by Barbara Ebel
“Forget it.” He stepped out and closed the door.
“Tell me where to go,” Annabel said when they buckled up in her car.
On the way, Bob directed her while she spilled out details about the entire day: Dr. Enno and Jae Nixon’s case, Dr. Mejia and Jordan, and Dr. Schott blowing up at her and then his lawsuit and apology.
“I hate to say it,” she said in the end, “but if you had to be absent from the wards, now is the time to do it. Out team has too much conflict.”
“On the contrary. You’re making me jealous I’m not there. Your patient is an intriguing case, the likes of which you may never see again. You’re finishing up the rotation with a superficially pleasant team that is secretly dysfunctional with a backstabbing, self-righteous medical student; a dog-whisperer of an infectious disease consultant; a depressed, angry chief resident; and a gullible, flashy attending. There are two female residents who keep their personalities in check and a brilliant other medical student who would come out of a burning building unscathed.”
Annabel glanced over at him quickly and then laughed. “If anything is missing, it’s you.”
“Yeah.” He smiled back at her. “The biggest personality is missing.”
-----
Bob handed over his insurance information and filled out the paperwork in Dr. Raymond’s waiting room. Without much of a wait, a nurse called him back and Annabel stayed put. A man with an artificial leg sat across from her, the metal evident below the hem of his trousers, and a few seats down an old couple held hands and intermittently talked softly to each other like they were telling secrets.
Annabel placed her Internal Medicine Handbook on the table next to her and texted Dustin.
Looks like I’ll be ready by about 7, but I’ll keep you posted. I don’t want you waiting on me.
Annabel held her phone waiting for a response while the woman nearby talked to her partner. “I hope this doctor is older and wiser than that one last week. He was young enough to be my grandson.”
“Anyone is young enough to be your grandkid,” her spouse said.
Annabel and the man across from her smiled at each other as a ding sounded on her phone and Dustin’s response popped up.
As long as we continue to communicate, I’ll wait on you!
Thank you. Where are we going?
A restaurant downtown with a New Orleans flare. Do you like Cajun?
You bet. Is it dressy?
You always look dressy.
That’s not always true. You should see me sometimes.
I hope to.
She stifled a chuckle. His flirting via text messages was way more fun than reading medicine.
-----
The nurse left Bob’s room without telling him to take off his shirt and to put on any type of patient gown, so he considered himself lucky. He stepped up, sat on the white paper cover on the exam table, and glared at the certificates on the doctor’s wall: CME documents, resident certificates, and a state license. Not interesting reading material for most patients. The activity of simply coming in for the appointment made him feel extra tired, so he pulled out the footrest and lay back.
The door opened with a little swat and a big bald man with flat ears and a slow smile walked in. Bob pushed himself up and the two men shook hands.
“I’m Dr. Raymond. You’ve come to the right place. There is no room for illness when you’re a medical student.”
CHAPTER 18
Bob wrung his hands as he sat on the exam table in front of his new physician.
“Dr. Raymond,” Bob said, “I’m losing days on an internal medicine rotation, so I hope you’re as good a doctor as they say you are.”
“Who said that?”
“That’s the general consensus over at the V.A. Hospital.”
“Never trust what you hear.” He winked, read Bob’s vital signs, and pushed in the table extension so Bob could sit up. “Now, tell me what brought you in here to be poked and prodded on.”
“I am so tired, I can barely function. I’ve been knocked out on the couch for days. Along with that, I have mild body aches, but that may be because all I’m doing is lying around.”
“When did this start?”
“About one or two weeks ago.”
“Any major upsets in your life that could have catalyzed a depression?”
Bob shook his head slowly. “Nothing out of the ordinary and I am not depressed.”
“Any fever, headache, or chills?”
“Once in a while I run a low-grade temperature.”
“Nausea, vomiting, or diarrhea?”
“No, sir.”
“Confusion or a rash?”
