Perfectly Reasonable

by O'Connor, Linda

  She set it back in the drawer and pulled out the smaller one covered in bright orange and yellow flowers. A Christmas gift to herself that she hadn’t yet used. She cracked open the spine and picked up a pen.

  She stared off in the distance and wondered why she bothered.

  She felt guilty. Writing it down hadn’t helped in the past. Keeping a journal just reminded her how awful she was. What was the point of trying again? She closed the book with a snap and threw it in the drawer. Slamming the drawer shut, she clicked off the light and flounced back against the pillows. Stupid process. Whoever came up with that?

  She stared at the ceiling and wished for sleep.

  Chapter 9

  Margo huffed out a breath and glanced at the clock on the dashboard. Just her luck to get behind a green van. She didn’t need the green-van treatment this morning.

  Her alarm had startled her out of a deep sleep, mainly because the deep sleep didn’t happen until three in the morning. She had burned her tongue on her coffee, her hair was a mess, and her brain still in a fog. She was going to have to make a detour for another coffee. And the brake happy, ‘it’s-such-a-nice-day-let’s-admire-the-scenery’ green van wasn’t even hitting the speed limit.

  Holy cow, could you drive any slower? She stared at the little stick figure drawings of a dad, mom, four children, dog, and two cats on the back windshield of the van. Great. Potentially four more green van people in the wings. Just what the world needed.

  She threw her left blinker on and cut around the corner. She accelerated a hundred feet and cut into the Tim Hortons drive-thru. And groaned. There were at least eight cars inching toward the window. She didn’t have time for that.

  She made a uey, her wheels screeching, pulled out onto the road, and gave a large sigh. What were the chances of Trace having coffee ready?

  Margo unbuttoned her coat and knocked on the door of Trace’s condo. She shifted the can of paint she carried to the opposite hand and glanced at the time. Ten-fifteen. She hated being late. She knocked again with a little more force.

  The door opened with a flourish.

  “Hold onto your hat, sweet pea, I’m here.” Trace flashed her a brilliant smile and waved her inside.

  Margo scowled and walked in. She set the can of paint down and slipped off her coat.

  “And good morning to you, too,” Trace said with a laugh. “Coffee?”

  “Please,” said Margo. She toed off her shoes and looked at the different colored socks she wore. They had looked the same in the dim light of her bedroom. Grimacing, she slipped them off and stuffed them in her shoes. Hopefully Trace wouldn’t notice.

  She brushed a curl impatiently from her face and looked around at the walls.

  The color looked good. A quiet settled in, and her body relaxed as she turned in a circle and looked at all the walls. The blue was perfect. There were streaks here and there, definitely needed a second coat, but it looked good.

  She smelled fresh brewed coffee and inhaled deeply. Need. Need. Need. Trace walked into the room with a steaming mug. Want.

  He wore gray sweatpants and a navy hoodie with the Bennett Homes logo. He handed her the coffee with a smile and didn’t say a word.

  Margo took a sip and closed her eyes on a groan. “Delicious. Thank you.”

  “My pleasure.”

  Margo caught his glance and looked away at the twinkle in his eye.

  “Can I help with anything?” he asked.

  Margo took a few more sips and felt the buzz of caffeine burn away the fog. “It’s not necessary. I’ll get the tarps down again and the second coat on. How do you like the color?”

  He looked around the room, nodding. “Looks good. I didn’t think it would change the room so much.”

  She raised her eyebrows at him. “In a good way? Or bad?”

  “Definitely good. The followers of feng shui know what they’re doing.”

  Margo laughed. “It’ll be even better once it’s done.”

  She set her coffee down and pulled out a tarp to cover the floor. Trace grabbed one end and unfolded it until it reached the wall.

  Margo set out a paint tray and reached for the tool to open the paint can. “How was your squash game?”

  Trace took a seat by the island. “Good. I won.” He sipped his coffee. “If you ever want to start a fan club, Dan the Man could be president.”

  Margo looked over at him, startled. “What?”

