by Barbara Ebel
Mr. Miller’s mouth fell open. “Oh my God. I expected you to say something about twenty-five or fifty-year survival rates over ninety percent!”
The man quickly exited the room, as there was no containing the grief he felt and the sobbing that tried to rack his body. Dr. Gillespie followed and Annabel minded Stephanie. She had been close to a cancer patient before during internal medicine, but a young child was a different ball game.
She gave Stephanie a hug from behind. “I promise you I’m going to buy you another stuffed animal that can be best friends with Panda. How does that sound?”
A smile lit up her face. “I will give the present to my Daddy.”
“You keep the new panda. We can get one for him too.”
CHAPTER 12
Annabel opened the office door at the end of the day to a misty rain and low-lying clouds that floated above the taller buildings. Although her SUV was parked close, she made a quick dash, scooted in, and placed her things on the passenger seat. First order of business was to pick up Oliver from Bob’s apartment since Bob was hauling an overnight call. She decided to dig in her backpack outside compartment for his key and put it in a cup holder.
Frustrated at the several zippered pouches, which mostly held extraneous items like extra pens and mints, she couldn’t find the key. It was hard to suppress a smile sitting alone in the car, because all she could think of was Rowan Atkinson in Rat Race, exclaiming with bulging eyes to a baby on a plane, “The key! What did you do with the key?”
She suppressed the laughter. In essence, it was no fun not finding the key that she was supposed to have packed. She rolled her eyes at herself and grabbed her phone to text Bob.
“You can’t believe what I did. Too stupid!”
There was no choice but to wait for his answer, but she still sat contemplating what to do next.
“I give up. What?” he finally responded.
“I forgot your key. I’m closer to the hospital than I am to my apartment. Can I drop by and steal yours?”
“Sure. And watch my team’s real hospital pediatric medicine in action.”
“I’ll text when I arrive.”
Annabel entered the back entrance to the hospital and scurried through the ER, where the pandemonium of the late day was palpable. She texted Bob at the elevator doors, which prompted a real call from him.
“Hey, come on up. My chief resident is going to conduct quick rounds soon, so I am set to hurriedly check on all my patients. I’m starting on the ortho ward, where I have one consult. Meet me there.”
The doors opened and she got off on the fifth floor, where Bob was perched on the armrest of a lobby chair underneath a banner that stated “It’s summer. Don’t break your bones!” His index cards held him captive, so Annabel reached into her lab jacket, which she’d purposely left on, and pulled out the box of chocolate-covered blueberries she had stashed for him. She couldn’t see his rich blue eyes yet, only his blonde locks. She had to admit they were a crowd pleaser in and of themselves.
“You plan on that, don’t you?” she asked.
He jerked his head up. “Hey. Plan on what?”
She nodded above him.
“Ha! One medical problem in the last few months was enough, thank you. No broken bones for me.” As he stood, he smiled, and then nodded towards the hallway.
“Walk with me.”
“You’re busy, I can tell, and the ER will most likely not give you a break tonight.”
“It better. After all, we’re going to the fair in the morning.”
He dug in his pocket as they walked. Annabel did the same and they stopped outside Room 532, where the door was shut.
“We’ll trade,” Annabel said, handing him the box of chocolates. “A night on call will be blessed if you have these.”
Bob’s face lit up while he forked over the key. “Thanks. You can forget my apartment key any time.”
“Except that stupid me is keeping Oliver waiting.”
“He’s lucky to have us. We’re responsible dog owners.”
The brown door popped open and a bespectacled woman came scurrying out. She ran straight into Bob and Annabel. “I guess all you students work together,” Anne Owens said and looked specifically at Annabel. “Do you always come to the hospital after your medical student assignment in the pediatrician’s office? I had no idea students have that much on their plates.”
At first, Annabel couldn’t place her. Then it came to her … a parent of one of Dr. Gillespie’s patients that they’d seen earlier in the week. She wondered what she was doing here.