“No, sir.”
Dr. Raymond deviated and asked him for a full family, social, and medical history, just like the students asked of their patients.
“Believe me, I’m a healthy guy,” Bob ended.
Contemplating, Dr. Raymond rubbed his ear and looked over Bob’s head. “Any of your patients come to mind that you could be mimicking their symptoms?”
“Not really. Before I left, I had the usual COPDers, diabetics, and cancer patients.”
“Besides the fact that you can pick up anything nasty in a hospital, were you anywhere suspicious or out-of-the-ordinary lately? And where do you go for recreation?”
“The last time I went out of town, it was to Tennessee with the female medical student in your lobby. She’s fine and the time line doesn’t fit. I haven’t been to the gym in a month. The only other place I went was for a run in a park garden and along the river with my same friend.” He scrunched his forehead. “That was two weeks ago.”
The doctor pulled an ophthalmoscope from his pocket and shined it in Bob’s eyes. “Have your eyes been red?”
Bob shook his head, Dr. Raymond went on with his examination, and then sat on a stool. He leaned over and ticked off little boxes on two lab sheets. “Follow me.”
Outside, he handed the sheets to a lab tech, and pointed Bob into their room. Bob rolled up his sleeve and a woman drew a couple of vials of blood. He went back to the exam room and waited.
Sitting there with nothing active to do, Bob worried more about Annabel being late for her date than what the doctor would say when he came back. If he had a say in the matter, he thought, he wished Annabel didn’t have a date, and that her relationship with Dustin Lowe had not resurfaced.
Twenty minutes later, at the close of office hours, Dr. Raymond came back in. “I think I know your diagnosis,” he said confidently, “but I don’t think you’ll be finishing your rotation. You need rest to gain back your strength and, based on clinical signs and symptoms, I will not withhold treatment to wait on confirmatory tests. I’m starting you on antibiotics.”
Bob’s shoulders sagged with the thought of being pulled from medicine. And did Dr. Raymond really know the diagnosis and treatment?
“Antibiotics for what?”
“Ehrlichiosis.”
Bob squinted and shook his head. “I never heard of it. What is it?”
“You’re carrying a disease caused by Ehrlichial bacteria, of which there are at least three species known to affect humans.”
“Any ideas about how I got it?”
Dr. Raymond’s wide chest heaved with a sigh. “From the bite of an infected tick. Specifically, the lone star tick.”
Bob stared with disbelief. “This is crazy. What I mean is … I am not aware of being bitten by a tick. And don’t they only come out in summer?”
Dr. Raymond sat on his stool. “Half of the infected people who develop Ehrlichiosis never find a tick on themselves and never remember being bitten. The victim can be clueless because the bite can be painless, the little bugger can be brushed off, or it falls off. But the damn tick takes a nip out of you. Not all ticks end up clinging onto human flesh like a rock climber to a summit.”
Bob scratched his neck just thinking about the beastly little things. His eyes grew wide as he sensed a strong deja vu.
“Wait a minute. I mentioned a recent run. I did a stupid thing and sat down on the ground - right against tall weeds along an embankment down by the river. I remember being itchy with something bugging me on my upper back, behind my right shoulder.”
Dr. Raymond grinned. “I bet the weather was unseasonably mild too.”
Bob rolled his eyes and nodded. “I guess my fortunate luck finally failed me.”
“Not yet. We’re going to get a handle on this before you suffer a more severe course with life-threatening symptoms. Or a prolongation which requires hospitalization and IV antibiotics. There is even up to a 2% fatality rate with this disease.”
“Dr. Raymond, you’re scaring me to death. What did my lab work show?”
“I made you a copy.” He handed over the CBC with a differential and all the chemistries.
Bob scanned it with dismay, and reread it again.
“Thrombocytopenia, leukopenia, and elevated LFTs,” Dr. Raymond said. “Classic, especially that deplorable platelet count, in the context of everything else.”
