by Barbara Ebel
Annabel gulped. She felt so bad for May, but there was nothing more the team could do. In her limited clinical training, she had yet to witness a braver patient.
Dr. Schott peeled his eyes away from May. “Yes, carry optimism with you at all times. Enjoy the rest of that strawberry drink.”
The team cluttered back up the hallway and Bob patted Annabel’s shoulder. “You made her hospitalization more tolerable,” he said softly.
“Thanks. I’m going to do what my dad started doing a few years ago when he let religion back into his life. I’m going to say a prayer for her.”
As if he was privy to Annabel’s thoughts, Dr. Schott said, “Patients don’t always get better from our health care. Sometimes healing comes from spiritualism or an unknown force which infuses someone with the ability to overcome their own medical obstacle.”
“I tend to be more pragmatic,” Dr. Mejia said. “Maybe that’s why I went into cardiology and deal with the straightforward physical and electrical elements of the heart.”
“I’m going into cardiology too,” Jordan reminded him. “My thinking precisely.”
Annabel wanted to say, “No one asked you,” but she bit her tongue. She noticed Dr. Schott shake his head probably because Jordan had overstepped his rank in front of the attending doctor.
“Religious discussion aside, who’s our next patient?” Dr. Mejia asked.
“We should do Mrs. Helm next,” Donn said. “She’s next door and is Annabel’s new patient from last night.”
All eyes focused on Annabel again as she slipped out her patient’s index card and checked the patient’s age.
“Meagan Helm is a forty-seven-year-old Caucasian mother of three who came in with an onset yesterday of rapid heart palpitations, shortness of breath, and dizziness. Her heart gave her similar problems when she was pregnant with twins and she has a history of rheumatic heart disease. Other than that, her past medical and surgical history is negative, and she never had a follow up for her heart.”
Annabel slipped the cards back in her pocket and continued. “On her admission physical exam, her heartbeat and pulse were fast and erratic and her EKG indicated atrial fibrillation.”
Jordan took a baby step forward, his enthusiasm for the heart condition as apparent as Dr. Mejia’s.
Annabel continued. “Her diagnosis is atrial fibrillation and the plan was to convert her pharmacologically and not by cardioversion. Dr. Watts ordered an IV calcium channel blocker and Mrs. Helm’s heart responded perfectly; her rhythm is now normal and regular.”
Dr. Mejia rubbed his hands back and forth. “Ahh. A clean, classic case. Dr. Schott must have told you atrial fib is the most common cardiac dysrhythmia and mostly occurs in the elderly. However, cases are increasing in younger people without structural heart disease.” He turned his attention to Jordan Maldonado. “They are a challenge and, by the time you are out of residency, you’ll be seeing more and more of them in the ER where the first diagnosis and treatment occur.
“Now I’ll ask the resident … Dr. Wattts, now that Mrs. Helm’s reason for admission is taken care of, are we sending her home?”
“We need to find out the cause of her atrial fib.”
“Correct.” Dr. Mejia turned to Jordan. “What causes a heart to be jumpy like that?”
All eyes rested on Jordan as his eyes grew smaller and no words came out of his mouth.
Chineka Watts waited like the rest of them, but then decided to salvage Jordan’s pride and spoke up. “Structural heart disease, such as mitral valve disease, or from hypertension. Also hyperthyroidism, pulmonary disease, ischemic heart disease, and pericarditis, to name a few others.”
Dr. Mejia nodded and then checked on his hair again with his hand. “What are you going to order first?”
“An echocardiogram, sir.”
“Students, besides rattling off tests that we order on our patients, you must always know how they work. Echocardiography uses ultrasound waves which produce images of the valves, the chambers, and the pericardium, or lining, around the heart. What we’re dealing with here, most likely, is mitral stenosis. If that is the case, what will we see on the echo?”
“Left atrial enlargement,” Chineka said.
Dr. Mejia broke out in a smile. “Don’t you just love it?” he asked, mostly to himself. “Let’s go.” He bobbed his head toward the door and went in. By the time they left, Mrs. Helm understood their reasoning to order her an echocardiogram.
-----
“Who’s going to the Medicine Department?” Annabel asked as the team piled into the office after rounds, minus Dr. Mejia. Their attending already parted ways to go roto-rooter a patient’s coronary arteries.
Jordan’s head was planted six inches from his cell phone as he texted. “I’m coming after I fire off this message to your sister.”
“Tell her I said hello,” Annabel said and frowned.
“Let’s go,” the fourth medical student said. “Jordan, we’ll let you know if you passed.” Stuart Schneider held his head down low, like usual, and was thin as a dime. The fact that he was in the top of their class overshadowed his quiet personality. Unless pressed, he never let on that he knew so much, but he did.
“I’m coming,” Jordan barked at Stuart. Jordan tugged at Annabel. “Your sister said she and I should meet halfway between Cincinnati and Nashville one of these weekends.”
“Better for your first date than one of you driving the whole way,” Bob said.
Jordan stooped over and grabbed his bag and jacket. “And who are you dating these days?”
“Nobody.”
“That older med student is out of the picture?”
“Totally.”
