“I really cannot think of what to say here,” I confessed.
“Yeah, sometimes I overshare,” said Dr. Tamara. “Anyway. Moving on. We’ve got a call from radiology.” She gestured with a thumb toward the radiology outpost in the center of the ER work area. “They’ve got something for us,” she said.
Inside the dark little cave, there was an ambient glow from the ghostly reading screens. This gave the radiology guys a slightly vampirish appearance, like they might shriek and fall over clutching their chests if exposed to the harsh brilliance of the ER proper or, even worse, the outdoors. Our summoner stood up from his chair when we entered, continuing to murmur into a black dictation device as he motioned us over to the gleaming wall. It was covered in rectangular black films, each of them subdivided into smaller images of blacks and whites and grays. This must be the scan of the gentleman who’d been coughing blood.
“George Chang,” said the radiology resident, setting down his microphone and extending his hand to me. He was a trim Asian guy in a button-down, with little owl-eye glasses perched neatly on his nose. “And who might you be?”
“I’m Zadie,” I answered. “I’m a third-year student. This is my ER rotation.”
“And they turned Dr. Tamara loose on you? How are you holding up?” he inquired, his gaze mischievous.
“Well, I—”
“Georgie, you perv, stop hitting on my med student.”
“You can’t blame a man for trying.” He smiled, shrugging. “Seriously, Zadie. Are you free for dinner?”
Dr. Tamara was firm. “I mean it, George. We are busy saving lives here. Move on.”
George lost the smile, turning toward the films on the board. “It’s really bad for this patient, Alanna.”
I looked at the incomprehensible films while Dr. Chang was talking. “. . . soft tissue attenuation, with these scattered well-circumscribed lesions in the lung periphery. And you can see, there are extensive liver mets too. Guy is all eaten up.” He pushed his glasses back up absentmindedly.
“Shit,” said Dr. Tamara. “This sucks.”
“Yes. And, actually, the primary could be colorectal. He’ll need a workup, of course, but that’s my guess.”
“How the hell did we miss this on the plain film?”
“Oh, we didn’t,” said Dr. Chang, sounding surprised. “That’s his X-ray hanging next to the CT. You can plainly see the outline of these larger nodules. Don’t you ever look at my reports, Sensei?”
“I thought I’d rely on the third-year med student’s reading, Georgie. You hedge too much.”
“Oh no,” I said, feeling my face betray me with a hot blush. “Oh, I am so sorry. I don’t know what I did. I must’ve looked at the wrong X-ray.”
“You wouldn’t be the first to do that,” said Dr. Chang kindly. “It’s a good lesson to learn early. Always double-check the names. You don’t want to send this guy home with an ‘all clear’ and tell the guy in the next room he’s got metastatic cancer and a few months to live.”
“No, I don’t,” I agreed fervently. “But, oh my God. Does he have months to live? He’s forty.”
“Well, let’s not jump the gun here, George,” Dr. Tamara interjected. “We’ll get him admitted and biopsied and let the onc guys get started with all their toxic potions and shit. Zadie, we need to talk with him.”
“What are we going to— I mean, how do you tell him something like that?”
“I’m going to let you tell him.” Dr. Tamara studied the films as she spoke. “But I’m a strong believer in just coming out with it. Don’t use a lot of euphemisms or half the people you’re talking to will be clueless from the get-go. Same thing for telling folks someone croaked. You really need to say ‘died.’ No one will hear a thing you say after that either, so if you have other information to give, you gotta get that in first.” She rocked up and down on her heels. “Okay, I’m done with the pearls. Let’s roll.”
Dr. Chang seized the moment. He handed me a small piece of paper. “Here’s my number, gorgeous,” he said. “Let’s try for dinner, yes?” Clearly, audacity had worked for him in the past, or possibly he was a perpetual optimist. His round owly face was beaming with hope. I had to smile.
“Thank you,” I said.
There was a rustle from the other side of the viewing board, and someone stepped into our half of the room.
“Well, looks like you can hang it up right now, Georgie,” said Dr. Tamara. “Casanova is here.”
