by Barbara Ebel
“Hey,” his friend yelled.
Annabel snickered, knowing the two men had a humorous running commentary on Casey’s paramedic job. “Okay, Dad, thanks. Hate to dump you with the bad news. I’ll tell Mom my fun news.”
“Bye, honey. Your mom and I will fill each other in tonight.”
Danny handed Sara the phone, rinsed his empty mug, and headed to his car.
“Annabel,” Sara said, “what’s going on?”
“Bob and I got a dog last night. You all are going to love him.”
Sara furrowed her eyebrows.
“Put her on the speaker,” Casey said.
“You’re on the speaker now,” Sara said. “How and why did you get a dog? How will that work out?”
“For the time being, Bob and I are separated from the same schedule. Between the two of us, we think this can work out. We picked him out from a shelter. Another dog can’t replace Dakota, Mom, but I think this one may be good for me.”
“All right. I’ll give you and the dog and Bob my blessing. Take care of him and yourself.”
“What did you name him?” Casey asked.
“After one of my former patients, whose last name was Oliver. Casey, he’s the most gorgeous thing!”
“You sound happy about him. Give him a biscuit from Uncle Casey.”
“Thanks.”
Sara cut back in. “I haven’t asked you in a while. Are you and your sister talking to each other yet?”
Annabel hated to tell her mother what she didn’t want to hear. “Not yet.”
“You two are wasting precious time. She’s the only sister you have left.”
Annabel gulped. Her oldest sister had died, ironically enough from a medical problem which theoretically should not have happened. And she and Nancy, her younger sister, had had an argument and fallout.
“Mom, I’m not the one being immature.”
“Since you are older and the mature one, why don’t you take the bull by the horns and call her?”
“Mom, please, I tried already. Right now, I’m dealing with more blazing fires than her.”
“Okay, sweetheart.”
“Bye, you two. Hope to see you soon.”
“Bye yourself,” Casey said.
“Love you,” Sara said and hung up.
Annabel focused on the song the driver bobbed his head to. Blake Shelton crooned “I’ll Name the Dogs.”
Ha! she thought. She had named Oliver and hummed along just thinking about him.
-----
The driver dropped Annabel off. She was early and hoped to bump into Stuart before he left after being on call overnight. Better than hunting for him upstairs, she could spot him anywhere. In the hospital’s lobby, Stuart sipped a frothy cappuccino outside the coffee shop.
“You’re studying before 7 a.m.?” She rested her backpack on the table and added, “You’re amazing.”
“But not as dramatic as you.”
“What did you hear?”
“Probably rumors. You didn’t tell some nurse to give a patient 200 mgs of morphine.”
“You’re correct, but convince my attending.” Annabel pulled out a chair.
“I’m not assertive enough to speak up about certain issues, but if you need me to, I will.”
“Thanks, Stuart. Are you faring any better than me by doing the night hours?”
“My problem is I don’t like the subject matter.”
“Really? I assumed most guys looked forward to it. After all, I assumed since it has to do with female genitalia and your gender gets a hard on about that, they’d mostly love it … if I may be blunt.”
“Hey, all barriers about anatomy and sensitivity about discussing body parts and what they do go out the window in medical school. This is different. Seeing bulging vaginas with heads popping out and afterbirth is opposite than a turn on. And a resident told me last night what’s worse is doing smelly exams in the clinic on women with discharges and foul odors from bacterial vaginosis.”
“Oh, Stuart. That’s more information than I need. A resident said that?”
“Yeah.”
“Come to think about it, that’s a different perspective I didn’t think about. However, there are other areas in medicine that aren’t fun either. Take being a gastroenterologist, working in a GI suite a good deal of your time, and doing colonoscopies. Or being a urologist and sticking scopes up penises, especially the ones with venereal diseases or whatever.”
“See. There you go.”
“In any case, we’ve come across some bad attitudes. Why does it seem like the residents now are moaning more than usual?”
