Desperate to Die

by Barbara Ebel

  Annabel’s heart raced and she held her breath. “You did promise me a dinner,” she said cheerfully.

  “How about the day after tomorrow, which at least falls on the weekend? I’m on call tomorrow.”

  “So am I,” she said. “That would work.”

  “How about a diversion from medicine? Let’s grab an early evening movie and then go for a bite to eat.”

  “That sounds fine. I’ll dress casual.”

  “I’ll find out the movie times and I’ll pick you up at your place this time. I’ll be by at 5:30.”

  After giving him directions to her apartment and hanging up, Annabel wrapped her arms around her knees and gave them a squeeze. How would she concentrate on the wards tomorrow after he had called her and they were set again to go out? She let go of her legs and slumped back on her pillow, creating visions of him in her mind. His chocolate eyes and hair; his height and toned, tall physique; and his preppy dressing drove her crazy. As she drifted off to sleep, she realized she couldn’t wait to tell Bob that a date with Robby was imminent.

  -----

  The sports section of USA Today covered Dr. Schott’s face as the students and residents gathered in the office. “I sure am overdue,” he said, “to visit a sport’s bar for a couple of beers and a triad of screens showing football and basketball at the same time.”

  “I’ll second that,” Bob said. “What’s more fun? The Super Bowl or the Final Four?”

  “Both,” Donn said and folded the paper. “And for living here, the University of Cincinnati isn’t too shabby as far as basketball.”

  “I won’t discuss teams with any doctor somewhat in charge of my grade,” Bob said.

  “I will,” Annabel said. “I must be loyal to my hometown Vanderbilt.”

  “Hmm,” Donn said. “She’s got more guts than you do.” He stood and went straight to the blackboard. “This patient list is going to grow today since we’re on call, but a nice afternoon break will be the outpatient clinic. We’re due downstairs at 1 p.m. If we’re not too swamped, you students can do preliminary visits with the patients and present them to Dr. Burg and Dr. Watts. Otherwise, just follow us around.”

  “Outpatients aren’t as interesting as inpatients,” Jordan said.

  “They are our success stories after we care for some of them in the hospital,” Dr. Schott said. “So, no, they are as interesting. And they still can present with an insidious problem that requires us to admit them for observance or treatment. Now then, let’s get going and see our patients. Annabel, May Oliver needs her workup today, so we won’t spend much time with her. Let’s go see what psychiatry said about Darlene Pratt.”

  “I saw the psychiatrist headed into her room after I saw her,” Annabel said. “Her daughter, Gloria, was in there as usual.” Donn walked faster and Annabel decided to tell Bob later about her date with Robby Burk.

  Darlene Pratt was bolstered up in the chair, trying to grab the string hanging off her personal nightgown. The psychiatrist, Dr. Amin, was a long, lanky, older physician wearing a red bow tie on a white shirt. His lab coat was also bleach white like it came straight from the cleaners.

  “Come in, come in,” Dr. Amin said to the team. “You should all hear this too.”

  “Thanks for being so prompt,” Donn said.

  “No problem,” he said. “I’m explaining to Mrs. Pratt about her mother’s progressive decline in cognitive function. She understands, but the students should know … her downward spiral consists of diminished thinking, organizing, planning, and problem solving. All the fundamentals comprising dementia. She is so much worse than the last time we evaluated her; she is not capable of any of those normal behaviors.”

  Gloria nodded with understanding and Dr. Amin continued with a steady, slow pace. “The new behavior, which is another game changer, is that Mrs. Pratt has developed a psychosis. This predicts a very poor prognosis. I’m afraid, Mrs. Pratt, this increases your mother’s need for nursing home placement as well as the likelihood of an early mortality.”

  Gloria peeked at her mother, who had slumped to the side, her resting limb active with a hand tremor; her legs hanging; her feet unsupported.

  “Dr. Amin,” Gloria said, “you all give out advice like you know what goes on outside of these hospital walls. I live with my mother and take care of her better than any facility can. Our home is set up like a nursing home and she has 24/7 care. I am way ahead of your needs analysis.”