It was Nick, and without a word, he moved in, sweeping me backward in a low-dipping embrace, kissing my throat. After a few seconds, he released me, gallantly heaving me upright to face Dr. Tamara and Dr. Chang, who were both agape at this alpha-dog display of prowess.
For once Dr. Tamara appeared speechless. It was George who finally spoke, fixing X with a stare of unabashed admiration.
“I’m going to try that next time,” he said.
—
“So,” I said, “months of insisting we keep it secret”—I had discovered it was important to avoid the word “relationship,” because that shut Nick down like a kill switch—“and you choose to tell the world we’re dating with a public attack in the radiology department?”
“I didn’t tell anyone anything. I am a man of mystery,” Nick said calmly, turning the page of a surgery journal he was reading. He did the sexy-reading-in-bed thing perfectly, clad only in boxers, even managing to look hot in glasses.
Clues to Nick’s personal life were sparse. The only photograph in the room was an old black-and-white of a rescue dog afflicted with a terrible underbite, which gave him a lovable but maximally stupid look. This worked out better on a dog than on a human, however: it was one of those he’s-so-ugly-he’s-cute situations. He was facing away from the camera but was looking excitedly back over his shoulder, with one floppy ear half covering his eye and the underbite giving him a lemon-sucking Doh! of a smile. At least this was one thing about Nick’s past I did know: the dog in the picture was his favorite childhood pet, who had been named Pedro.
“Well,” I said to the man of mystery. “Whether you used words or just relied on the, ah, stunning visual, it was pretty obvious after that display that we’re together.” I allowed myself a small yawn, in the interest of seeming nonchalant.
“Nonsense,” said Nick. “All those dorks know is that the ladies can’t keep their hands off me.” He smirked at me over his glasses, smugly cocking an eyebrow before returning his attention to the journal.
“You know that was degrading, right?”
“Zadie,” he said, setting down his journal and looking straight at me, “you liked it.”
I strongly wished to deny this.
He regarded me with a trace of amusement. “Go ahead,” he said. “Tell me you didn’t.”
“I didn’t!”
“Oh. Well, my bad. I misunderstood.” He idly laid a finger below my waist, right on the prominence of my iliac crest, and began tracing the outline of my hip bone.
“Right, okay,” I mumbled, making a heroic effort not to start melting, which could have been construed as a tad hypocritical during one’s delivery of a lecture against sexual objectification. “I am hereby declaring I’m off-limits until you acknowledge to God and Dr. Markham and everybody that we are dating.”
“I am not at all concerned about your nooky moratorium, my little biscuit.” Nick eyed me with amusement. “I know you’re not about to start turning it down just to prove a point. You’re the sexiest girl I’ve ever met.” He returned to his journal, peering over his glasses to check my reaction.
Well, this was true. I was pretty much a sex fiend. I smiled to myself, then hastily tried to figure out how to redirect the course of events. Somehow, Nick could get the better of me in our conversations without ever seeming to address anything head-on. How did he do that?
I needed to stick to my g
uns here. “You are the most exasperating human being,” I grumped. “Are you going to continue to defy any attempt at discussing the rela—this?”
“Yup,” said Nick. Then, reconsidering: “Well, there is something we could discuss.”
“What?” I asked.
“This,” said Nick, lunging across the bed and tackling me.
“Get off me, you insatiable bull!” I howled. “I’m conversing!”
“Later,” he growled, pinning me under him and licking my face with giant disgusting laps until I was helpless with laughter.
—
Later, of course, there was no conversation about it, since we both fell into an exhausted sleep. Although he wouldn’t admit it, Nick loved cuddling in bed. It was the one time his face relaxed into unguarded sweetness; he liked caressing my hair, smoothing it over and over with his large hands while he murmured little compliments about my beauty, my accomplishments, my wit. The fact that he clearly appreciated my intelligence as well as my body reassured me.
