by Barbara Ebel
“How old is the baby we’re going to see?”
He handed her the folder. “Four months old. Today, she’s also due for a second dose of certain immunizations. Be aware the evaluation covers more than those measurements. I’ll evaluate developmental milestones, do a psychosocial and behavioral assessment, and perform a physical exam.” He began to raise his fist to knock on the door but paused. “What part of a physical exam is unique to this age group?”
Delighted that he was teaching her something, she unashamedly shrugged.
“The soft spots on a baby’s head. In this patient, they should disappear within eight to fourteen months.”
“Fontanels,” Annabel said.
“Of course. I’ll also make note of the baby’s head shape. It should be rounding out nicely.” He knocked and went straight in.
A woman stood alongside the exam table against the wall. She interacted with her daughter, Mandy, and also served as a protective barrier in case the baby slipped toward the edge.
“Hi, Dr. Gillespie.” Mrs. Stanton broke out in a smile and glanced at Annabel.
“A new student is with me,” he said. “Annabel Tilson.”
Annabel nodded, and not sure where to stand, she sat down.
“Can you believe how big Mandy has grown since last time?!” Mrs. Stanton’s eyes grew wide as a proud expression crossed her face. Without being asked, she began describing Mandy’s behavior since her last visit and backed up into a chair at a right angle to Annabel. Dr. Gillespie’s ears were already hooked up to his stethoscope, which rested on Mandy’s chest.
Annabel saw intermittent parts of his exam as he stepped from right to left. He examined the baby’s skull and then checked her eyes, ears, and mouth.
“Mandy switched over to formula without any problems,” Mrs. Stanton went on, “but I miss breastfeeding her.”
Dr. Gillespie palpated Mandy’s abdomen and undid the plastic tab on her diaper. He pulled the diaper out from under her by holding her two legs up for a moment. He moved her hips and legs, apparently satisfied with their movement, and then held her little legs apart. After fixed on looking at her genitalia longer than a brief moment, he slipped something out of his pocket.
Annabel wondered if he noted an abnormality. He placed something over one eye. With a somewhat obstructed view, she realized it was a magnifying glass. She thought she heard low humming. It was George. It must be more of a habit of his than she thought.
The pediatrician separated Mandy’s labia. That much she was sure of. Annabel wondered why she ever thought that the first significant exposure a female had to a very private exam from a doctor was as a teenager or a young woman having an OB/GYN pelvic exam. Obviously, this wasn’t an internal pelvic exam, but it was as private as it gets.
Annabel diverted her eyes. At least she could focus on something else. Above the exam table hung a large print of an alphabet zoo. She stared at the “M” square with a friendly-looking picture of a monkey.
Dr. Gillespie’s humming sped up and he pocketed his magnifying glass before he fastened the baby’s diaper back on. In the meantime, Mrs. Stanton used the free time for herself and rearranged and cleaned out her purse.
George turned around. “Annabel, stand here a moment.”
Annabel rose and took a step to watch over the baby. Dr. Gillespie brought the growth curve chart over to Mrs. Stanton. “Mandy is coming along just fine. She’s in the middle of growth and development for her age. My nurse will be back in to get a little blood so we can test Mandy’s hemoglobin and she also needs her second doses of immunizations today. Schedule an appointment in two more months before leaving.”
“Thanks, Dr. Gillespie.”
Annabel followed George out the door and went back to the kitchenette while Dr. Gillespie finished recording the office visit. She grabbed the rest of her donut while wondering about the first year of life and what the standard of care was for well-baby visits. Opening her paperback, she checked the guidelines. The chapter said that babies should get a head-to-toe exam from the doctor at each visit — ears, eyes, mouth, skin, heart and lungs, abdomen, hips and legs, and genitalia. She closed the book and gulped down the last bite.
-----
Toby Owens pranced up and down shoe aisles, one step behind his mother. They were there to select a new pair of sneakers for him in the nearby mall’s shoe store and, after checking many price tags, she had more enthusiasm to buy him a no-name pair of sneakers than the Nike, Adidas, and Jordans on the end displays.