“Only if someone smart and perceptive like you puts this whole clinical picture together,” Bob acknowledged. “I can’t believe these numbers are mine. What antibiotics do you suggest? And will it be a definitive treatment?”
“The first line of treatment is Doxycycline - for seven to fourteen days. I expect you’ll start showing clinical improvement, but you may not be up to your old self for a few weeks. The stamina you need right now for the rest of your rotation will not exist.”
“I can’t believe this,” Bob pouted.
“I took an extra vial of blood for specialized laboratory testing. Your immune system should be producing antibodies to Ehrlichia by now if that is what’s streaming around in your circulatory system. Like I mentioned, my index of suspicion is high, so I will not withhold treatment. Also, by the way, Ehrlichia cannot even be detected by blood cultures.”
A shudder ran up Bob’s spine. The more Dr. Raymond talked, the more he wanted to purge himself of the awful bacteria zipping through his bloodstream.
“Thank you,” Bob said, “for your help. I’m fortunate I came in to see you. I better not take up any more of your time.”
“No problem.” He tapped Bob’s chart in his hand and opened the door as Bob stepped down.
The front office was quiet as most of his staff had left. “By the way,” Dr. Raymond said, “you are correct. I see one or two Ehrlichiosis cases a year and they show up in June and July. However, cases do pop up during any month of the year, especially with the slow northern progression of this tick population from the southeastern and southcentral United States. Due to global warming.”
Bob nodded while clutching the lab results.
“Make a follow-up appointment in a week,” the doctor said and poked his head into the front office window. “You two ladies leave when you’ve checked out Bob Palmer. I’m going back to my office. I need to contact the CDC with a reportable case of Ehrlichiosis and confirm it when the remaining labwork comes back.”
-----
Annabel paced the office waiting room after sitting too long. Finally, Bob came out and he tried to force a smile.
“Uh-oh,” she said. “What did he tell you?”
Bob twisted his face with disapproval. “You know what a normal platelet count is, right?”
“Sure. 150 to 400 in the usual reference range units. Thrombocytopenia, a low platelet count, is less than 100. And susceptibility for hemorrhagic bleeding conditions is a count less than 50. Why?”
“My platelet count is 40.”
“What! Are you serious?”
“No kidding.” He handed her the yellow sheet with all his lab values. In dark capital letters next to his platelet count was the word “LOW.”
“Oh no,” she mumbled. “This is awful.”
She handed the paper back to him and sank into a chair. “Don’t bump into anything. You’ll bruise or crack open your skin and bleed to death.”
“I agree. Now is your opportunity to punch me, make me bleed like water from a hose, and get away with murder.”
“I don’t think so, and don’t mention or even think about such a thing. Does he have any concrete suggestions about your diagnosis?”
“Ehrlichiosis.”
“Ehrlicy what?”
“A disease caused by ticks.”
“No way. Impossible.”
“I thought the same thing, but I probably had one crawl into my shirt the day we went for a run. Down by the Ohio. From the weeds.”
She shook her head, not wanting to believe it, and dragged out her Internal Medicine Handbook. After checking in the index, she shook her head more emphatically the second time. “Your disease isn’t in our book.”
“Ha! Because Ehrlichiosis is rare and doesn’t make the cut for a standard student’s textbook.”
“I should say.”
Annabel realized … she was the one who dragged him for a run. “This is partly my fault.”
“No way. Shit happens.”
“Only to me. Not you.”
Bob pointed to the exit door, she stood up, and they ambled out.
“Is there a treatment?” she asked.
“Yes, doxycycline, but I’m not going to feel better overnight. I’m off the rotation for sure. However, I should still try and pass the final.”
Annabel thought about it as they stopped in front of her car. “I can help you to the end. We can study the same stuff. Are you open to me half moving in with you? Crashing on your couch so I don’t have to go back and forth?”
Bob raised his eyebrows. “That’s too much to ask.”
