by Robin Cook
“Oh, come off it,” Kim said, becoming angry himself. “Becky could have gotten sick whether you left town or not. In fact if she’s got a virus, she could easily have contracted it before the weekend when you were here.”
“I thought you said it was food poisoning,” Tracy said.
“That was just a statistical guess by a pediatric resident,” Kim said.
“Did Ginger make food this weekend?” Tracy asked.
“As a matter of fact she did,” Kim said. “She made a wonderful chicken dinner last night.”
“Chicken!” Tracy exclaimed. “I could have guessed. That must have been it.”
“So you’re already blaming Ginger,” Kim said mockingly. “You really dislike her, don’t you?”
“No, I don’t dislike her,” Tracy said. “Not anymore. At this point, I’m indifferent to her. But the fact of the matter is, she’s young and undoubtedly hasn’t had much experience in the kitchen. Those of us who have, know that you have to be very careful with chicken.”
“You think you know everything,” Kim said. “Well, for your information Becky hardly touched the chicken. Besides, she’d been feeling punk since Saturday morning. That means that if she’s got a touch of food poisoning, then she got it from the Onion Ring out on Prairie Highway, the place that your new boyfriend bragged to Becky that he owned.”
Tracy reached around Kim and opened the door. “Goodnight, Kim!” she said sharply.
“There’s something else I’d like to say,” Kim spat. “I resent you implying to Becky that I’m some kind of ogre for encouraging her to compete in the Nationals.”
“I never made a value judgment about your wishes for our daughter,” Tracy said. “When Becky informed me of her reluctance to face that kind of competition, I supported her. I also told her that you might try to change her mind. That was all I said.”
Kim stared daggers at his former wife. The air of psychological superiority she assumed whenever they argued enraged him, especially in this instance when she felt she had to warn their daughter about what he might say to her.
“Goodnight, Kim!” Tracy repeated. She was still holding the door open.
Kim spun on his heels and left.
SIX
Monday, January 19th
Kim’s alarm was set to go off at five-fifteen in the morning, but it was rarely needed. He usually awoke just before the alarm, which allowed him to turn it off before it could shatter the early-morning peace. Kim had been getting up before dawn ever since he’d been a first-year surgical resident. And this particular morning was no exception. He climbed out of his warm bed in the pitch black and dashed stark naked into the bathroom.
Following a routine that needed no thought, Kim pulled open the heavy glass door of the shower and turned on the water full-blast. Kim and Tracy had always preferred showering to bathtub bathing, and the bathroom was the only room they’d wanted renovated back when he and Tracy had first purchased the house ten years earlier. They’d had the tub pulled out, as well as its attached tiny shower stall. In their place a generous five-by-nine-foot custom shower was constructed. Three sides were marble slab. The fourth was half-inch glass, including the door that had vertically oriented, bright brass, U-shaped handles mounted as if they pierced the thick, tempered glass. In Kim’s estimation it was a bathing extravaganza worthy of a spread in a design magazine.
Breakfast was a donut and a cup of half-milk half-coffee that Kim stopped for at a Dunkin’ Donuts shop near his home. He ate while he drove through the morning darkness. He also used the time to listen to medical tapes. By six he was already in his office dictating consult letters and writing checks for various overhead expenses. At six-forty-five he was in the hospital for teaching rounds with the thoracic surgery residents at which time he made it a point to see his own patients. By seven-thirty he was in the conference room for the unavoidable, daily hospital meeting. That morning it concerned hospital credentials and admitting privileges.
After the administrative meeting, Kim met with the thoracic surgery fellows whose research he supervised and participated in. That meeting went over, so he was a few minutes late to surgical grand rounds, where he presented a case of triple-valve replacement.
By ten o’clock Kim was back at his office and already behind schedule. He found out that Ginger had booked emergency patients for nine-thirty and nine-forty-five. Cheryl Constantine, Kim’s office nurse, had the patients already in the two examining rooms.