  “I commend you for that. You are more diligent than most family members, so I apologize for thinking otherwise.”

  “That’s okay,” she said.

  He took a step back and addressed them all. “In my note, I suggested another medication, clozapine, to help with the psychoses. It may or may not help but feel free to give it a try.”

  “Thanks for your help,” Dr. Schott said.

  Dr. Amin leaned forward and patted Gloria on the arm. “All the best with your mom.”

  With Dr. Amin gone, Gloria plodded over to the chair in her thick shoes. “One of you help me move my mom back to the bed for a midmorning nap,” she said.

  Annabel and Bob obliged and gave Darlene support in her armpits. The woman took one step and stopped as if she would take a fall; she repeated the same movement with the other foot. When they situated her in the bed, Gloria thanked them.

  “We’ll write up your mom’s discharge papers,” Dr. Schott said. “I think we’ve done all we can for her. Would you be able to bring her back to clinic in about two weeks?”

  “Of course,” Gloria said. “If my mother could, she would thank you too.” She turned to the sink and squirted hand sanitizer in her palms as they left.

  The team reconvened near the nurses’ station. “That was the first time you students probably witnessed a Parkinson’s patient with what’s called a freezing gait. They experience a sense of falling every time they lift a foot off the floor. If you noticed, each step Mrs. Pratt took resembled a controlled fall. Unfortunately, that gait appears late in the course of Parkinson’s.”

  “What a terrible disease,” Annabel said. “I’m grateful we had her as a patient. I had no idea.”

  “Are you and Dr. Watts satisfied that we’ve done the best we could?”

  “We took care of her UTI,” Dr. Watts said, “and helped clarify the end-stage of her disease.”

  “And,” Annabel commented, “we are sending her home in good hands.”

  -----

  Annabel unzipped her thermal bag from home and pulled out a yogurt, sandwich crackers, and fruit which she’d packed that morning to bring in because of call. It was one thing to eat a single meal from the cafeteria later on, but she couldn’t force herself to do it for lunch too. She peeled off the paper lid and dipped her spoon into a strawberry Greek yogurt.

  Everyone was off somewhere else, but she knew they’d burst in soon because they were all due soon in clinic. Dr. Schott’s newspaper was at the other corner of the couch so she reached over and flipped to the Life section.

  As she savored another mouthful, Bob came breezing in and went straight to his bag. “I don’t have much time, but I brought a sandwich,” he said, opening a baggie. “You can’t seriously be reading that newspaper.”

  “Why? I can’t eliminate all life outside of medicine. I have a Robby Burk update and that’s why I’m glancing through here.”

  “Is his picture in the newspaper? I suppose you’d never forget him then.” He moved the paper a bit and sat down. “I’m just giving you grief,” he added and took a bite.

  “No. He’s not in the paper. A local paper I could understand, but not a national paper.” She thumped his elbow.

  “I make the best sandwiches,” he said, “but I digress. What’s your update?”

  “After I went home last night … after we met at the café, he called.”

  Bob raised an eyebrow and chased down his bite with a gulp of water from a bottle.

  “We’re going out tomorrow,” she said, excited. “After w
e get a twenty-four or thirty-six hour call behind us.”

  “Congratulations. I hope you both figured out ahead of time the correct name of the restaurant to meet at.”

  “No, we’re driving wherever together. I’m flipping through the paper to check what’s playing because we’re going to the movies and then to eat. But stupid me just realized they don’t list local movie theatres.”

  “That sounds like fun. A real date. Finally. I’m happy for you.” He took another bite to camouflage the lack of a smile.

  “Have you heard of any good flicks playing now?”

  “I bet you would appreciate the new blockbuster comedy, which has a decent cast and isn’t too goofy.”

  “Sounds like the perfect escape,” she said and then thought that sitting next to Robby in a theater would be the best part about it.

