by Barbara Ebel
The anesthesia record was up on the screen and the doctor was going through the details of the anesthetic drugs given as well as the patient’s immediate postop course. She had been paying attention to Wilbur during the end of the case and now she had a better appreciation of what a complex job he had. The two departments’ focuses were drastically different; both were experts in what they did. She wanted to talk to Wilbur further; since the cause of death was still not totally conclusive, maybe they could put their heads together and speculate.
Having stayed to almost the end, Annabel stepped out of the room unnoticed. Bringing her phone back up, she noticed a return message from the young man she had replied to.
“I have an early morning meeting for our Cincinnati region in a hotel across the river. I’m staying here all week. What do you have in mind?”
“A bite to eat and then it depends.”
“I like the ‘it depends’ part.”
“Meet at 7 p.m.?”
“Sure. At the hotel’s outside restaurant?”
Annabel agreed and, after getting directions, she wondered if he was even married. But what difference did it make?
-----
With the department’s test, clinic, and M&M over with, only the residents met with the chief resident for late afternoon rounds which were practically evening rounds. The students were given a break. A better way to look at it, Annabel thought, was that they were given an opportunity to celebrate a good test score or, in her case, to lick her wounds.
Annabel wanted to hibernate after multiple humiliating experiences but her new plan was to get laid instead. She rushed through a shower at home and picked out something more feminine than all the hospital clothing she’d been wearing; a form-fitting skirt, a loose and comfortable pale blue blouse, sandals, and she was ready to go. She hoped this Mark fellow was as handsome as his picture.
Although caught up in bridge traffic, she walked up to the restaurant’s desk only five minutes late. A man sprang up from the bench off to the side.
“You look like Annabel,” he said.
“Yes,” she replied. “And you must be Mark.” He looked older than the picture and the photo had been more flattering than real life. But still not bad.
“Glad to meet you. Let’s head to the patio, shall we?”
“Yes. I could use a decent dinner. So there’s no pressure, why don’t we do Dutch treat?”
“That’s fine with me,” he said and let her walk in front of him.
They sat down at a wrought iron table with a little vase of daisies. As the waitress came over, Mark gave Annabel a smile. She tried to shrug off her worries, hoping the next few hours would be the highlight of her week.
Chapter 18
When a middle-aged waitress stopped at their table, Annabel ordered a house salad with grilled chicken. Mark asked for a rib eye sandwich while Annabel continued to study him. He had a pointed nose and faint hair stubble on his chin.
“So what kind of medical equipment do you sell?” she asked.
“Mostly kits like central lines and Foley catheters,” he said, thinking she wouldn’t know what he was talking about. “What I like about it is that I set up at conventions in the vendor areas; that’s why I’m here this week because there’s a physician conference. I get to meet a lot of people and get my expenses paid for. I’m actually a pretty good salesman.”
“Sounds lucrative. Across the river is a decent-sized medical town so you should do well.” She took a sip of water as the waitress left him a beer
“Have you been doing this long?” Annabel asked.
“What, selling?”
“No, using social apps.”
“On and off for a year. How about you?”
“Not too long. I’m feeling it out.”
“You’ll enjoy using it if you’re a busy person. Would you like to go look at the exhibit hall when we’re finished?”
“Sure. I’ve never been to a medical vendor site.”
When the food came, they continued talking but Annabel realized he didn’t ask her too much about herself, which she preferred. They paid their respective bills, walked to the mezzanine, and then into the large room. A security guard was in the front to safeguard the exhibits and Mark showed him his badge.
“My setup is over here,” Mark said.
Impressed at the size and contents of the exhibit, Annabel peeked at a few billboards and devices as they headed to his table. When they arrived, he took a mint from a glass bowl, unwrapped it and smiled at her. “Here you go,” he said, putting it to her lips. She let him slip it into her mouth.
“Thank you,” she said.
Mark tore open another one for himself and then showed her the gadgets on his neat and nicely arranged table. He then took her hand. “Come on over here. There’s a hot cappuccino machine if you’d like some after that meal.”
At the coffeemaker, Annabel chose vanilla latte and Mark grabbed the same.
“How about sitting down with these?” he asked.
“Sure.”
“How about going to my room with them?”
“Sure,” she said again, refraining from smiling.
They both snapped lids on the to-go cups. On the way out, Mark nodded at the guard, then pressed the elevator button. On the sixth floor, he inserted his key card and they went inside having said very little on the way up.
Inside, Annabel was surprised how tidy it was. With no clothes on the floor or strewn towels in the bathroom, she thought maybe he had already assumed he’d have her company after dinner. She sat on the short sofa by the table and finished her latte while Mark did the same.
“I should have offered you some wine up here instead,” he said.
“Like you, I have a busy schedule tomorrow so I prefer the coffee which can’t possibly give me a hangover.”
“I could have used another beer,” he said, “but I’m good. That’s something my wife would get on me about – binge beer drinking. Yeah, I was married for one year and I’ll never do that again.”
He put his empty cup down and waited for a response.
Annabel shrugged her shoulders. “At least not her again,” she said.