“How about you, Annabel?” Jordan asked. “You snuck out for a date the other night after we were all together.”
“Don’t mention that one. However, the policeman involved with our medical case during the first half of the rotation has asked me out again. I actually met him while on my psychiatry rotation.”
Surprised, Bob’s pace slowed and he glanced at her. Maybe it won’t go anywhere, he thought. Then again, he didn’t know why the two of them had not continued dating before.
Stuart bulldozed ahead of them and, outside in the parking lot, they each climbed into their own car. Downtown on the main campus, the hallway of the medicine department came alive with their footsteps. Bob opened the door to the office and they lined up like school children waiting on the bathroom. The secretary sorted through the alphabetically arranged test results.
“Should I say the test scores aloud or do you each want privacy?” she said with utmost importance.
All four of them shrugged.
“We don’t care,” Stuart spoke up.
“Easy for you to say,” Bob said. He smiled at the woman with a stacked figure and a tight permanent. “Yeah, it’s okay. He speaks for all of us.”
“You all passed, but Dr. Schneider wins the trophy with a perfect hundred.”
“Congratulations,” Annabel acknowledged in awe to her classmate.
Stuart hung his head. “To all of us,” he said.
-----
Annabel drove home with relief that her call night was over, she wasn’t dead tired, and that she passed the mid-term test. She’d scored a ninety-one … not too shabby.
She was glad for Bob too, who surpassed her this time with a ninety-two. They knew Stuart’s result, but Jordan did not divulge his. The way he acted, however, she almost thought that he was the one with the one hundred and not Stuart, especially since he had cheated.
She pulled off of I-75 and soon drove in her eclectic neighborhood of small houses, which were mostly three-story apartment rentals. The area was hilly and charming and had a small garden park close to the end of her street where the view encompassed the dark channel of the churning Ohio River making its way towards the great Mississippi.
Annabel weaved her SUV up and down the streets flanking where she lived and sighed with despair over th
e parking situation. Renting someone’s garage for parking was a luxury commodity and garages rarely became available, so she did what most of the other younger people did who worked - be at the right place at the right time and snag a space when someone happened to pull out of a spot.
The sun was shining and she was in a good mood, so she cranked the top country playlist a little louder and kept circling.
It seemed like she heard Keith Urban a second time by the time a brown-suited young woman in heels beeped open her car door and scrambled in. Annabel gave her enough space to pull out and then she parallel parked like an expert. Luckily, the proximity of the fire hydrant was not an issue and she was at least on the upper end of her own street.
No matter how small her third floor two-room apartment was, it was always heartwarming to open the door to her own place. She dumped her things on the kitchen counter and went into the bedroom, which also housed her desk and only comfortable chair.
After peeling off her scrubs, she took a hot shower and dressed in polyester running pants and a long-sleeved T-shirt. All the while, she contemplated the parking situation. Jae Nixon, the sick man she drove to the hospital, had solved his transportation problem back to his parked vehicle without any fuss at all.
She had a parking problem, not so much a transportation problem, but why hadn’t she thought of it before?
She grabbed her cell phone. Both her parents would be working, but they would either take her call or let it forward to voicemail if they were tied up. She called her dad, who might be doing surgery on a cranial case or seeing patients in the office.
“Hi, honey,” he said right away.
“Hey, Dad. Can you talk?”
“I’m in the doctors’ lounge between cases, trying to saw my way through a bagel with a plastic knife.”
“You can get into someone’s head easier than that.”
“So true. Surgical equipment companies are more skillful making their products than the humans churning out plastic cutlery, that’s all.” He laughed and added, “Is everything all right?”
“I passed my internal medicine mid-term.”
“Congratulations. Was there a doubt in your mind?”
“I suppose not. My friend, Bob, did well too.”
“Treat yourself and Bob to your favorite restaurant. It goes on my credit card anyway.”
“We’re going to run together today, which we’ve never done before. We’re post call and we weren’t slammed too bad.”
“I often have worse nights than you and I’m the one finished with training.”
“Although you say you’re always learning, Dad.”
“That is the truth and the way it will be for you too.”
“I miss Dakota,” she said. “But I’m sure you grieve for him more.”
“That dog is in my heart every day. Nevertheless, yes, I miss my faithful companion. I better go. Anesthesia is ready to put my next patient to sleep.”
“Dad, another thing. Can I start putting something else on the credit card bill?”
“I’m listening.”
“The parking around here has only gotten worse and I shudder every time I pull out of a space. When I come back home, finding a parking spot is as evasive as finding Bigfoot. I’d like to leave my Nissan where it is on hospital days and instead call Uber. The service is not that expensive.”
Danny considered her request. His daughter never made outrageous requests when it came to money. “However, your safety comes first.”
“The substitute taxi cab service is safe. In the major cities, people are using it like crazy.”
“Okay. Give it a try. Let me know how it works out.”
“Thanks, Dad. Say hello to everyone at home and good luck with your next case.”
“I’ll tell them.”
Annabel closed the call and punched in another one. This time to Bob.
“A real phone call and not a text,” Bob said when he answered. “Are you all right?”
“I’m fine. Can we change our plans from driving over to Eden Park and meeting there to run and, instead, run a loop from my place? Down my usual route?”