“No, really. It could work. I would even have available parking in your complex, so I don’t have to call Uber to take me back and forth. We can pack in the studying and try and do better than Stuart. We just have to make sure you don’t overdo it, take breaks, and get adequate rest and sleep. Look at it this way … it would help me focus too.”
“Okay. I won’t argue. When your mind is made up about something, I doubt if it will budge. Plus, I’d love your company.”
“So the arrangement is settled. Let’s go fill your prescription. Tomorrow the team’s on call, so I won’t be over until Thursday.”
-----
Annabel dropped Bob at his place after they stopped at the pharmacy and then she drove home to change for her date. She texted Dustin.
I’m running a half hour late. Sorry about that.
I’ll pick you up. Not to worry.
See you soon, she replied.
Annabel looked on her bed, grateful she had already picked out what to wear. After slipping into a dark orange dress, she topped it off with a complementary matching brown jacket. She didn’t spare the jewelry on two fingers, her wrist, and earlobes: all warm amber resin in silver settings. After applying a smidgeon of makeup, she brushed her hair and highlighted its shine with mousse.
Her seldom-used doorbell rang. Annabel slipped on flat brown shoes and opened the door. Dustin’s head turned from looking down the staircase and he broke out into a smile.
“Don’t you look fantastic.”
“Nothing too special.”
“On the contrary. You’re glamorous no matter what you wear.”
Annabel stepped out and they went single file down the stairs as Travis came up two steps at a time and stopped at his door.
“It’s too early in the week for a date,” Travis said as Annabel passed.
“Maybe so,” she laughed. “But we’re going to do it anyway.”
“Have fun.”
Downstairs, Dustin pointed down the block. “My Acura’s around the corner.”
She walked alongside him on the narrow sidewalk. “So what happened with the domestic abuse case the other day?”
“Edgar and I sometimes go back and forth to the same homes. For the same calls. For the same recurrent situations. We call them ‘frequent flyers’; the domestic abuse is so routine. Last week was our third time going t
o that woman’s home with three kids. After our second trip there, she got a restraining order against her ex, but some good that did. Apparently, however, he got locked up yesterday for another offense.”
“At least you won’t be making a fourth trip any time soon.”
“So true.”
Dustin opened the passenger door for her and they headed downtown. As he changed CDs, she thought ahead about the evening. She’d been so busy with the wards and with Bob that she had neglected to guess or fantasize about her date with Dustin. She absolutely liked him but failed to consider. Would they end up in bed together?
Neglecting to think about that possibility was not like her at all. Was medicine starting to rule her life? She deserved a social life on the side; maybe not as active as her Findar app past history, but certainly she needed a little hanky panky once in a while.
Dustin settled on a top country CD, which she also liked, but what was she going to do about later, if sleeping together came up as an option? It was already late enough to be going out to eat and she had a long call tomorrow. Staying up late would have repercussions for tomorrow. Yet, with all the dates the two of them had been on, they still hadn’t bunked down together.
For the benefit of her medical education, getting to bed on time, and not rushing through sex with him, she thought, it would be best not to sleep with him tonight. On the other hand, they were overdue. Wasn’t sexual compatibility and likability in bed important to find out about before investing more time with him? For sure, since meeting him, she’d grown to like him more and more, regardless of knowing if he was a good lover.
He hummed along with the music as he parked and then lightly steered her into the front door of a vibrant restaurant with short white tablecloths. They walked to the right of the head waiter and cash register. Dustin pulled out a chair for her and slid to the other side of the table, facing the entrance.
“Don’t mind me,” he said. “My background training and career puts me on alert all the time. I always take this side of a table … to observe people as they come in.”
“To monitor for unusual situations or suspicious behavior?”
He nodded and she realized he had done the same thing when they went out before. They both took menus from a waitress and listened to her spiel on the jambalaya special of the day. The two of them smiled.