  “He had only good things to say about you.”

  “Must have been a short conversation.”

  “Just the opposite. Said you were dedicated, hardworking, brilliant–”

  Margo snorted.

  “Compassionate, creative, respected–”

  Margo squirmed and frowned. “Holy cow. Didn’t you have anything more interesting to talk about?” How much did Daniel know about her and Ernie Pearce? How much did he say? Her hand shook as she pried open the lid.

  Trace grinned. “Nope. I was all ears.”

  Margo was silent, frantically thinking about how to change the topic.

  “You know what else he said?” Trace teased.

  “You talk too much?”

  Trace laughed. “Nope. He said he really hopes you go back to medicine.”

  Margo picked up the stir stick and slowly dipped it in the can. She swirled the paint, careful not to spill any over the edge.

  “No comment?” Trace asked quietly.

  “No comment.” A heaviness settled in her chest.

  Trace came over and crouched down beside her. “Hey.”

  Margo couldn’t look at him.

  Trace covered her hand with his. “I didn’t mean to make you sad,” he said in a low voice. “Dan said it was a huge loss when you dropped medicine. He seems to have his shit together, so I took that as a pretty big compliment.” He squeezed her hand. “You should, too.”

  She nodded silently.

  “Plus, I was reassured you were qualified to help me.”

  She looked at him grinning, and smiled reluctantly. “Checking my credentials, eh?”

  “Of course.” He stood. “Don’t want just any hack giving me advice.”

  She shook her head with a laugh. “Nice that I come so highly recommended. Hope I live up to that.”

  “Yup. So what’s next?”

  “Empathy. Making you care.”

  “How much time you got?” he joked.

  She rolled her eyes and poured paint into the tray. “Okay here’s the scenario. A twenty-six-year-old single mom brings her three-year-old daughter into the Emergency Department with severe asthma. The child ends up in the intensive care unit intubated and on a respirator. Mom smokes at home. This is the third time the child has been admitted. There’s some discussion about whether the child needs to be put in foster care. How would you talk to the mom about this?”

  “I’d say, ‘Holy shit. Are you stupid or what? You can’t smoke around the kid. Now your kid’s in ICU. It’s. A. Big. Deal. The kid could die. So three strikes you’re out and a relief pitcher is coming in. The kid will be going home with another family. One that won’t try to kill her. End of story.’ Next.”

  Margo raised her eyebrows and gave a short laugh. “Ah. Well, points for honesty, but perhaps you need to tone it down just a little. Put yourself in the mother’s shoes and ask ‘what if.’ What if she’s trying her hardest? What if she tried to change, cut back, smoked outside? Maybe the child has other triggers. What can you do to help the mother be successful? Smoking cessation counseling, nicotine replacement, parenting strategies. It may be that she’s so stressed about the child that she’s smoking to calm her nerves.”

  “But what about the kid? Who’s advocating for her?”

  “Good point. You are. Ultimately, keeping families together is really in the best interest of everyone. Unless there’s abuse or neglect. That’s a different story. But if the mother is willing and able to make some changes, she should be given the chance.”

&nbs
p; Trace didn’t look convinced. “Okay. So bottom line, at least find out what the mother’s perspective is.”

  “Yes. Keep in mind you don’t have to feel empathy to show it.” Margo continued to roll the paint on the wall. “What if the child dies in the ICU and the mom gets angry and claims the care was substandard?”

  “Then I think it would be fair to point out the mother’s role in this. Her smoking, how long it took her to bring the child in …”

  “Think about it though. Her child has died. She’s angry.”

  Trace sipped his coffee. “So the anger isn’t exactly a lawsuit brewing. It’s a mother’s grief.”

  Margo turned and pointed at him. “Exactly. The slightest suggestion that the mother’s at fault could make it worse. Much worse. Can you imagine the guilt that would sit on the mother’s shoulders if you suggested she killed the child by smoking? And for what? The child’s dead. Don’t do it. It’s cruel.”