The morning passed with nonstop patients. Lunch consisted of a sandwich that Ginger had ordered in. Kim ate while he went over cath results and X-rays. He also found time to return a semi-emergency phone call to a Salt Lake City cardiologist about a patient who needed a triple-valve replacement.
The afternoon was a mirror image of the morning, with back-to-back patients, including a few emergencies that Ginger slipped into the schedule. At four o’clock Kim took a short break to dash over to the hospital to handle a minor problem with one of his inpatients. While he was there he quickly did afternoon rounds.
Back at the office Kim vainly tried to catch up, but he never could. Several hours and a number of patients later, he paused for a moment to catch his breath before pushing into what was called examine room A. He used the brief respite to glance at the chart. He was relieved to see it was merely a routine post-op check. That promised the visit would most likely be a “quickie.” The patient’s name was Phil Norton, and as Kim entered the cubicle, Phil was already obligingly sitting on the examination table with his shirt off.
“Congratulations, Mr. Norton,” Kim said, lifting his eyes from the chart. “Your stress test is now normal.”
“Thank God!” Phil said.
And thank modern-day cardiac surgery, Kim mused. He bent over and examined the incision that ran down the center of Phil’s chest. Gently Kim palpated the raised ridge of healing tissue with the tips of his fingers. By such observation and touch Kim could accurately tell the internal state of the wound.
“And the incision looks great,” Kim added. He straightened up. “Well, as far as I’m concerned you can start training for the Boston Marathon.”
“I don’t think that’s in my future,” Phil joked. “But come spring I’ll certainly be out on the links.”
Kim gave the man a pat on the shoulder and then shook his hand. “Enjoy yourself,” he said. “But remember to maintain the change we’ve made in your lifestyle.”
“Don’t worry about that,” Phil said. “I read all the material you sent home with me. And I’ve taken it to heart. No more smoking for this fellow.”
“And don’t forget the diet and exercise,” Kim added.
“Don’t worry,” Phil said. “I don’t want to go through this again.”
“Now, it wasn’t that bad,” Kim joked.
“No, but it was scary,” Phil said.
Kim gave Phil another pat on the back, jotted a quick note on the chart, and left the examination room. He stepped across the hall to examine room B but noticed there was no waiting chart in the rack on the door.
“Mr. Norton was the last patient,” Cheryl said from behind Kim.
Kim turned around and smiled at his office nurse. He ran a tired hand through his tussled hair. “Good,” Kim said. “What time is it?”
“It’s after seven,” Cheryl said.
“Thanks for staying,” Kim said.
“You’re welcome,” Cheryl said.
“I hope this chronic overtime doesn’t cause you any trouble at home,” Kim said.
“It’s not a problem,” Cheryl said. “I’m getting used to it and so is my husband. He knows now to pick my son up from day care.”
Kim reversed direction and went into his private office. He collapsed into his desk chair and eyed the stack of phone messages he’d have to respond to before leaving. He rubbed his eyes. He was exhausted yet on edge. As per usual the stresses of the day had accumulated. He would have loved to play some tennis, and he vaguely thought about stopping in
at the athletic club on his way home. Maybe he could at least use a StairMaster.
The door to his office opened and Ginger leaned in.
“Tracy just called,” she said with an edge to her voice.
“What about?” Kim asked.
“She wouldn’t say,” Ginger reported. “All she said was to have you call.”
“Why are you upset?”
Ginger exhaled and shifted her weight. “She’s just rude. I try to be nice and all. I even asked how Becky was.”
“And what did she say?”
“She said just to have you call.”
“Okay, thanks,” Kim said. He picked up the phone and started to dial.
“I’m leaving for aerobics class,” Ginger said.
With a wave, Kim acknowledged that he’d heard.
“Call me later,” Ginger said.
Kim nodded. Ginger left and closed the door behind her. Then Tracy answered.
“What’s up?” Kim asked with no preamble.
“Becky is worse,” Tracy said.
“How so?”
“Her cramps are worse to the point of tears and there’s blood in her diarrhea.”
“What color?” Kim asked.
“For chrissake, what do you mean what color?” Tracy demanded.
