by Barbara Ebel
“Give us a summary,” Dr. Mejia said to Jordan.
“I had family concerns that day. I had to skip the lecture.”
“Family concerns? Right after you were sprung from the wards and supposed to be on the medical campus?”
“The timing wasn’t perfect. I didn’t want to ask Dr. Schott if I could leave early.” He began rubbing one thumb over his other hand.
“We know Dr. Palmer was there,” Dr. Mejia said. “Annabel, tell us the gist of the lecture.”
“A patient presented with thrombocytopenia and an interesting, sudden mononucleosis-like illness. One thing the team thought was that he had ITP or idiopathic thrombocytopenia, but when they did laboratory testing to search for a secondary cause, they discovered he had HIV. The lecture was all about human immunodeficiency virus.”
Dr. Mejia nodded, fell silent, and narrowed his eyes at Stuart. “What about you?”
“We learned that PJP is the most common opportunistic infection affecting AIDS patients, sir, and very difficult to diagnose.”
“Tell your fellow class-cutter what that stands for.”
“Pneumocystis jirovecii pneumonia.”
Dr. Mejia pointed down the hallway, ready to resume seeing patients. He ignored looking again at Jordan as they turned and walked alongside Dr. Schott. “You have a quiet, smart student and an arrogant young man who later on will probably give doctors a bad reputation.”
Annabel and Bob were directly behind them and couldn’t believe their attending spoke without discretion; they wondered if Jordan and Stuart overheard him.
“There are also two fine students who work synergistically with each other,” Dr. Mejia added.
Annabel and Bob glanced at each other and smiled. She dug her fingers into the espresso bean’s box in her white coat, pulled out a few, and shared them with Bob.
-----
“Did anyone talk to the pulmonologist about May Oliver’s bronchoscopy results from yesterday?” Dr. Schott asked as they rounded the bend to the nurse’s station.
“They were still working on slides yesterday afternoon,” Melody said.
Up ahead, the lung doctor sat hunched over May’s chart and looked up at them with a glum face.
“Uh-oh,” Annabel said for all to hear. Earlier, she had no biopsy news and tactfully told May that pathology results often take time. Now she dreaded hearing what Dr. Cantrell had to say.
The team reached the counter and Dr. Schott sat beside her while the others huddled around them.
“I retrieved good lung samples yesterday,” Dr. Cantrell said, “and the pathologist’s findings are crystal clear. Mrs. Oliver has cancer; which is no surprise. Unfortunately, it is adenocarcinoma.”
A shudder ran through Annabel. Because of her reading and studying so far on the topic, she wished May had one of the other types of lung cancer. This was dire news for the young woman.
“We were afraid of that,” Dr. Schott said. “She fits the profile; young and never smoked.” His eyes glossed over as if he had received bad news himself.
“Too bad,” Dr. Mejia said. “We will continue to need your assistance with the case. Any input for our patients’ treatments will be appreciated. This diagnosis, however, now turns our attention to the fact that she may have metastases. Before we start doing anything invasive on her lung or getting into chemotherapy or radiation, Dr. Burg and Dr. Tilson need to start looking at other organ systems.”
“I agree,” Dr. Cantrell said. “Before I make recommendations, we will need to find out what she wants to do and if her disease has spread. I haven’t told her anything yet.”
“We’ll inform her of her diagnosis right now,” Dr. Schott said.
The pulmonologist nodded, handed him May’s chart, and the team headed to May’s room.
May had positioned the bedside chair facing the window and she sat with her feet propped on the heating duct, staring out the window. Clouds swept along the sky and the sun intermittently shone on the scarce amount of snow on the grassy sections of the parking lot. She didn’t move when they gathered beside her bed; she only turned her head to the side.
“Mrs. Oliver,” Dr. Mejia said, “Dr. Schott discussed your case with the pulmonologist.”