“It’s alright with me. How come?”
“I spent freaking fifteen minutes searching for a parking space when I arrived home and I don’t want to do that again today.”
“Hmm. So what you’re saying is that you want me to go there instead and enjoy the same hassle, eliminating it for you.”
Annabel’s hand flew to her mouth. “I’m sorry. I didn’t think of it that way.”
Bob grinned. “I know you didn’t. I’m yanking your chain. I’ll be over at 1 o’clock, but who knows when I’ll be rapping at your door.”
Annabel grimaced when she hung up. He tolerated her bright ideas a lot more than she deserved.
CHAPTER 6
Jae Nixon finished one hour of paper pushing in the visitors’ center and ambled back over to the cabins.
First, he went inside to his kitchen and pulled out a drink mix. He mixed the orange powder with water and hoped the fluid and electrolyte combination would prevent him from wilting any more. Like a leaf blowing to the ground, his energy was draining by the hour.
Still wearing his outdoor walking boots, he gathered the bucket with mouse deterrants he’d used earlier in the morning when he had mouse-proofed inside the cabins, storage shed, and make-shift garage. Those spots were ideal for the white-footed mice in the cooler months, but now he needed to survey outside; it was time for them to begin their breeding season. Finding burrows and nests were on his agenda.
When he drove in from the hospital the night before, his headlights had spotted one of the nocturnal critters, a full six inches including its tail, scurrying ahead towards stumps and rock piles behind his place. The furry fellow’s underside was white but the upper body coloration was dark. The bicolored fast rodents could zoom away from headlights like lightning compared to the stunned deer that froze when he rounded a corner and caught them by surprise.
When he poked at the ground where he saw one disappear the previous night, he knew the site made a fine protective cover for them to burrow. He found a soil crack with evidence of mouse droppings and not only did he drop down poison, but he took a shovel from the nearby shed and filled it in.
As he took a break, his eyes scanned the edge of the woods while he drank down the refreshing drink in stops and starts.
Two old rotting logs were several feet away. The second one proved to harbor a mouse nest underneath, so he dismantled it with the shovel.
An hour later, he struck gold several feet above ground with an abandoned squirrel’s nest. Because of his thorough biology background, he could spot the usefulness of this newly inhabited mouse home for breeding purposes. Two startled white-footed mice practically flew off the tree above him while he was working.
Although he wore no jacket or hat and had done no strenuous work, moisture began to accumulate under Jae’s armpits and the base of his neck. He finished the twenty-four-ounce bottled drink he had mixed, put the shovel away, and went back to his place.
Inside, he swallowed an over-the-counter pill for his headache first, took off his boots, and sat on the plaid cloth couch. He could barely fend off the tiredness, so he fluffed the pillow by the armrest and lay sideways.
Just a short catnap, he thought …
-----
Sitting at her desk, Annabel heard a thump and put down her pen. She scurried across the kitchen floor and opened the stiff door. Bob stood there in a short-sleeved T-shirt and navy blue running pants like herself. His hair was fixed just right and he wore a smile.
“Fancy sneakers,” she commented.
“They’re brand new and need breaking in.”
She stepped aside, letting him walk in. “What’s the deal with those shoelaces?”
He glanced at her shoes and grinned. “You’re the runner, but you use traditional laces?”
“You answered my question with a question,” she said, frustrated.
“Besides our mid-term test, I guess you outsmart me in running gear too. I don’t know anything about traditional or non-traditional shoelaces.”
“Then it’s my pleasure to show you something new. They are elastic no-tie shoelaces. These lock laces did not come with the sneakers; I bought them separately.”
“So they are for people too lazy to tie their laces?” She kept a straight face and then tapped him and laughed.
“No. Why bother with regular flat nylon laces that drape over your shoes? You have to double knot them to prevent tripping over them. Or why bother making knots with them at all, causing you to waste precious time?”
Annabel shook her head. “Bob Palmer, now I understand. You’re studying more than me because you’re salvaging more study time by not tying shoelaces.”
They both laughed “Are you ready to hit the pavement?” he asked.
“Follow me on this grueling route. We’re going to do stairs as well. They go down to the major thoroughfare along the Ohio. And by the way, my dad congratulated us on passing our test. He said a dinner for the two of us is on him.”
“Can we take him up on it?”
“How about going up the block to Pete’s for a late lunch when we’re finished? That would be more our style.”
“Your call.”
Annabel grabbed her keys, locked the door behind them, and they scrambled down the two flights of stairs. She pointed down the narrow block but focused on the pavement as they began their jaunt. The blocks of cement were old and uneven and she hated the hazard.
“Falling is not permissible,” she yelled over her shoulder. “We’re finishing internal medicine without an incident.”
“No problem.” They joined alongside each other when they crossed the street at the end and followed a safer pavement through the little park ripe with greenery from non-deciduous bushes.
“Come on this way.” They paused at the top of the staircase. “The hard part’s coming back up.” She grinned and took off ahead of him.
Bob followed, and at the halfway mark, they took an overpass across the road to the other side. They both walked a bit on the sidewalk and watched two barges going in opposite directions.