“Maybe they wouldn’t be happy no matter what they do. You know, burn out and all. Perhaps more of that is going on.” He licked his lips to clear off the steamed milk foam from his cappuccino while Annabel eyed his paper cup. Maybe she would supplement her earlier Keurig with what he was drinking.
Annabel leaned forward. “I miss you, me, and Bob rotating together. There is safety in medical student numbers. Who woulda thought?!”
“Speaking of Bob … do you know how he’s doing?”
“He’s following the predicted path of recovery from his tick disease. Next Monday, he goes back to internal medicine and finishes up and we embarked on getting a dog together yesterday.”
“How’s that going to work out for you?”
“I don’t have a clue, but we’re off to a decent start.” They both got up and Annabel slung her backpack over her shoulder. “I have the unpleasant task upstairs of trying to talk to Dr. Harvey in private about this accusation against me. Otherwise, it will never get cleared up.”
“I’m headed out. By the way, Amy Wagner’s induction is going along well and Bonnie Barker slept through the night on the ventilator. The medicine service is extubating her soon.”
“Thanks, Stuart. Catch you tomorrow, I hope.”
Annabel skipped the added coffee indulgence and went upstairs. She dumped her bag in the lounge, threw on her white jacket, and was still early. Before Dr. Harvey made an appearance, she hustled to the ICU and witnessed a great relief. A doctor and a nurse exited Bonnie’s room, where the young woman was devoid of her breathing tube.
As she walked in, Bonnie cleared her throat. Annabel remembered to scan the monitors; her patient’s vital signs registered as normal as if she was walking around a shopping mall. She wondered, however, what Bonnie was told about what had happened to her and how she would react to such information. She stepped to the bedside cautiously.
“Dr. Tilson, I made it, didn’t I?”
“You did. Believe me, I am as relieved as you are to find you awake and without breathing assistance from a machine.”
She leaned her upper body towards Annabel and her eyes widened. “If this traumatic experience had not occurred, I would not have seen the light.”
“What light?”
“Don’t say anything, but Tony talked to me. I realize what a super guy he is and how much he genuinely cares about me and Samantha. But I also heard that our baby is not one-hundred-percent well.”
“Yes, Sam has what’s called OI.”
“We must talk to the pediatrician. I bet Tony and I will become experts and do what’s necessary for our child.”
“What a positive attitude. Samantha is a newborn with two mature parents.” Annabel thought about the answer to the next question. “How do you feel about the wrong medicine you received yesterday?”
“Like I said, I learned something. It could have been a lot worse if you hadn’t come in my room to help me out.”
“A school of thought says that I may have caused it.”
Bonnie tilted her head and pursed her lips. “Is there any truth to that?”
“No, Bonnie. In a miniscule manner, it could be construed that I enabled the sequence of errors, but that’s a stretch. If I had done anything to overtly put you here, my conscience would be killing me and I would be questioning my presence here as a medical student.”
&nbs
p; For a moment, Bonnie put her hand on Annabel’s sleeve. “I believe you.”
“Thank you.” Annabel unwrapped her stethoscope from her neck. “Won’t Tony be relieved to see you this morning?”
“He may be here any moment. Crazy Tony didn’t even go home. I was told he’s over in my obstetric room sleeping in the chair.”
“He is dedicated.”
“Like a faithful dog.”
Annabel smiled. She thought of Oliver. Hopefully, he would be a dog that followed that description. “May I listen to your heart and lungs?”
“Absolutely. Do your thing.”
The two women laughed and Annabel placed her stethoscope over Bonnie’s right lung and told her to take a big breath.
-----
Annabel scrutinized Bonnie’s chart and gathered every update she could. Only one more lab was pending, an arterial blood gas ordered by the internal medicine doctor after he took out her endotracheal tube. She waited on writing a progress note until after formal rounds, if that was even going to occur.
After using the staircase back to the OB/GYN floor, she stumbled on Dr. Harvey getting out of the elevator. Her heart pitter-pattered in her chest and she ramped up the nerve to ask to talk to him.