  “What if she did it on purpose?”

  Margo shrugged. “I guess there’s a whole spectrum of possibilities. But that would be for the courts to decide. Our job is to help her heal. As much as we can.”

  “So what would you say to her?”

  “I’d say, ‘I’m sorry your child has died. Everything possible was done to try to save her.’”

  “That’s it?”

  “That’s it.” She dipped a brush in the paint and stood on the stool to paint the edge at the top. “Okay, next scenario.

  “A thirty-six-year-old truck driver comes in for a physical exam to renew his driver’s license. He has epilepsy and hasn’t had a seizure for seven years – until three weeks ago. He was partying, celebrating his wife’s pregnancy, and forgot to take his medication. The next day he had a seizure. He doesn’t want you to write it down because he’ll lose his driver’s license for a year. He needs it, especially now with the baby coming. He swears he’ll never forget his medication again. What do you do?”

  “Put myself in his shoes. You gotta feel sorry for him. A bun in the oven, his livelihood on the line. I’d have to say I’d side with the dude and pretend he never told me.”

  Margo nodded and rolled the paint on the wall. “The following week he’s driving on the highway, has a seizure and causes an accident, killing three people, one of them your Aunt Teresa.”

  Trace jerked back with a wince. “Shit. Not Mother Teresa. Harsh.”

  Margo shrugged. “Empathy isn’t about avoiding harsh decisions. It’s about supporting patients when those harsh decisions come down the wire.”

  “So you tell the dude that you have to write it down and watch all hell break loose.”

  “Pretty much. Make sure that it’s fair and necessary in your head and then try to explain it. In this case, the law states that you have to disclose the information. So the decision is out of your hands. But it doesn’t make it any easier to tell the patient.”

  “What would you say to him?”

  “Tell him that you don’t have any choice, you have to write it down. Apologize. Brainstorm possible solutions with him. Offer to advocate for him. Get him seen by a neurologist to assess whether his condition is changing. Stay calm while he vents.”

  “Basically sit by helplessly.”

  Margo smirked. “Pretty much, yup.” She turned and looked at him. “Although it surprises me how much better patients feel when their feelings are validated. Knowing that someone commiserates with them is often help enough.”

  “Misery loves company?”

  She tilted her head. “Yes. But more, we acknowledge that it is a rough go, and other people in their situation would also find it difficult.”

  Trace nodded.

  “K. Here’s another. You’re a surgeon.”

  Trace’s face lit up. “Always wanted to be a surgeon.”

  Margo laughed. “You operate on a three-year-old child to remove a mass. During the operation, the specimen is sent to a pathologist and you’re told it’s cancer. Immediately following the surgery, you tell the parents. Obviously they’re devastated. The next day, the pathologist calls you and tells you that now that they’ve had a chance to look at the sample more closely, do further testing, and consult another pathologist with more expertise, they’ve determined that it’s benign. It’s not cancer.” She paused. “What do you do?”

  “Call the parents with the good news.”

  Margo nodded.

  “Apologize and explain,” he added.

  “Good. Say they’re angry for putting them through hell, would you lay the blame on the pathologist?”

  Trace thought for a moment. “Be hard not to. But no. They’re doing the best with what they’ve got. But it might change the way I do things. Like wait until they’re sure.”

  “Yes, very good. You’re a team. You shouldn’t diss the team members. It’s done and no good will come of it. Apologize and thank the stars that the result didn’t go the other way.” Margo dipped the roller in the paint. She turned to raise an eyebrow at Trace. “More?”

  “Yes, but let me get some cereal and another coffee. Do you want anything?”

  “Any of those muffins left?”

  Trace pointed to the container still sitting on the island counter. “Help yourself. I’ll get you a plate. Coffee?”

  Margo shook her head. “Just the muffin.”

  Trace returned with a bowl of Cap’n Crunch cereal and a plate for her.

  Margo set her brush down and walked over to sit on the stool at the island. “Aren’t you too old to be eating sugar for breakfast?”