“Unlike my med student friend, Dr. Palmer, I won’t be here long,” Annabel responded.
Anne Owens nodded. “Toby is just not himself in there. I suppose that his leg fracture is a bigger deal than I thought.”
“I’ll check on him and my team will be around later,” Bob said. “Are you leaving?”
“Yes, I’m heading home after being here all day. Plus, I need to eat a real dinner.” She pushed her glasses up on the bridge of her nose and eyeballed each one of them.
“Will your husband be visiting Toby this evening?” Bob added.
“He’ll be by in the morning, especially if Dr. Castle decides to discharge him. Jack owns and manages his own hardware store and, unfortunately, they stay open late on Friday night.”
“Not a problem,” Bob said.
“Good night, then.” She turned and weaved her way past patients with crutches and wheelchairs.
Annabel faced Bob. “Leg fracture? Dr. Gillespie saw him on Monday for his school physical and gave him a clean bill of health.”
“Last night, he was in the back seat of a car that got side-swept by another vehicle. Broke his fibula.”
“What bad luck. Does your team or the orthopedic surgeon think it will jeopardize him starting school on time?”
“It really shouldn’t. The only reason he’s still here is that we’re erring with caution to discharge him since he’s running a fever, but I also don’t know how his physical therapy went this afternoon.”
Bob took a step. “I’m popping in. Come say hello.”
The television volume was low in the room, set on an old Lassie black and white episode. Toby’s eyes were at half-mast as he tried to maintain an attention span as good as the dog’s.
“Toby,” Bob said, “instead of one medical student visiting you, there are two.”
The youth stirred and glanced over at Annabel.
“Remember me?” she asked. “At your pediatrician’s office?”
Toby narrowed his eyes. “I do. Dr. Gillespie doesn’t always have female medical students in the room with him. Mostly guys.”
“That’s changing. There are more women going into medicine.”
“Like Dr. Clark. Recently, I suggested to my mom that she change me over to her as my doctor, but she said that would be tacky.”
“Your mom knows best. Look at it this way. When you get older, you can pick and choose your own doctors.”
Bob stood at the bottom of the bed and reread Toby’s vital signs from the clipboard. “How did physical therapy go today?”
Toby shrugged his shoulders. “Not too good. She kidded me that I complained too much and that I was a slacker, but my legs were too tired to cooperate.”
“She’s the boss over that.”
“Can I butt in?” Annabel asked.
Bob waved his hand forward and Annabel added, “You said ‘legs.’ I thought you only fractured one leg, which is enough. So what do you mean that your ‘legs’ were tired?”
“Like I told you the other day, my muscles are achy.”
Annabel and Bob looked at each other and considered his statement. “Hmm,” she mumbled. “You did.”
“I’m going to listen to your chest in a minute,” Bob said, “but I better walk Annabel to the door. She has to go mind our own Lassie, our own dog, at home.”
“Oh, are you two married or something?”
Annabel tilte
d her head while Bob peeked over at her.
“Why? Do we look like a couple?” Bob’s face lit up.
Annabel didn’t wait for the boy’s response. “Toby, nobody gets married during medical school!”
With indifference, Toby shrugged. “Well, if y’all take care of a dog together, I just thought …”
“It’s okay,” Bob said. “We understand. I’ll be right back.”
Annabel followed Bob to the hallway, a bit embarrassed about the marital remark. She realized that from his perspective, Toby’s remark made sense. After all, how many households shared a dog between them?
“You’re probably right,” Bob said. “Not many students marry in medical school, but there are quite a few that tie the knot in residency.” He searched her face.
Annabel sighed. At least the conversation had shifted to medical colleagues other than themselves. “I wonder how many of those work out in the long run.” She glanced back to the room. “You know, with the aches he’s been complaining about, maybe he’s got some type of cold or early flu.”
“It could be. Unfortunately, if it is, that will slow down the orthopedic agenda his surgeon has ordered for him.”