“Bright red or dark?” Kim asked.
“Chartreuse,” Tracy said impatiently.
“I’m serious,” Kim said. “Bright red or dark red, almost brown?”
“Bright red,” Tracy said.
“How much?”
“How am I to tell?” Tracy responded irritably. “It’s blood, and it’s red, and it’s scary. Isn’t that enough?”
“It’s not so abnormal to have a little blood in diarrhea,” Kim said.
“I don’t like it,” Tracy said.
“What do you want to do?”
“You’re asking me?” Tracy questioned with disbelief. “Listen! You’re the doctor, not me.”
“Maybe I should try to call George Turner in Boston,” Kim said.
“And what is he going to do a thousand-plus miles away?” Tracy complained. “I want her seen, and I want her seen tonight!”
“Okay, okay,” Kim said. “Calm down!”
Kim paused for a moment to gather his thoughts. With George gone, he didn’t have any handy contacts in pediatrics. He considered having one of his internal medicine acquaintances take a peek at Becky but was reluctant. It seemed excessive to call someone out at night because of mild diarrhea of a couple days’ duration even if it were tinged with a small amount of bright red blood.
“I’ll tell you what,” Kim said. “Meet me over at the University Med Center emergency room.”
“When?”
“When can you be there?” Kim asked.
“I guess in about a half hour,” Tracy said.
“I’ll see you then,” Kim said.
Since he was only about ten minutes away from the hospital now that peak traffic time had passed, Kim used the intervening twenty minutes to return as many phone calls as he could. When he got to the emergency room, he discovered he’d still beat Tracy, so he stood out on the receiving dock and waited. While he stood there, several ambulances pulled up to the platform with their screaming sirens trailing off. Hurriedly the EMT’s unloaded a couple of patients in dire need of emergency care. One of them was being given CPR. Kim watched them disappear inside, and it made him nostalgically recall his days as a surgical resident. Kim had worked hard and had been rewarded by being told repeatedly he was one of the best residents who had ever come through the program. It had been a heady time and in many ways more fulfilling than now.
Kim was just about to use his cell phone to try to contact Tracy when he saw Tracy’s Volvo station wagon round the corner and pull to a stop. Kim dropped to the pavement and trotted over to the car as the doors were being opened. He went directly to the passenger side and helped Becky. She smiled at him weakly as she got out.
“Are you okay, Pumpkin?” Kim asked.
“My cramps are worse,” Becky said.
“Well, we’ll get them taken care of,” Kim said. He glanced at Tracy, who’d come around the car. Kim noticed she looked as irritated as she had the night before.
Kim led the way back to the platform and up the half dozen steps. He pushed open the swinging doors, and they entered.
As the major emergency room in a large, sprawling, Midwestern city, the unit was so jammed it looked like a busy, urban bus station. Monday nights tended to be particularly busy because of a leftover effect from the weekend.
With his arm around his daughter, Kim steered her through the throng in the anteroom where the main admitting desk was located and past the crowded waiting room. He was almost past the nurses’ desk when an enormous, Brunhild-type nurse stepped out from behind the counter. Her bulk effectively blocked Kim from proceeding any further. Her name tag read: MOLLY MCFADDEN. Her height was such that she just about looked Kim in the eye.
“Sorry,” Molly said. “You can’t come in here on your own. You have to check in at the receiving desk.”
Kim tried to push by, but Molly held her ground.
“Excuse me,” Kim said. “I’m Dr. Reggis. I’m on the staff here, and I’m bringing my daughter in to be seen.”
Molly gave a short laugh. “I don’t care if you’re Pope John whatever,” she snorted. “Everyone, and I mean everyone, checks in at the front desk unless they’re carried in here by the EMT’s.”
Kim was so shocked he was rendered momentarily speechless. He could not believe that not only wasn’t he being deferred to, he was being openly challenged. Kim stared disbelievingly into the woman’s defiant blue eyes. She seemed as formidable as a Sumo wrestler dressed in white. If she’d heard Kim identify himself as a member of the professional staff she gave no indication whatsoever.