“I figure if it was okay news, you all would have told me already,” she said glumly. She wore a sweatshirt and sweat pants and shuddered beneath them with a chill.
“May,” Dr. Schott said, “I’m afraid the lung tissue biopsy that Dr. Cantrell took is significant for lung cancer.”
May went back to focusing out the window. “Strange,” she said after a prolonged silence. “I sensed bad news. What did I do, health wise or otherwise, to deserve this?”
“More than likely, nothing at all,” Donn said. “Your type of cancer does not need a precursor of bad habits.”
“It figures. What’s it called anyway?”
“Adenocarcinoma.”
“I’ve heard of that. So, where do I go from here?”
“We need to know the extent of it. In other words, has it traveled to other parts of your body?”
She turned her head and opened her eyes wider. “It may not only be lung cancer? It could be other places? That’s a horrific idea. I’m shocked enough with being told what I suspected. I don’t understand how I’m going to wrap my head around that.”
“You have a lot to think about. Dr. Burg and Dr. Tilson will be ordering some tests, however, which will let us evaluate other areas of your body. Is that okay?”
May closed her eyes and nodded. The team retreated in silence but, outside the door, Annabel touched her chief resident’s sleeve. “Do you mind if I spend a moment with her? I’ll catch up.”
“Go ahead,” he said. “We’re going to Darlene Pratt’s room and you can meet us there.”
Annabel walked back in and squatted next to May’s chair. “I believe I know what you’re feeling,” Annabel said. “Shock, despair, anger that it happened to you, maybe even some denial. Absolute sadness that your own body is a host to cancer.”
With skepticism, May turned towards Annabel. “Yes, but on top of it, I’m too damn young.”
“So am I.”
May narrowed her eyes and tilted her head.
“I was diagnosed with malignant melanoma a few months ago,” Annabel said. “I experienced all those emotions: rage, disbelief, despair, etc. You believe the universe signaled you out and dealt a death card.”
May leaned closer to Annabel. “What did you do? Do you still have the same diagnosis?”
“I had surgery. The lesion was fully removed. Although I have a clean bill of health, the threat will always be in the back of my mind. However, now I appreciate life in a more spiritual and potent way.”
May swallowed and took Annabel’s hand. “Thanks. I hope I turn out as lucky as you.”
Annabel patted her hand. “You’re welcome. Be optimistic, May, and we’ll keep our fingers crossed.”
When Annabel hurried back to her team, her insides twisted in a knot. May looked too terrible to simply be harboring the single lesion in her lung. Sometimes it didn’t take a big “workup” to figure out when someone was not well at all.
-----
Inside Darlene Pratt’s room, the elderly woman pushed her daughter’s hand off of her hair. Annabel watched from the side as her agitation grew worse and she began hitting into the air, aiming at her daughter.
“Mama, stop it,” Gloria said. “All I’m trying to do is brush your hair.” She put the brush on the bed and turned to the team. “This kind of behavior from her is escalating.”
“Let’s address that,” Dr. Schott said. “In the meantime, Dr. Tilson can give us an update.”
Annabel stepped between Bob and Jordan. “Mrs. Pratt has been afebrile for forty-eight hours and her IV course of antibiotics ends today. The results this morning of yesterday’s urine sample appear to be clear of a UTI. When I examined her this morning and palpated her lower abdomen, she had no guarding. All her other lab work
appears normal and her dose of carbidopa/levodopa seems to be well tolerated; the efficacy of her medication is not declining.”
“Which would be a problem if it were,” Donn said and turned to Gloria. “Mrs. Pratt, do you believe your mother’s cognitive function is growing worse?”
“Her mental status deteriorated the last few years but, yes, now it’s jumped to another level. Sometimes I think she’s gone crazy over and above her disease.”
“She’s back to baseline as far as why she came to the hospital and we can prepare to send her home. However, why don’t we have psychiatry come by and evaluate her again? They saw her in the past; they’ll be able to judge her progression and offer suggestions.”