He laughed at her comeback. “The only problem is that every time I have a beer, I think of her.”
“That’s no good. But I guess if we’re going to talk about her, I’ll head out.”
“Whoa. I think there are much better things we can be doing.” With two steps he was nearer, sat on the table, and put his arm on her shoulder. Tugging slightly, he brought her lips to his and they kissed slowly, testing each other out.
Several more minutes elapsed as their lips stayed locked longer and then, with her help, he unbuttoned her blouse. Annabel unhooked her bra while he removed his shirt. They gripped each other tightly, the skin contact making her close her eyes and sink into a fantasy unlike the stark reality she lived in.
For an hour, Annabel left her clinical rotation problems outside the door. The taste of her latte was long gone when they finally grinded into each other. She would have preferred being straight on top of him or him on her but every time she tried to maneuver those positions, he kept the both of them on their sides. Some kind of fetish about being sideways, she thought. But it was better than being at home or dealing with all her problems.
They laid on top of the comforter for an extra fifteen minutes commenting on the lousy artwork in the room. After Annabel used the bathroom, dressed, and had her hand on the door knob, Mark said, “Maybe we can do this again if I come back again for a conference.”
Annabel looked back at him. “Maybe. It was fun. Enjoy another beer tonight.” She left with her bag strung over her shoulder and went straight home.
-----
When the alarm went off in the morning, Annabel thought about her ‘Mark’ encounter. It had worked out okay; in essence, she’d gotten what she wanted. Then her focus shifted to the fact that it was Thursday, that a lot could happen today. It was possible that by e
vening she could be off her present career path and that was without even knowing more about her malignant melanoma.
It had started drizzling when she got to her car and the rain ramped up by the time she made it to the hospital. Without an umbrella, she felt soggy as she entered the elevator. The door started to close but someone’s hand popped in and stopped it; Robby stepped in. He ran his hand through his damp hair and looked at Annabel.
“Hello there,” he said. “I’m a bit early this morning so why don’t you step into my office before seeing your patients? I have scores from yesterday.”
She tried to smile and act nonchalant as she followed him into his office, a quiet out-of-the-way place. He picked up a stack of papers on the only other chair and said, “You can sit here.”
“Thanks. So the scores are already in?”
“Yes.” He eyed her with a sympathetic look.
She glanced down. Since she failed, she wished someone else was telling her instead of him.
“As you know,” he said, “getting six questions wrong at four points each, gives a student a seventy-six. That’s the passing grade. I’m afraid you got seven questions wrong.”
Annabel’s heart sped up but she felt nauseous at the same time. Even though it wasn’t a surprise, it still felt like a hammer had just struck her chest.
He noticed her pale face. “Yes, you got a seventy-two.” Leaning back in his chair, he thumbed through the file he’d placed in his lap and pulled out her test. “However, I put those five extra credit questions in there as a serious maneuver to maybe help someone out. But you were the only student to get all five correct. Shows that you are paying attention in and around the OR.”
“You mean I passed due to the extra credit?”
“Yes. Now what you need to do is to really focus on learning the surgical material needed for the next exam. You’ve already mastered ‘Give me what I want, not what I ask for’ and a couple of other things.” He cracked a smile and the lines around his eyes twinkled.
The relief swarmed over Annabel like walking into a steam room. As she sat there allowing the contentment to flow through her, she realized she was taking up his time.
“Oh, I’m sorry. Thank you so much. It hasn’t been easy.” She got up to leave. “Especially because of Dr. Mack.” The last sentence slipped out before she even realized it.
“Yes, I considered bringing him up. He is having difficulty with you. So don’t just concentrate on your final written exam because you also need to beef up your clinical skills now. Besides what I am seeing, Dr. Mack reports that you are doing a poor job.
Not wanting to talk above him, Annabel slinked back down into the chair. “Dr. Burk, I am being portrayed in a poor light. I am one-hundred percent sure that I did not leave that surgical gauze in Mr. Simmons. Dr. Mack did.”
Robby tilted his head. He eyed her and considered what she had said. “I wish that neither of you had done it. Surgical mishaps do occur, but that was not a deep cavity for such a blatant mistake.”
“Honest, Dr. Burk.” Annabel tried to keep her voice steady and not sound like she was begging. The facts were the facts and now she had an opportunity to tell him. “And the Munchausen’s syndrome patient … he led me down the wrong path without giving me guidance that she did not have appendicitis. It’s like he let me fall on my face in front of the whole team.”
“You’re sure about that?”
“I am.” She twisted her hands in her lap but her gaze stayed steady as she tried not to look like a pleading youngster.
Robby’s eyes narrowed. She was accusing Marlin of the indiscretions, exactly opposite than how it appeared.
“Why don’t you go get to your clinical duties before rounds? I’ll be keeping my eye on the both of you.”
“Thank you,” Annabel said. She got up and for a moment their eyes held.
“Another thing,” Robby said, as she neared the door. “It’s important to keep your focus on surgery and not anesthesia. That’s another complaint he has about you.”
Knowing she better not comment on that, she nodded and left the room.