  CHAPTER 12

  “We’re going to see all these patients?!” Jordan exclaimed after the students walked single file through the outpatient waiting room and into the office area. “Almost all the chairs are taken out there and some men are standing.”

  “I bet you can handle it,” Bob said.

  “Even all by yourself,” Stuart added.

  Annabel smiled at Bob. For the first time, Stuart added a smart quip relative to Jordan’s behavior.

  “You all forget,” Jordan said. “We go back to the hospital after this for an all-nighter. We’ll be dead tired after dealing with all those patients.”

  “Maybe you should take a Viagra,” Bob said, his face serious. “That’ll perk you up in more ways than one.”

  Jordan narrowed his eyes. “I don’t think I appreciate your comment.”

  Bob shrugged his shoulders. “I’m just trying to help.”

  “Two of you come over here to Dr. Burg,” Donn waved as he saw them approach, “and whoever’s left go over to Dr. Watts.”

  Bob walked towards Chineka and Annabel followed. She tugged his sleeve and leaned into him and laughed. “I can’t believe you said that to him. That was the best.”

  “You two look like you’re having way too much fun,” Chineka said, handing them each a sheet. “I made copies of the patient list for today, which also has their diagnosis and indication for the visit. Use it as a helpful summary before grabbing their charts from the plastic boxes outside the exam rooms. Annabel, come in the first patient’s room with me while Bob does a preliminary evaluation of the next patient.”

  Chineka grabbed the first patient’s folder and thumbed through it in the hallway. “This woman is a veteran’s spouse and I remember seeing her two weeks ago because of high blood pressure. Sometimes patients are given the label of being hypertensive without the adequate initial clinical approach. Patients’ blood pressures must be measured on two or more separate occasions before hypertension can be diagnosed.”

  “Makes sense,” Annabel said. “I’ll be sure to tell Bob in case he doesn’t know. It also sounds like a good question for an exam.”

  “Her last name is Picks,” Chineka said, knocking on the door.

  Inside, a woman with matching pants and a blouse crossed her legs over the side of the exam table. She was average height and weight, which caused Annabel to discount obesity as a risk factor for hypertension.

  “Hello, Mrs. Picks,” Dr. Watts said. “This is Dr. Tilson, one of our medical school students on rotation.”

  “Nice to meet you.”

  “The clinic CNA recorded another high pressure today,” Chineka said. “134/90.”

  “I told this to Dr. Watts last time,” Mrs. Picks said to Annabel. “I used one of those supermarket blood pressure machines and found out I am above normal. I want to get pregnant soon and want to be as healthy as possible if I’m going to be carrying a baby around.”

  “Smart planning,” Annabel said.

  “As you’ll find out on your ob/gyn rotation,” Dr. Watts said to Annabel, “hypertension during pregnancy is not without its risks to mother and baby.”

  “Should we check Mrs. Picks’ pressure again?” Annabel asked.

  “Yes. Don’t use the automated machine.” Chineka handed Annabel the cuff from the counter and Annabel pulled her stethoscope off from around her neck. She took Mrs. Picks arm and listened to the sounds corresponding to her systolic and diastolic measurements as the cuff deflated. “132/90.”

  “Which means we have reproduced her high blood pressure numbers several times,” Dr. Watts said. She leaned in and said, “Last time, I gave you a thorough exam and we determined there are no apparent complications from your pressure. Your hypertension is considered stage one and I’ll note that in your record. Now comes our decision for treatment.”

  Chineka grasped her hands in front of her mouth and then put them down. “There is a multitude of high blood pressure medications and reasons to use one or two over the others. In your case, our consideration rests on your possible impending pregnancy. However, most of the drugs are contraindicated for all nine months or all stages. We do possess a tried-and-true safe class of drugs for pregnant women called beta-blockers; the one most widely used is labetalol.”

  A look of relief washed over Mrs. Picks face and she smiled.

  “I’ll send you home with a prescription and we’ll see you back here in two weeks. Call sooner if you experience unpleasant side effects such as lightheadedness, dizziness, or excessive fatigue.”