“Dr. Harvey,” she said, “I am terribly uncomfortable with what transpired yesterday. May I talk to you about it further?” She grimaced with her selection of words. He could shut her down with her weak appeal.
“We covered the situation already, Annabel.” He kept walking and she stayed next to him.
“Dr. Harvey, this is extremely important to me. I am a rock-solid student who deserves to be heard. If you don’t mind, sir.”
Roosevelt glanced back over to the lounge where no visitors were in sight. He turned on his heels and wandered over beside a potted plant. “I’m listening.”
“Dr. Harvey, the morphine order did not originate with me. Clearly, the order to give it came from what was handwritten in Bonnie Barker’s chart by the resident. The absolute fact is that every person who looked at the chart had difficulty with interpreting it. Melba Fox interpreted the order her own way and I had little to do with her decision. I questioned her thinking, but she did her job of dispensing medication the way she saw fit. Honestly, Dr. Harvey, if I may be so bold. I’ve been implicated as the fall guy.”
Roosevelt listened more attentively than yesterday. The day was early and burdens had not yet sagged his shoulders or dampened down his toupee. “Hmm. I suppose medical students make good scapegoats. I remember being told to start an IV on an old man. He ended up slapping my hand. He told me he didn’t want no God damn medical school student touching him. I told him that even he had learned to crawl before he walked. I was accused of being disrespectful to him.” He squinted his eyes and repeated his “Hmm.”
Annabel took in a long breath, hoping his comment was because she’d made the situation better and not worse.
“I worry about our patient, how she is doing this morning, and how she is going to react to all of this.”
“I just rounded on her. She is off the ventilator and extubated. Her pulse oximeter registers an oxygen saturation of ninety-nine percent. Her lungs are clear, her heart a normal rhythm. Her CBC and electrolytes are normal and an ABG is pending. After discussing with her the events that happened, she is grateful that nothing worse occurred. She also knows about her baby’s diagnosis from her boyfriend, and wants to focus on her family.”
Dr. Harvey made no attempt to move. “What is her baby’s diagnosis?”
“She has osteogenesis imperfecta. The baby is being handled with special care and attention. Dr. Thomas seems to be an expert about the genetic disease.”
“The baby does have a rare problem. Did you know those babies sweat a lot?”
“I did not know that.”
“Somehow that fact stuck in my mind from doctor lounge talk with pediatricians.” He smiled, surprised he remembered, and added, “It appears you are multi-versed and up-to-date about your patient. And, it also sounds to me like she trusts you.”
Dr. Harvey nodded not once, but twice.
“Bravo, Annabel.”
CHAPTER 18
Ling Watson arrived in the lounge and scoffed at the board on the wall. Two new patients were written there, the black magic marker ink seemingly mocking her in big letters. “At least I don’t need to work them up,” she mumbled while she grabbed her white jacket off the coat hanger.
The ward secretary held a chart and peered into the doorway. “Good morning, Dr. Watson. Here’s this patient’s paper chart to refresh your memory. She was discharged a few days ago, but I’m supposed to tell you that electronic medical records has no discharge summary on her.”
Ling glared at her and pulled the chart out of her hands. “The day hasn’t even started.”
“Make it worthwhile then,” the woman said in a neutral tone.
“Smart-ass,” Ling muttered. She needed to dictate the discharge dictation as soon as possible, she thought, before the records department gave her a demerit like she was in grade school.
The phone rang several times. “Where the hell is everybody?” She yanked the receiver off the wall. “OB.” An ER physician advised her of an admission. “Why didn’t you page me?” she asked.
“I did,” the man said.
“Not that I’m aware of. I’ll be there when I can.” She hung up, snapped her pager off her pants, looked down, and frowned. She had not turned it on.
A nurse stepped in. “Is it okay if Dr. Fleming does an epidural in Room 4?”