Mrs. Owens picked up a pair with a luster of silver and turned them over. Toby shook his head at her and grabbed the same style in a white with black accents.
“Try them on,” she said.
He went to the bench and untied the laces to the pair he wore. As he took them off, he glanced at the soles. His mother had dragged him to the store with her because they were worn down. He’d worn them for almost a year; for school, for basketball, and the whole summer so far. Any kid would be ecstatic to be buying new ones; he just wished he didn’t feel so achy. Not only achy, but a bit nauseous since he had eaten breakfast. No way was he was going to give up the opportunity for a new pair, however, so he went along with her shopping plan.
Toby shoved both feet into the sneakers, stood, and strode past his mother. He stopped at the mirror in the middle of the aisle and turned at forty-five degree angles. They would do fine, just fine; as a matter of fact, he liked them. No name brand, but stylish, and they hugged his feet like a baby in a blanket.
“How do they fit?” his mom asked.
“Pretty good. Can we buy them?”
“You betcha.”
Relief swept over him. He wasn’t fond of shopping and at least it didn’t take too long to find something he liked. Sitting back down, he switched shoes and peered at the price tag. Expensive enough, but nothing like the name brand sneakers. He rose, which caused his nausea to ramp up. Stagnant food in his GI tract churned upward instead of downward.
Mrs. Owens walked away, but not in the direction he wanted. She went further to the back of the store and disappeared around the corner. In slow pursuit, he followed to find her stepping into the women’s shoe section, where aisles were full of shoes of various heights, colors, and styles. His mother remained oblivious to him and intently stood in one spot looking high and low on the racks.
This would be purgatory, he thought. When she shopped, it was insane. She took forever and, plus, she could be damn picky. He glanced in the mirror as he headed past her. He had to admit that he looked pasty; even his freckles looked pale.
Toby kept walking to the bench to sit. He needed to be more comfortable to endure however long she would take. She was only two shoes further along in her quest than when he turned into the aisle, but she hesitated, holding one pair. With a nudge to a shoe she was wearing, it fell on the carpet, and she slipped on a low-heeled tan shoe.
He put his head lower towards his knees, but that didn’t suppress the bile-like acid taste in his mouth. Looking around, he figured the rest rooms were located in the back corner of the store, so he went around another aisle and barely made it to the men’s room. Without a soul inside, he flew to a stall and spewed forth his breakfast. His stomach felt like a washing machine spinning everything around and, after a second time, there was little left to heave up. He grabbed some toilet paper, wiped his mouth, and stood straight. Actually, now he felt a tad bit better. He headed to the sink and thought it over … whether or not to tell his mother. No sense in her making a big deal about it, he thought, so better not to say anything.
When he went back to the aisle, Mrs. Owens was at the end of the same aisle and she still didn’t have a pair that she liked. He sat next to his box of sneakers and waited it out.
-----
Annabel and Stuart peeled out of the pediatrician’s office at lunch time, grateful that they didn’t have to stay with their attendings for the next patients. Families had been heavy with questions during the morning visits and
Dr. Gillespie and Dr. Clark were both behind.
“So how’d it go last night?” Stuart asked.
Annabel laughed to herself. He couldn’t be referring to her sex with Dustin, but that was what she thought of first.
“Dustin’s mom was really nice. I think we hit it off with no problems. And thanks to you, she enjoyed the blueberry cheesecake I bought her. Nice touch.” They stepped off a curb and she added, “You’re already a practiced psychologist, soon-to-be future psychiatrist.”
Stuart glanced up and nodded. “Glad to help.”
“So Bob survived his first night on pediatric call last night. They were pretty busy.”
“Is he getting any studying done?”
“Less than we are.”
“Did you have any interesting cases this morning?”
“Mostly well-baby checks,” she said, frowning. “But later today, a three-year-old and her father who came in yesterday should return with a twenty-four-hour urine sample. I don’t know what tree Dr. Gillespie is barking up with that one.”