She glanced at the key in the palm of her hand. “I better go give Oliver his walk before taking him home. To my place,” she added with a smile. “Would you like to meet Oliver, Dustin, and me at eleven at the fairgrounds?”
“Sure, at the pet show registration table. I’ll check with Nell if we’re going to carpool or meet there. And please leave my key under the doormat.”
“Sure thing. See you tomorrow morning.” She turned while Bob went back into Toby’s room. She hoped Bob would get some sleep on call or in the morning before showing up at the fair. Nell might be tired too, but if anyone was going to be up more during the night, she hoped it would be her and not Bob.
-----
When Bob returned, he dangled his stethoscope from his hand, noticed the television was turned off, and that Toby’s food tray was untouched. “You didn’t finish your dinner, or I should say, you didn’t even start it.”
Toby gave him an imploring glance and waved his hand toward the emesis basin on the nightstand.
“Quick,” Toby said and lurched his head forward just in time for Bob to propel the bucket in front of him.
Bob watched and waited, but what came up from Toby’s gut wasn’t much. It didn’t surprise him, since he hadn’t eaten anything. Bob handed him some tissues and removed the pan.
Toby wiped his lips and then narrowed his eyes. “Dr. Palmer, I’m getting a headache.”
“Do you ever get headaches?”
“Not really.”
“Let me examine you and then I’ll ask my resident if we can order some labs on you.’
Bob checked Toby out even more thoroughly than his first H&P. His eyes, ears, and throat looked fine and his lungs sounded fine. His heart rate was up more than a resting heartrate.
“Chances are, you’re dehydrated,” Bob said. “We can also advise the orthopedic docs to restart the fluids you were receiving. I’m glad they kept that heplock in your hand.”
Toby sighed. “For once in my life, I would like to start back to school. It would be better than being here.” He clasped his hand over his forehead.
“I’m sorry you’re having a rough time, Toby. We’ll get you straightened out.”
Bob hastened out the door. Dr. Mares was probably in the ER. He needed to go pick his brain.
-----
Annabel stuck her SUV into a tight spot at Bob’s apartment complex and hurried. When she scurried down to his door and unlocked it, Oliver sat there with his big Australian Shepherd happy face.
“How come you can be so tolerant of us humans keeping you waiting to relieve yourself?” She glanced around as she grabbed his leash and didn’t notice any accidental messes. “Oliver, you’re such a sweetheart. Let’s go.”
They walked away from the apartments for a decent stroll and then decided to step back into the apartment and leave Bob a note. Oliver lapped from his water bowl as she scribbled on a piece of paper “Hope you got some sleep!” and left it on the counter.
The dog sniffed at his food bowl and looked up at her. “You poor thing. You’re due for dinner and I kept you waiting on that too.” She opened Bob’s pantry, scooped out his dry food ration from the bag, and trickled the kibbles into his bowl. “Here you go.” She gave him an emphatic “okay,” and Oliver’s muzzle lowered and began slurping up his meal.
Annabel stepped to Bob’s oversized chair, nestled into the leather comfort, and plopped her legs on the ottoman. She had to laugh at how wonderful it felt, especially since Bob had bought secondhand furniture from a local on-line site.
Oliver ate every last morsel, came over to join her, and pushed his back against the chair. He nodded his head backwards towards her, demanding that she pet him. Her hand settled on his fur, and soon her fingers were immersed in his soft hair, rubbing with gentleness and love for the pet they had both taken into their lives.
It had been a hectic day, so she willingly welcomed the peace and solitude. She closed her eyes and could not find the strength to reopen them.
-----
In the ER, Bob clutched a handful of curtain and peered in the cubicle at Dr. Mares seeing a patient. Linnell stood on the other side of the stretcher, so he knew this was her admission to work up and follow. He was glad for that because, right now, he wanted to follow through with Toby Owens.
Rick looked over, stopped looking at a little boy’s rash, and stepped outside the curtain.
“Sorry to barge in,” Bob said.
“My team of medical students this time is very dependable. You would not have interrupted if you thought it wasn’t important.”