-----
On rounds, it was apparent that the other students didn’t know their test scores yet and Annabel realized Robby had made an exception by telling her early. It was probably because she would have failed if it were not for the extra credit; however, she was glad she had spoken to him about Marlin Mack.
Then she thought about her sexual encounter. Last night, she didn’t think she had passed the exam so - by being with Mark - she had escaped the mental torture of thinking about it. Too late now, she thought … the evening had entertained her.
-----
For rounds, Dr. Pittman joined them; he took one step back, fixed his shoulders against the wall, and looked at Annabel.
“Dr. Tilson, we’re seeing your patient, Mrs. Watkins, next. I understand she’s on the surgery schedule today. You can tell us about that. As a physician, you will be asked to consult on patients for other doctors and learn to think like a clinician. Can you simply fill me in on her since last time?”
“Yes, sir,” she said. “Mrs. Watkins has been followed closely by the pulmonary service and her respiratory therapy treatments have made her much better. Two days ago they thought her pulmonary function tests were good enough for her to undergo her thyroid cancer surgery. She also reports feeling better, her vital signs are normal, and her chest sounds clear.”
Marlin shoved his hand into his pocket and cleared his throat. “Mrs. Watkins requested that no students be present for her case,” he said. “I think the word is out on the floor about Mr. Simmons’ return to the OR and his eventual death. Patients are afraid of students right now.”
“This is a teaching hospital,” Robby said. “What did students have to do with Mr. Simmons’ death?”
“Well, you know.”
“No. I don’t know.”
“Gentlemen,” Dr. Pittman said, “let’s not go any further with this conversation.” He pulled his eyes away from Marlin and looked at Robby. “Dr. Burk, I have to run off immediately after rounds so I might as well tell you now. I was told the preliminary results of Mr. Simmons’ autopsy this morning. There is nothing that indicates he could have died from a pulmonary or cardiovascular cause. Labs so far look normal except for what you’d expect because of his infection, such as a high white count. They are going to run other tests for more obscure possibilities.”
Robby nodded. “I’m not sure what I expected, but I’m not surprised it’s inconclusive.”
Dr. Pittman stepped away from the wall. “We’ve cut into my teaching time, so let’s go see Mrs. Watkins. But since you all passed your exam, I won’t worry about the four of you right now.”
Bob, Da’wan, and Ginny broke out in a smile.
Bob looked at Annabel as they walked side-by-side. She put her hand out to him. “Aren’t we going to eat celebratory espresso beans?”
He was happy to oblige as they walked in and said good morning to the team’s first surgical case of the day.
-----
By mid-morning, Annabel had finished doing all her clinical errands and since her presence was off limits for Mrs. Watkins thyroidectomy, she huddled in a corner of the OR lounge with a buttered bagel, coffee, and her surgery book. As the hours went by, she had ramped up her resolve to pass the next and final surgery exam with a wider margin of safety than she had done with this week’s test. She figured it had been a small miracle that Robby had asked the department to plug in those extra credit questions and that she had benefited. So if not for herself, she owed it to him to not flunk out in the end.
She savored the taste of her breakfast and turned a page to a new chapter. In the corner of her eye, she sensed someone standing near her, the blue scrubs almost touching her chair.
“Hey, Annabel.”
She looked up to see Wilbur Gill, his short stature making it easy not to strain her neck. He wore a concerned look on his face.
“I hear
d Mrs. Watkins is your patient,” he said. “I’m doing her case but another resident relieved me for a break. You don’t have to be in there for her surgery?”
“No,” she said. “Apparently a few patients on the wards got wind of Mr. Simmons’ death. They’re gun-shy and may be misinformed that a student, namely me, left a gauze in his surgical site. It’s possible they think that caused his death.”
Wilbur scrunched up his face while Annabel pointed to the chair next to her. He placed a cup of juice on the table and sat down. “That’s too bad. I didn’t see the mistake being made but, then again, I was back and forth at the other side of the drapes attending to the patient’s anesthesia. Could it have been Dr. Mack?”
“Even if it was, he’s denying even the remotest possibility.”
“Doesn’t surprise me.”
Annabel took a small bite of her bagel, then said, “I passed by your grand rounds yesterday. Your department presented the same patient that my chief resident focused on. I guess you all look more closely at morbidity or mortality if it happens in the recovery period right after anesthesia.”
“Or further out than that,” Wilbur said. “For instance, there can be a bad sequela from patient positioning during surgery or a complication from a central line that anesthesia put in. All sorts of things.”
“That makes sense,” she said. “I bet multiple specialties are often involved with lawsuits.”
“As well as the hospital,” he said. “I already know from the rumors flying today that the attendings and chief residents of both our departments received lawsuit papers this morning from Mr. Simmons’ brother.”
“Oh no,” she mumbled, realizing that Robby must now be quite upset doing his case. “But what did anesthesia have to do with it?”
“Like I said, lawyers often sue everyone involved until they can delineate who, if anyone, is really to blame.”
“Has your department also mentioned their recent case statistics are higher as far as morbidity and mortality?” Annabel asked.