“The sooner you check in, Doctor,” Molly added, “the sooner the girl will be seen.”
“You did hear me, didn’t you?” Kim questioned. “I’m a senior attending in the department of cardiac surgery.”
“Of course I heard you, Doctor,” Molly said. “The question is: Did you hear me?”
Kim glared at the woman but she was not to be intimidated.
Tracy sensed an impasse. Having an all-too-good idea of her former husband’s temper, she took it upon herself to defuse the situation.
“Come on, dear,” Tracy said to Becky. “Let’s follow orders and get you checked in.” She guided Becky back the way they’d come.
Kim shot one more nasty look at Molly, then turned and caught up to Tracy and Becky. Together they joined the ragtag line of patients waiting to check in. But Kim was still fuming.
“I’m going to complain about that woman,” Kim said. “She’s not going to get away with that kind of insolence. The nerve! I can’t believe it.”
“She was only doing her job,” Tracy replied, content to let the incident drop. She was relieved that Kim hadn’t caused more of a scene.
“Oh really?” Kim snapped. “Does that mean you’re trying to defend her?”
“Calm down!” Tracy said. “She’s undoubtedly just following orders. You don’t think she makes up the rules, do you?”
Kim shook his head. The line inched ahead. At the moment there was only one clerk taking admissions. It was her job to fill out the check-in sheet with all the pertinent information, including insurance coverage if the patient was not a member of AmeriCare’s health plan.
Becky’s face suddenly contorted in pain. Pressing her hand into her abdomen, she whimpered.
“What’s the matter?” Kim asked.
“What do you think?” Tracy said. “It’s another cramp.”
Perspiration appeared on Becky’s forehead and she became pale. She looked pleadingly at her mother.
“It’ll pass like the others, dear,” Tracy said. Tracy stroked Becky’s head and then used her hand to remove the moisture from Becky’s face. “Do you want to sit down?”
Bec
ky nodded.
“Keep our place!” Tracy said to Kim.
Kim watched Tracy lead Becky over to one of the molded-plastic chairs along the wall. Becky sat down. Kim could tell that Tracy was talking with her because Becky was nodding her head. Becky’s color returned. A few minutes later Tracy came back.
“How is she?” Kim asked.
“She feels better for the moment,” Tracy said. Tracy noted how little the line had advanced since they’d joined it. “Can’t you think of an alternative to this?”
“It’s Monday night,” Kim said. “A tough night anywhere.”
Tracy exhaled noisily. “I certainly miss Dr. Turner.”
Kim nodded. He rose up on his tiptoes to see if he could figure out why the queue wasn’t moving, but he couldn’t.
“This is ridiculous,” he exclaimed. “I’ll be right back!”
With his mouth set in a grim line, Kim skirted the people in front of him to reach the counter. Immediately he could see why they had not moved forward. An inebriated man in a soiled and wrinkled business suit was struggling through the process of checking in. All his credit cards had fallen from his wallet. On the back of his head was an angry scalp laceration.
“Hello!” Kim called out, trying to get the receptionist’s attention. She was an African-American woman in her mid-twenties. “I’m Dr. Reggis. I’m on staff in the department of cardiac surgery. I have my . . .”
“Excuse me,” the receptionist said, interrupting Kim. “I can only deal with one person at a time.”
“Listen!” Kim ordered. “I’m on the staff here . . .”
“It doesn’t matter,” the woman interjected. “We’re an equal-opportunity server. It’s first-come first-served for all routine emergencies.”
“Routine emergencies?” Kim questioned. It was a ridiculous oxymoron. All at once the idea of trying to talk to this clerk reminded him of the frustration of having to deal with medically untrained people when he called insurance companies or managed-care plans to get clearance for patients. That chore had become one of the truly exasperating problems of modern office practice.
“Please wait at the end of the line,” the receptionist said. “If you’ll allow me to concentrate and get these people before you signed in, I’ll be able to take your information sooner.” She then directed her full attention to the drunk. In the interim he’d managed to gather the contents of his wallet.