Bob felt like a higher-up on the totem pole because Rick Mares treated him like he was a resident. He wished all the chiefs treated their students like him.
“Dr. Mares, we thought Toby Owens was a straight-forward consult from the orthopedic department, but he may be turning out to be a quagmire.”
“Tell me in medical terms, Dr. Palmer.”
“Toby is still running a low fever and he’s not eating. He vomited once or twice and continues to have muscle aches, which absolutely started earlier this week before his fracture. Annabel Tilson, a med student friend of mine, is rotating in the pediatrician’s office and assured me of that because he went there for his school physical. Also, when I just saw him, he’s complaining about a new onset headache.”
“What do you suggest we do, Dr. Palmer?”
“First, I would order a full set of labs. Check his BUN and creatinine and see where he stands as far as hydration. Also a CBC. I did not see a note in the chart today mentioning the surgeon taking a look at the fracture site. Maybe they missed something after the closed fibular reduction; maybe there’s an infection under his skin.”
“Yes, order the labs and I’ll co-sign your order. Don’t write a note about your specific infection concern in the chart. Dr. Castle is thorough; he’s on call tonight like us, so hunt him down and ask him about that. And, Dr. Palmer, don’t be so surprised at my acknowledgment of your concern. You are beginning your fourth year of medical school, your residency specialty selection is imminent, and match day is right around the corner from that. You will be sharing more direct patient care sooner than you think.”
Bob left with more purpose and mulled over Rick’s words, which made him more confident. It had been months since he’d done his general surgery rotation and been near the OR, but it was the most likely place to find an on-call orthopedic surgeon on a Friday night.
The OR charge nurse at the desk pointed behind the OR doors. She read Bob’s name tag. “If you must talk to Dr. Castle, Student Palmer, he’s in Room 7.”
Wanting to get his question answered, Bob changed into scrubs, donned a mask and bonnet, and entered the ortho room. Not being able to approach the sterile field, he lingered to the side. Anesthesia was busy at the head
of the table, and there was a full group involved with the case.
“And who do we have here?” Dr. Castle asked from his peripheral vision.
“I’m Bob Palmer with pediatrics. Just a quick question. I’ve been writing medical students notes on Toby Owens. Not to be presumptuous, but he has a fever and some other vague flu-like symptoms. Just want to cross off the possibility of an infection at his fracture site.”
“Looked at it myself today. All’s well with his closed reduction and the area around it. Does Dr. Mares have you tied up right now? Want to watch an ORIF?”
“I haven’t stood in on any ortho procedures and certainly not an open reduction and internal fixation. I’d love to. Until Dr. Mares calls me, of course.”
A male adult patient was under anesthesia and his right leg was exposed between the sterile blue drapes. Bob gulped with the bloody mess and hardware, which made him think of an assembly line for parts in a car factory.
“This fellow’s left tibia took the brunt of a free-for-all this afternoon at a soccer game. We use rods and plates, and metal screws and pins to fix the broken bone. A lot different than Toby’s accident, where his fibula was set in a closed fashion.”
Bob thought this was a lot more amazing than general surgery. He checked to absolutely make sure his beeper was on the waistline of his scrubs in case Dr. Mares needed him. During the next hour, he stood in awe of Dr. Castle’s open reduction and internal fixation. It seemed like the chief resident and his first-year resident were also enjoying themselves; that their surgical efforts gave them utmost gratification by the end of the case. Their patient was brought out from under his anesthesia with hardware sticking out of his leg and on the way to a healed bone.
CHAPTER 13
Dustin Lowe absent-mindedly leaned against his desk with a cup of coffee instead of rolling out his chair and settling in front of the computer. The police station was busy for a three-to-eleven shift but not as hectic as a lot of typical Friday nights. Whoever had brewed the coffee made it extra strong and he was half bent on pouring it down the drain. He plucked his iPhone out of a snug shirt pocket, set it to the side of him, and tapped the screen. It came alive, but there was still no return text or call from Annabel.