“Sure, send them on. The sooner the better so I can get Mom home and we get back to a routine. I need to work, you know.”
“Consider it done,” Dr. Mejia added.
-----
With the day behind them, Stuart picked up his things from the office right after Jordan left. “Good night,” he said. “See you both tomorrow.”
“Later,” Bob said and reached over and grabbed Annabel’s bag.
“We’re getting out at a decent time,” he said. “How about getting a bite to eat together?”
“Sure. Do you mind if we go to my neighborhood coffee shop? They sell sandwiches and salads and the place is close to home for me and not out of the way for you.”
“All right,” he said. They took the stairs and they both rushed in the cold air to their cars. “See you there,” Bob said.
Annabel parked two streets over from her apartment and trudged up the hill to the corner coffee shop. She pulled her warm hat further over her ears and smiled at the cloudy condensation from her breath. At the corner, Bob came from a different direction and they went in, giggling as they hurried into the warmth of the shop.
They piled their things against the wall and, after sitting at the nearest wooden table, Annabel handed him a single-page menu. “Here,” she said. “And there are other items listed on the blackboard. But we order up there.”
The young manager Annabel knew from before smiled from behind the counter as they approached.
“So your first date obviously went well,” the young man said.
“Huh?” Bob said.
“Oh, no,” Annabel said. “The date got mixed up and we never met.”
“That’s too bad. Maybe it was a blessing in disguise. Well then, this must be your fine friend that you bought the special purchases for.”
Annabel laughed. “Yes, you have a good memory.”
“Special items?” Bob asked.
Annabel laughed again and pointed below to the wooden cubbyholes at the counter filled with snacks. “He sells our espresso beans and blueberries.”
Bob smiled. “Then it’s my turn to stock up. We thrive on these when we’re in the hospital. Between us, it is an expression of friendship.”
“Quite a friendship.”
Although she didn’t know why, Annabel felt her cheeks reddening. “Are you still serving some soup?” she asked.
“Broccoli cheddar. And with a grilled cheese Panera, you’ll be ready to study tonight together.”
“I’ll take the soup and sandwich,” she said.
“And make that two,” Bob added, “with a hot chocolate.”
“I’ll take a hot tea,” Annabel said.
Bob insisted on paying. “Not a big deal,” he said. “You stashed us with snacks so forget about it.”
Annabel shrugged. “Thank you.”
They went back to the table and Annabel made herself ignore her cell phone. Robby had still not contacted her since their failed date and she had likewise kept from contacting him.
CHAPTER 11
“We could do what the manager suggested,” Bob said while shaking salt and pepper on the broccoli soup.
“What’s that?” Annabel asked.
“Study together tonight. You’re right down the block and we both have our books.”
“We could, but you’ve never been to my small place. All I have is one comfortable chair, a desk chair, and two kitchen stools to sit on. But besides that, I hesitate because of what Karla might think of us studying in my apartment.”
“When it comes to our training, she’s been under similar circumstances. The sexes merge when it comes to call rooms and study habits. In any case, she’s so busy these days, we’re lucky if we get together once a week.”
Annabel picked up her sandwich and took a bite. “How can such a simple grilled cheese taste this special?” she asked.
“Because you’ve hungry and it’s damn good.”
She nodded in agreement and steeped the tea bag. “Is there still a spark between the two of you?”
“I don’t know. You posed a thought-provoking question. But as far as studying, I don’t mind sitting on your desk chair for an hour.”
“Not tonight. I just want to kick back on my bed and do some reading there. And by the way, that was brilliant what you did on rounds.”
“What did I do?”
“You finagled the subject of this week’s grand rounds into the discussion without mentioning the topic. You ensnarled Jordan with Dr. Mejia because of his lack of attendance. I can’t think of any student more deserving to be tripped up.”
“He embarrassed himself and got what he deserved. Maybe he’ll stop being intellectually arrogant.”