My sleep was restless. I kept partially waking and thinking of the day, with a hollow half realization that Emma hadn’t paged me yet. I sat up and shot a glance at Nick’s bedside clock: eleven forty-three. Oh, hell. I’d been completely lobotomized by sex. I should have just shown up at the ER and dragged her out for a minute.
I looked at Nick. He was lying stark naked, flat on his back, mouth open, arms and legs flung wide, managing to look simultaneously ridiculous and dear. All his ferocity was transformed to dopey sweetness. I felt a sudden swelling of love for him; despite his gruff manly exterior, he was a loving person, in his way. In a sudden flash of the future, I saw myself marrying him, kissing him goodbye each morning, tending to a slew of tiny Nicks and Zadies before coasting off to my own surgery job.
I touched his arm and he made a small snorty sound, as if he were a very tiny pig. I leaned in and kissed him lightly on the lips, then rose and gathered up my things. Time to slink out and apologize to my bereaved roommate. I nudged open Nick’s creaky bedroom door with my hip.
“Wha’? Zadie?” croaked Nick. “Whereygoing?”
“I gotta go,” I whispered. “Emma wants to talk to me.”
Slightly less groggy: “She does?”
“Yes. She’s going to tell me about what happened with Graham, I think. Anyway, I’ll call you tomorrow and tell you about it.”
“She’s at work; why not wait? Besides”—now he sounded alert—“I have tomorrow morning free. We can stay together tonight, and I’ll bring you cappuccino and croissants in bed in the morning before you go into the ER. How often does that happen?”
“What? Never!” I said, excited. He was probably right. How much could we discuss between Emma’s patients? Whatever had happened with Graham, it would be better to talk about it privately tomorrow night, when we were both off. I almost never spent the night with Nick; our brutal schedules rarely permitted it.
“It’s settled, then,” said Nick, smiling at me. He took my pager from my hand and tucked it in his bedside drawer. “Come here, sex biscuit, and cuddle up to me.”
“Coming!” I sang. I’d page Emma first thing in the morning; she must be busy now. “But do you mind if I borrow some boxers or something to sleep in? We’re facing an enormous hygiene emergency if I don’t change clothes soon.” I started to pull open the drawer where he kept his underwear, and yelped in fright as Nick lunged out of bed and caught me by the shoulder.
“Those are dirty,” he said, shutting the drawer. His bare chest gleamed in the room’s dimmed ambient light.
“That’s not right,” I said, suspicious. “Who keeps dirty underwear in a drawer? What’s in there?”
“Nothing,” he said firmly, spinning me around toward the bed. “That’s where I keep my private items.”
I was immediately intrigued. “What private items?”
“Stop being so nosy.” He flashed a feral grin at me. “Or I’ll tie you to the bed.”
“Rawrrr,” I purred, casting a longing glance in the direction of the mysterious drawer, resolving to peek in it at the first opportunity. Nick took no chances, however: he tucked me into the crook of his shoulder and flung a muscled leg over my hip, his fingers drifting lazily through my hair. “Say it,” I instructed happily.
“I love you,” he whispered. “I do.” I could feel his heartbeat against my back. I nestled against him, soothed into a happy state of well-being, and fell fast into a dreamless sleep.
Chapter Thirty-six
SURGICAL SECRETS
Late Autumn, 1999: Louisville, Kentucky
Incoming Code Blue. Today I was being supervised by the chief resident of the ER, a beautiful brown-haired doctor named Rachel McMann, who was probably five feet one in heels but nonetheless intimidated everyone with her brusque manner and horrifying New Jersey accent. I caught sight of her now, striding machinelike toward one of the big resuscitation rooms in front.
She saw me too. “Medical student!” she bellowed. “Got a good one coming in. Full cardiac arrest, fifteen minutes downtime.”
“Thanks for paging me,” I said, trying to keep up without breaking into a full-on sprint. How did such a short person move so quickly?
As always in a code, the room was crowded. Rachel assumed the place at the head of the stretcher and I wedged in at her elbow. Our timing was good; right after we positioned ourselves, the EMTs barreled in. One was bagging while the other did CPR, both of them pausing long enough for the nurses to pull the sheet with the patient on it over to the ER stretcher.
