached to walk through the park and the coll
ie stopped to sniff her shoe. She leaned down to pet her and then the dog rolled belly up. The youngster sat on the edge of the bench. “I love Sadie,” he said, also patting her head.
“I don’t blame you. Loving a dog is a lot easier than loving a person.”
“Do you have a dog?”
“No. I would if I could but I can’t.” Annabel smiled and he nodded.
“You can borrow Sadie if you ever need to.”
“You are so nice to offer. Thank you. She’s a sweetheart.”
“I must go now,” he said. “Bye.” Sadie popped up and after they took a few steps, the little boy turned and waved.
A short walk later, Annabel bought a ready-made chicken Caesar salad at the local corner café and brought it home. She put it on the kitchen counter. It could wait. She pressed the wake-up button on her cell phone, sat down, and opened up Findar. Not only was the social app the modern way to meet and find dating possibilities, but it was her answer to most dating problems she wanted to avoid such as taking time away from her studies and clinical commitments to find dating material. And now she didn’t want to invest that time and effort only to have some stupid relationship blow up in her face. Her other problem would be coming across men who are gold digging once they knew she was in medical school.
Sex had become so easy. And although she never broached the subject of Findar with fellow medical students, she knew the social app hookup culture was rampant for her generation in the big cities. Cincinnati probably ranked low on the scale of Findar kings and queens but, as a woman, she was becoming a master at the ‘text game’ where the best players were probably men. The key to the whole process was to lure members of the opposite sex – or the same sex for some people – into your bed on the basis of a few text exchanges, while letting them know a relationship was out of the question. And amazingly enough, she had felt no obstacle to physical intimacy despite there being a lack of an intimate knowledge of her sex partner.
Her last encounter using Findar for one-nighters, however, ended up being a surprise. She went to meet one man but, instead, two showed up. They had bright ideas about a ‘threesome,’ something she was not interested in, so she walked away from them. That’s why meeting men in public places made so much sense; they could take one step at a time the rest of the evening and maybe - or maybe not - sleep together.