“Our attendings both seem knowledgeable and dedicated.”
“I would have preferred working with Dr. Clark if I had a choice.”
“Why?”
“I don’t know. Maybe being in a room with a same sex doctor makes more sense for doing physical exams in such a private setting.”
“But all exams are ‘quote’ private, and that shouldn’t make a difference. Didn’t mean anything, even when we did our OB hospital rotation, and think how intimate that was.”
“Yeah, you’re right.”
They stopped in front of the restaurant and Stuart peered at the chalkboard on the sidewalk listing their lunch special. “What are you getting today?”
“Beats me. Let’s get back quick, though. I’d like to study.”
-----
At 4 p.m., the buzz of sick children coughing and sneezing and the clatter of toys from the kids in for school physicals was down to a quiet calm. Annabel was bent over a book while Dr. Gillespie was in his office talking to a family.
Becky came and hung out in the doorway. The bun in the back of her head was starting to unravel, so she un-speared a bobby pin and pierced it back through a clump of hair. “Mr. Miller is here from yesterday,” she said, “and Dr. Gillespie asked if you could go get the urine sample he should’ve brought in. It goes to the lab.”
“I’d be happy to.” Annabel left her study materials and went to the front desk, where Stuart was leaning against the exit counter. “Let’s go check out the toys,” she said and laughed.
The students entered the kids’ space. Legos were strewn on the carpet, a brown bear was face down, and a plastic doll was stuck in a dollhouse chimney. The children’s books in a wire rack were mostly stacked neatly in a row. Next to them, little Stephanie sat on a yellow plastic chair and her legs swung back and forth.
“Hi, Mr. Miller,” Annabel said and glanced at Stephie. “How are you today?”
“I’m okay. Daddy said I have to sit like a nice girl because we won’t be here long.”
“You are doing a fine job. This is my friend Stuart.”
“Hi, Stephie,” Stuart said. “You are wearing the prettiest shoes in here all day.”
Annabel turned to Mr. Miller. “Were you successful obtaining Stephanie’s urine for twenty-four hours?”
“My wife and I managed. Stephie’s cooperation was easier to get than getting her to clean up her toys every night. We told her it was for the doctor. He would test her pee, which might help him understand the bump in her belly.” He rolled his eyes at the mention of “pee.”
Mr. Miller’s muscular arms reached under his chair and he handed Annabel a bag with the container in it.
“Dr. Gillespie said we’ll see you and Stephie on Friday after all the test results are back.”
Mr. Miller rose. “Thanks, doc; see you then.”
Stephie and Stuart had a “Chester the Chesapeake” paperback from the book stand; she pointed to a picture of the dog wearing sun glasses and giggled.
“Do you have a dog at home?” Stuart asked.
“Our dog is old, but we love him.”
“He’s young at heart, I’m sure.”
“Bye,” Mr. Miller said as they left. Stephie looked back and waved.
Stuart held the door while Annabel carried the urine sample. “I was close to her,” Stuart said, “I couldn’t help but notice the pallor of her conjunctivae. Does that have anything to do with her sickness?”
“I don’t know. That and the lump in her belly. How do you tie those two signs and symptoms into one entity?”
“Or maybe they are two separate issues.”
“Precisely. Medicine is like an investigative police work field.”
“That explains it. There’s so much in common with that field of work, that’s why you get along with, and you’re dating, a police officer.”
CHAPTER 10
Toby sat on the front step of his house waiting for his friend Jonathon to show up with his mother. He admired the new sneakers his own mother had bought him earlier in the day. The urge to wear them had been too great and he had sprung them out of the box. That shopping excursion had cost him dearly, however, because his mother took no less than another hour to decide on not one pair of shoes for herself, but two. Then she dragged him to a coffee shop, where she lingered over a strong cup of caffeine. The smell of it practically made him puke again.
He didn’t want to do much, but when Jonathon called after dinner wanting him to go to the movies, and didn’t ask him to go play basketball, he decided it was better than hanging out in his room. His mother, however, had warned, “You’re still having those muscle aches, so head home right after the show.”