“Forty-nine-year-old male, collapsed during a meeting. Initial rhythm was V-fib, defibrillated times three, total of two milligrams epi. No time to tube him,” one of the EMTs reported breathlessly.
The usual flurry of activity ensued. I was hoping Dr. McMann would let me intubate the patient, but instead she did it herself while simultaneously pimping me on the management of various arrhythmias. This was disconcerting to everyone in the code because she kept shouting “Congratulations! You just killed the patient!” every time I fumbled an answer. Meanwhile, one of the second-year ER residents had shown up uninvited and poached the remaining good procedure: insertion of a central line into the internal jugular vein.
The code was not going well. The patient kept getting resuscitated and then immediately dying again. To make it even more confusing, he’d had so much epinephrine it was impossible for him to flatline; the residual drug in his system showed up on the monitor as a little oscillation of activity even though no one could detect a pulse. But nobody wanted to quit. He was too young to die. We were all sweaty and exhausted when Dr. McMann finally called it.
“Time of death, nine eighteen a.m.,” she said, her voice flat.
She showed me how to ascertain he was really dead: we checked his gag reflex, checked for pupillary constriction, breath sounds, a pulse; nothing. Then Dr. McMann closed his eyelids and said to the nurse, “Where’s the family?”
The family consisted of a wife named Ellen Anne Dubois, the nurse reported, and she was in the family room. We went in, the nurse and I trailing silently behind Dr. McMann. Mrs. Dubois was attractive: midforties, smooth ebony skin, thick hair in a ponytail, a slender form encased in exercise clothes. She glanced up with equal parts relief and anxiety when we introduced ourselves, repeating our names with a tenuous smile.
“What has Richie gone and done to himself?” she asked, hugging her arms around herself.
“Mrs. Dubois,” said Dr. McMann in a considerably quieter voice than her norm. “Has your husband been feeling unwell lately?”
“No, no, he’s been fine,” Mrs. Dubois answered.
“Does he have any medical problems? Who is his primary care doctor?”
It was dawning on Mrs. Dubois that these were questions to which Mr. Dubois should have already provided the answers.
“He . . . he has high choles
terol,” she ventured nervously. “Is he okay?”
There was a little pause. Dr. McMann spoke: “His colleagues called EMS because he collapsed at work. When the medics got there, they found he was not breathing. They pumped oxygen into him and began measures—CPR and medications—to try to restart his heart. When he got here, we inserted a breathing tube and gave him more medications.” She paused again. “Mrs. Dubois, I am so very sorry to tell you we were unsuccessful, despite trying for a very long time, and your husband died a little after nine o’clock.”
“What?” said Mrs. Dubois in a tiny voice.
I had a sudden mental image of Mrs. Dubois as a very old woman, sitting alone, hunched in the same posture she inhabited now, her little arms wrapped around herself, mourning and bewildered.
“I am so sorry.” Dr. McMann spoke gently. “We tried everything to save him.”
Very slowly, Mrs. Dubois lowered her head to her knees. She rocked back and forth a little.
“We have a hospital chaplain,” said Dr. McMann. “She’ll call someone to be here with you.”
“Oh,” said Mrs. Dubois.
“That should be her,” said Dr. McMann, as a quiet knock on the door sounded. She stood. “You may want to talk to me later, or you might have questions. Just ask for me; I’ll come back. We are all here for whatever you need. And Megan will stay with you.” Megan, the nurse, nodded.
We swung open the door, but stopped as Mrs. Dubois raised her bewildered face toward us.
“I’m grateful you tried,” she said, and her face broke as she tried to smile.
—
“Okay,” said Dr. McMann, as soon as we were clear of the room. She had resumed her motorized gait and was churning through the ER like a rocket-propelled grenade. “What killed him?”
“Uh. Heart attack?” I offered, wondering what it was about Dr. McMann that so unnerved me.
“We call it a myocardial infarction, yes. MIs are one cause of sudden death. What else makes you suddenly keel over?”
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