  Mrs. Picks placed her feet on the step of the exam table and stepped down. “I can’t thank you enough. I’ll make sure the medication is working before my husband and I start our family.”

  Annabel and Chineka went back to the central desk where the resident did her paperwork. “If all women were as thorough as her, there would be less obstetric complications,” Chineka said and pulled out their patient list. “Mr. Harty is next. Back after his recent hospitalization.”

  A nurse assistant passed in front of them as she escorted a patient to a room. “Mr. Harty hasn’t shown up,” she commented after overhearing them.

  “Maybe he’s just late,” Dr. Watts said. “Annabel, why don’t you call his assisted care facility to check if they are on their way while I go into the next room where Bob is with a patient?”

  “Sure thing.”

  Dr. Watts went off and Annabel rummaged through the pending patient file folders for his number. She dialed and when she had no answer from Mr. Harty’s room, she called the main number for assisted living.

  “Hello,” Annabel said after someone in the front office picked up. “This is one of the medical students at Mr. Harty’s outpatient clinic. He is late for his appointment. We’re wondering if the van is on its way with him.”

  A silence ensued. “No, it’s not,” a woman finally said. “Mr. Harty passed away. He committed suicide.”

  Annabel gasped. At first, she couldn’t think of what to say. His action made no sense; he was too smart to do something like that. Bob’s patient was one of the sharpest elderly patients she had come across. How does an old person commit suicide in a place that has employees checking on them anyway?

  “How?” she asked.

  “We didn’t know,” the woman said defensively. “We can’t monitor every little thing.”

  “Know what?”

  “That he previously hoarded, saved, and hid narcotic pills for pain and then took enough to accomplish his goal.”

  “Thank you for telling me. I’ll inform the other doctors who helped take care of him. We all liked him a lot.”

  Annabel hung up and stared at the chart with a heavy heart. She wasn’t exaggerating when she said they all liked him, especially her. But the more she sat undisturbed in the temporary quiet, the more she remembered the things he had said and the more she accepted what he had chosen for himself.

  -----

  Bob and Dr. Watts both came out of a room and headed Annabel’s way. “If you go into internal medicine,” Dr. Watts said when they stopped, “you will see so much COPD in your residency, diagnosis and treatment will become second nature. They
become more of a challenge when they land in the hospital. Any time someone has that much difficulty breathing, I end up with butterflies in my stomach. I have a low tolerance for calling anesthesia to come intubate them.”

  Chineka stopped her medical discussion and noticed Annabel with a forlorn expression.

  “I called like you asked me to, but you’re both not going to like this. Mr. Harty committed suicide.”

  “No,” Bob said. “He lived in a supervised environment.”

  “But when a person is determined enough …”

  Bob shook his head.

  “That’s terrible,” Chineka said. “Chances are he could have lived another year.”

  “Not the way he wanted,” Annabel said softly.

  “Human beings performing euthanasia on themselves is not acceptable,” Chineka said. “He shouldn’t have done that,” she added with more annoyance in her tone. “What a waste.”

  She frowned at the protruding charts from all the doorways. “We better start hustling because our patients are accumulating. No more of our patients better pull a stunt like that in the foreseeable future.”

  -----

  A half hour later than expected, the team saw their last outpatient while Dr. Schott’s pager beeped regarding their first admission.

  “I’m going over to the ER,” Donn said, “and taking Dr. Watts with me. I want all of you students to go grab dinner first before showing back up on the wards.”

  Thankful for the definitive break, the medical students disappeared fast; one by one, they slid through the hot food line and sat in the cafeteria.

  “My patient, Mr. Harty, didn’t show up in clinic today,” Bob informed Jordan and Stuart, “because he was found dead from an overdose.”

  “I wonder how rare that is,” Jordan said. “I never hear about old people doing themselves in with drugs.”

  “Maybe geriatric suicide is carried out more than you think,” Stuart said, “especially if they leave no trace. No one would think to question an elderly person’s death if it was feasible they died from a heart attack or just quit breathing due to old and slightly diseased lungs.”