“I doubt it. His God-syndrome is probably going to grow worse.”
“Dr. Mejia made a revealing discovery, however, which I never thought about. His comment bodes well for us studying together too.”
Annabel arched her eyebrows.
“He diagnosed how we work together. He didn’t say we’re symbiotic, which is a cooperative relationship, but he told Dr. Schott that we work together synergistically. We produce an effect together greater than the sum of our individual contributions. Can you believe it?”
Annabel poised her soup spoon. “I heard that and couldn’t discard it like he was simply making conversation. We’ve spent so much time together on rotations, we’re becoming like intuitive twins.”
“Not just time on rotations. We’ve been through some harrowing situations and have dealt with, and consoled each other, over a number of patients. Even an attending.” Bob frowned and handed Annabel a napkin from the dispenser.
“So true.” She stared out the window a moment and added, “My dad never told me medicine would be this gut-wrenching. No wonder doctors are accused of being unsympathetic. They have to become cold to all the emotional trauma or they themselves would become basket cases and unable to treat patients and remain objectively neutral.”
“We’ve kept empathy, Annabel. The key must be to hold on to some of it … not too much and not too little.”
She nodded. “I agree. And to think of all the years we still have in front of us. I could write a book already on everything we’ve been through.”
The manager walked over to their table. “How is everything?” he asked. “I waited to come over; you two are absorbed in conversation.”
“This is better than a five-star meal right now,” Annabel said. “By the way, what is your name?”
“Pete.”
“Thanks, Pete,” she said. “I’m fortunate your place is so close to me.”
“I won’t hesitate to order both of these again,” Bob said, “because I’ll try and come back with Annabel if she doesn’t mind.”
Pete gave them both a wide smile. “More water for your tea?” he asked.
Annabel acknowledged another refill and Pete went back to the counter as the bell on the top of the door sounded and another couple came in.
Annabel and Bob finished and dressed back warmly in their jackets and caps. With book gear in tow, they both left and huddled into the wind in two separate directions.
-----
In pajamas and sprawled on her bed an hour later, Annabel focused on reading about adenocarcinoma of the lung. She had read before, i
n general, about lung cancer, but now she was reading more about May Oliver’s specific type and how it metastasizes early. Since it was known to travel to the central nervous system, bones, and adrenal glands, they had ordered May specific tests for the next day - a bone scan and CTs of her head and abdomen. A shudder ran through her as she contemplated what the results may show.
In another hour, Annabel’s book slipped from her hand to the bedspread as she accidentally dozed off. She opened her eyes and padded over to the desk to set aside her textbook. On her way back from the bathroom, her cell phone rang and she gasped with excitement at the caller’s name: Robby Burk.
She sat cross-legged on the bed, took a deep breath, and answered.
“Annabel, hi. It’s Robby. I hope I’m not calling too late. You’re not in the hospital on call, are you? Otherwise, I can ring back tomorrow.”
“I’m home and wrapping up reading for the night.”
“I meant to call a few days earlier, but I was in San Diego for a conference.”
“I bet the weather was warmer than here.” She glanced out the front window and snow flurries had begun, twirling around outside like angel dust.
“It was beautiful but, as you’ll find out in the future, you don’t enjoy the weather when you go to a conference. Your days are spent sitting for hours in a large room trying to maintain your concentration on slides and a speaker who may or may not hold your interest. The highlight of each day is lunchtime and strolls to the bathroom.”
“I’ll remember that.”
“I also gave two of the lectures. Unfortunately these days, there are many attendees that sit in the back on their iPads checking emails and googling, which is distracting and disheartening to a speaker.”
“I’m sure that does not reflect on anything you said or did. If your teaching as a chief resident is any indication, your presentations must be awesome.”
“Thanks for saying so. I like teaching as much as the clinical aspect of doing surgery. But enough about me. We can talk more about you if we can arrange another date that doesn’t end up like the last time.”