Two SUVs went down his narrow dead-end street. Next, Jonathon’s mother came to a halt in a sedan wearing minor door damage. Toby pranced down the path past two Crepe Myrtles on either side and made sure to go around the back of the vehicle so he didn’t sit on the side of the previous accident. He didn’t trust the driving of his friend’s mother anyway.
Lucy Harmon and Jonathon greeted Toby as he settled in the back seat. She turned around in the cul-de-sac and focused again on the public radio discussion about a local political race.
“Nice sneakers,” Jonathon said. “When did you get them?”
“Today.” Toby rolled his eyes. “A shopping excursion,” he said softly.
“Still, you got something to show for it.”
Toby nodded. “I don’t feel like going this week, but I’ll have to try them out on the basketball court.”
“What do you mean? You don’t want to play this whole week?”
“Don’t tell my mom, but I threw up today. And my mom and dad didn’t see it before, but I scraped most of my dinner into the trash. After all, it’d be better to sit through a superhero movie tonight than have them confine me to my room.”
“I hear ya. I won’t say anything. I’ll eat popcorn for both of us.”
Toby stuck out his tongue with disgust and Jonathon giggled.
Lucy Harmon pulled into the multi-screen cinema complex and followed a line of cars with drivers looking for the best parking spaces. She glanced into the back mirror as she headed towards the front doors to let the boys out. “I’ll be back outside here at nine thirty sharp to pick you both up …”
The sound of loud pop music grew louder and drowned out Mrs. Harmon’s words as a four-by-four vehicle raced from the side street into the front lane of the entrance to the theatre. A loud metallic sound ensued as the Harmon’s sedan careened from the impact of the high-set vehicle. As movie-goers jumped out of the way, their vehicle pitched and vibrated until it came to a stop halfway up the curb.
As the side of her car still seemed to moan, Lucy Harmon caught her breath and recovered from the surprise and shock of what happened. She realized she was probably not injured and immediately turned around to the boys.
Toby still had his right foot up on the console
, where he’d been showing off his sneakers to Jonathon. But the crush to the right side of the car had shoved the front passenger seat. Toby held his leg, his face grimacing with pain. Her own son held his eyes wide open, and with a squeaky voice, said, “Mom?”
“You okay?” she asked.
“I think.”
They both looked at Toby, knowing his leg was not unscathed.
-----
The entrance of the movie theatre became an accident scene as two officers wrote up a report. Two EMS personnel deposited Toby on a stretcher and loaded him in the back of their ambulance.
“The cause of the accident is a twofer,” one cop said to the other while putting his pen back on the clipboard. “Between that driver’s reckless speeding in a crawl zone and that lady’s lack of attention, we got ourselves real live action outside the theatre instead of on the broad screen.”
They silenced as Mrs. Harmon walked over to say one last thing. “I called Toby’s parents and they’ll go straight to the ER, and a tow truck driver said it’ll be twenty minutes before someone gets here.”
“Another one is on the way for the other vehicle,” the clipboard officer said. “Do either of you want to hop into that ambulance and get checked out in the ER?”
“We’re good.” Lucy walked over to the ambulance with Jonathon and said good-bye to Toby.
-----
Toby had never been in an ambulance or an accident before, nor had he ever broken a bone. He guessed he was lucky to make it to eleven years without any significant medical problems. All these years, all his mother or father did was to bring him to Dr. Gillespie’s for physicals and stupid stuff like a sore throat or spring allergies. Now it seemed like bad luck was crushing on top of his whole life. In one day, some kind of GI bug was making him sick and his leg just took the brunt of an accident and it screamed out in pain.
With the beginning of sixth grade imminent, he couldn’t bear to consider what this all meant. He stared with a blank expression while a paramedic took his vital signs and the other one started the vehicle and pulled away from the scene. He disliked the bright lights inside, which spotlighted the medic as he began putting an IV in his forearm. After a substantial gulp, he held his breath as the catheter slid in.