  “Breakfast of champions.” He grinned with his mouth full.

  “All part of your strategy?”

  “You bet.” He scooped another mouthful. “Okay, ready. Hit me.”

  Margo smiled and split a muffin in two. “A couple comes into your office together for the results of the husband’s physical exam and tests. They’re told that the husband has a neuromuscular disorder and the outlook isn’t good. A week later the wife calls and asks you to write a letter outlining the disabilities so they can get the ball rolling for some insurance money to renovate their home.” She paused. “Do you write the letter?”

  Trace swallowed. “Yes. Poor bloke. I want to do whatever I can to help,” he said confidently.

  Margo nodded. “Turns out the wife wants to divorce the husband and uses the letter in court to prove he is incapable of looking after their children. She wins sole custody.”

  “Holy shit. What?”

  “True case. The doctor was sued for providing a letter without the patient’s written consent.”

  “Even though the wife was at the visit and knew it all anyway.”

  “Even though. Confidentiality is a big deal. You can’t let on what you know, or even say if a person is a patient, without their permission.” She popped a piece of muffin in her mouth. “And no discussing details in an elevator or at the coffee shop. Eavesdroppers are everywhere.”

  “It’s a mine field. How do you figure it all out?”

  Margo finished the muffin and brushed the crumbs to the center of the plate. “Some of it’s common sense. Being humble helps. And respectful. Once you’ve had patients who trust you with their stories, you appreciate what a gift it is to be able to help them.” She gave a crooked smile. “That probably sounds a bit hokey.”

  He smiled at her. “I’m using feng shui. Get in the hokey pokey line behind me.”

  She laughed and wondered what it would be like to wake up beside those twinkling blue eyes. “I better get back to work.” She stood up.

  “This is really helpful. Is this what you were asked when you applied?”

  She shook her head. “This is stuff I saw during my clerkship. Sixteen months of seeing patients.”

  “Wow, a lot of shit goes down. Got any more?”

  “Unfortunately, yes.” She picked up the paintbrush and stepped on the step stool to touch up the edge by the ceiling. “A twenty-two-year-old male comes in asking for a renewal of
his asthma medication. He states that he’s been asthmatic since he was little, but the vague history is out of keeping for someone living with asthma for years. You know that the inhaler device has a street value. It can be sold and used to inhale street drugs. You wonder if that’s how this prescription is going to be used.” She stepped down and picked up the roller. “Do you write the prescription?”

  “What if he truly is asthmatic?”

  “He could have an acute asthma attack and die without the medication.”

  Trace frowned. “Damned if you do, damned if you don’t.”

  Margo smiled and nodded.

  “I think I’d go with trusting what he says. His dying seems a bigger risk. And it wouldn’t look too good on my CV.”

  “It’s frowned upon,” she agreed. “That’s what I did, too. I suppose I could have called his pharmacy, but he was visiting from out of town, and I didn’t get a gut sense that he was lying. I could’ve been wrong, but the doctor-patient relationship is built on trust, and at some point you have to trust that the patient isn’t lying to you.”

  Trace nodded as he finished the cereal.

  “How about this,” Margo continued. “What would you do if you saw a resident using cocaine at a party?”

  “A resident is a student?”

  “They have their medical degree and are working toward a full license to practice. Often they see patients on their own, but technically they’re still supervised.”

  “So snorting cocaine would be frowned upon, as you say.”

  “Yes.”

  “And it’s pretty unlikely that they would only snort once, so something should be done.”

  “Yes. I’ve not been in that situation, but I think I would report it. They obviously need help. And a cocaine-using doctor is a very scary combo, any way you look at it.

  “When you’re applying to medicine, they love to throw these ethical dilemmas at you. And often there’s no right or wrong. They want to see how you think, how you approach the problem. They want to see that you can be nonjudgmental and empathetic.”

  “Right. So consider what it’s like to be in the other person’s skin. Show them I get it. Ideally they should leave feeling better. And keep everything confidential,” he said.