“Wouldn’t I shout from the rooftop or write it all over the board if I didn’t want the patient to get one?”
The nurse didn’t flinch. “Is that a yes?”
“Yes, with a capital ‘Y.’”
“Moron,” Ling said after the RN stepped out. She turned around and glanced at the coffee pot. Empty as a sinkhole waiting for a car. “Damn it. Must I do everything around here?” She opened the cabinet above the counter and saw a bag of house blend sitting on a plate. After wrapping her hand around it and yanking it out, she realized too late why the plate was there. The bag was already cut open and coffee grinds flew everywhere … the counter, the floor, and her blouse and white coat.
She stood staring, the expletive curled on her tongue, ready to explode out of her mouth like she’d spit out putrid milk.
Caleb walked in and approached her from behind. He spoke softly. “I brought you a present since we didn’t wake up together at your or my place.” He held up a Dunkin Donut bag off to her side.
She spun around. “Do I look like some obese pregnant lady who stuffs herself with donuts? Spare me the gift. Decrease my eighty-hour work week instead.” Her voice rose and Caleb was taken aback.
“Unburden me of the exams,” she continued with more potency, “and the research, and the presentations. Get rid of my educational debts, the medicolegal pressures, and the relentless paperwork. Blow up the ineffective electronic medical systems and make the administrative intrusions disappear!”
-----
Annabel and Dr. Harvey walked toward the lounge. Annabel was ecstatic; she had taken her father’s advice and talked to her attending right away. Now … if the dynamics with the most important person on the team had improved, she hoped she had less to worry about him writing an unflattering clinical review of her at the end of the rotation.
Caleb Gash was ahead of them, strutting along with his canvas bag with books, papers, and whatever snacks he lugged in for the day. In his left hand, he dangled a brown paper bag. Annabel and Roosevelt caught up and he turned into the lounge.
Dr. Harvey stopped at the doorway to smile at the secretary and the RN at the desk. He jolted his head, his ears questioning the loud voice he heard just inside, behind Caleb, whose back faced the door. Annabel realized her attending was listening.
After Ling finished with the part about the obese pregnant ladies eating donuts, the eighty-hour weeks, the exams, and on to blowing up
medical records and making intrusions disappear, Dr. Harvey had had enough. He walked in.
“Not to mention,” Dr. Harvey said, startling both Ling and Caleb, “obstetrics is a branch of medicine affected disproportionately by medical malpractice. Insurance premiums of one hundred thousand dollars a year are becoming commonplace nationally. You have that to look forward to. Bad outcomes in obstetrics can lead to multimillion-dollar awards.”
Caleb stood there with a silly grin. Ling moved her head to the side at first with a questioning expression. But then she surmised that her attending really realized how crappy she had it.
“That too,” Ling said.
Roosevelt stared at the coffee grinds splattered on her clothes. Annabel glanced at the spillage sprinkled all over the floor. Caleb slid the donut bag on the round table beside him.
“Dr. Watson,” Roosevelt said. “I want you to do these things in order. Write up a medical error incident report on the Motrin order you wrote yesterday for Bonnie Barker. Don’t write down any ‘hearsay,’ only the facts pertaining to your part in it. Then, straight away, go over to the OB/GYN department office. Wait for me there. It may be some time because I need to round on the patients here first. You can leave now.”
Ling’s mouth opened with surprise. Why was he instructing her to leave the ward when there were patients to take care of? Plus, she wanted to make her coffee and then clean up the mess. She hesitated, but Dr. Harvey held his ground. She had a bad feeling about this.
She stepped past them and found the courage to walk out to the desk. She asked the secretary for the necessary papers to fill out her report.
Roosevelt proceeded to address Caleb and Annabel. “You two meet me upstairs in the ICU. Based on Dr. Tilson’s progress report on Ms. Barker this morning, I believe we can transfer her back down here. We’ll start there. I won’t be far behind you.” He grinned, glanced at the brown bag, and back at Caleb. “Mind if I help myself to that donut?”
