Foreign Threat

by Mitchell Goldstein

  After the team finished rounds, they went to the cafeteria for the usual cup of coffee and something to eat. Jake announced his plans for delegation of duties for the day. “…and Carmichael, you will scrub with me on the esophageal resection.”

  “But Dr. Douglas, we have the intern lecture today at ten, and I don’t know if we’ll be done by then.” Steve tried to be very political about it. “Dr. Rosberg has told us over and over again that he expects all surgery interns to be at those lectures. He doesn’t care what excuses we have, he just wants us there and on time. I’m sure you remember his concern for attendance to those lectures.”

  Jake remembered all too well the times when he had missed

  the lectures and then got bitched at by Rosberg in front of all the other residents and interns. “Yeah, I remember how demanding he is when it comes to the lecture series. Just scrub in until it’s time to take off for the lecture. What’s it on today?”

  Steve replied, “Appendectomies.”

  Jake laughed. “Oh, that’s why you want out so bad. Don’t assume that when you’re done with the lecture you can run off and get the next available appy.”

  Steve wasn’t sure if Jake was joking or not, but he was going to hope for that very opportunity anyway.

  Jake continued, “Make sure you get all the details down so you can teach me the latest technique in appendectomies. I’m sure there will be a few appys along the way this year.”

  Steve stared at Jake and then at Sally. He wasn’t sure what to make of Jake’s friendly behavior. He was waiting for a bomb to drop, but one never did.

  Sally finally interjected and asked the question that most of the team was wondering. “Jake, are you feeling okay? I know you’ve been under a lot of stress lately. Maybe we can give you a few days off so you can get some rest and-”

  “I’ll be fine,” replied Jake. “I think it would be a good idea to work it out that each resident get a day off a week. There is no need for all of us to come in and round each day of the weekend. Perhaps one of us or even two should take a day or two off each weekend. I’ll have to look at the schedule and see what I can arrange.”

  Tom, Sally, and Steve looked at each other and then at Jake.

  Sally appeared as though she had seen a ghost. She leaned back in her chair and put her hands to her head in disbelief. “What have you done with Jake Douglas? We demand that you tell us what you did with him!”

  Jake started to laugh and finished going over the plan for

  the day. He paid no particular attention to her or the others as they sat in total shock. They were stunned from meeting this side of Jake Douglas.

  Jake finished, “…and Carmichael, I’ll see you in the OR, and bring your choice of medical student with you to the case.” Jake stood up and left the cafeteria.

  After Jake was out of earshot, the group at the table buzzed about Jake’s abnormal behavior. For anyone else, it would be considered a pleasant attitude and normal behavior, but for Jake Douglas, it was definitely abnormal. Sally thought that maybe his ex-wife had called and wanted to get back together, but they agreed that would be ridiculous.

  “If you had a chance to leave Douglas and did, why in the hell would you want to go back?” questioned Tom.

  “Well, maybe his kids were missing their dad, and she felt they would be better off with a dad versus without a dad,” suggested one of the students.

  Tom told the student that Jake was barely ever home, and when he was, they would always fight. “The kids probably have enjoyed some peace and quiet since Jake left.”

  Steve added his two cents. “Maybe he just got lucky last night.” As the words were coming out of his mouth, he remembered how close Sally and Jake had been the last few weeks and began to turn red. “But who knows. Well, I guess I better head over to the OR. See ya, guys.” He kicked himself for being so stupid in front of Sally. He didn’t know for sure about Sally and Jake but still left the cafeteria feeling a little embarrassed.

  Steve was still thinking about what he had said as he made his way to the operating room. He was pulled from his guilty thoughts by a deep voice.

  “Carmichael, what the hell are you doing here? Aren’t you

  supposed to be at a lecture today? Damn it, I hate when you and all the interns ignore those lectures. You think you know it all, and then bam, you’re placed in the situation and what do you know, you guys screw up. Then you realize that you don’t know it all!”

  “Dr. Rosberg, Dr. Douglas asked me to help out on a case until the lecture. Sir, I reminded him about the appy lecture, and he assured me that I will be excused on time to attend.”

  “Carmichael, if you’re late for that lecture, so help me I will make sure your internship is spent with Douglas the entire year. And maybe I’ll have you repeat your intern year again just to be sure you don’t forget about the lectures! Do you understand, Carmichael?”

  “Yes, sir, I will remind Dr. Douglas again. Thank you, sir.”

  Steve was shaking as he finished putting on his scrubs. That was all he needed to do to screw up his residency – piss off Dr. Rosberg. Now the problem was not to piss off Jake while reminding him that he had to leave the esophagectomy early. Steve was thinking to himself and organizing a plan in his head as he walked through the locker room on his way to the operating room. He was so deep in thought that he didn’t even see Jake on the other side of his locker.

  “Hey, Steve,” yelled Jake. “I can’t find anybody else to scrub with me on this case so you are going to have to miss the lecture today. Sorry!”

  “What?! Didn’t you just hear my conversation with Dr. Rosberg?” Steve whispered frantically. “If I miss that lecture, my ass will be toast.”

  Jake replied in a husky voice, “Do you mean, Carmichael, that if you don’t make that lecture, you will have to spend your entire intern year with me, the terrible Jake Douglas?”

  Steve glared at Jake. “You asshole.” He walked away as

  Jake and another chief resident broke out in laughter.

  Steve did not talk with Jake for the first thirty minutes of the esophagectomy. Finally, Jake pleaded with Steve to let up. “Hey, Carmichael, it was just a joke. Relax. Nobody heard it except Gary and me. It was no big deal. You’ve got to relax a little more. Otherwise, your residency will take a toll on you. I mean, you’ve got to joke every once in a while or this business will get you down. When you are taking care of sick little kids or dying people with cancer or AIDS, you will need to break from reality occasionally or you’ll just lose it.”

  Steve didn’t reply, but he thought about what Jake was saying. He realized that Jake was right about chilling out because there are many serious issues that could bring a person down. Still, Steve didn’t appreciate being the butt of the jokes.

  He remembered a medical student who was taking care of a little boy with AIDS and how upsetting that whole rotation was for her. The student felt like the child didn’t have a chance: not only did he have AIDS, but his parents – or at least his mother – left him at the doorsteps of an emergency room with a note to help the child. She just left him there in a bassinet. Steve knew the student only from afar; he had never talked to her, but he heard that she had to receive counseling for the trauma she suffered during that rotation.

  While Steve thought about his poor colleague, Jake continued yapping. “Hey, listen, Carmichael. I promise I won’t do that again, so just get over it. All right? Besides, like I said, no one heard it, so stop sweating.”

  “Heard what?” demanded Dr. Rosberg as he walked into the operating room. He loomed behind Jake.

  “Uh, nothing sir,” lied Jake. “We were just talking about something a patient had said.”

  “Really? Now, why in the world would a patient want to go

  to a surgery intern lecture about appys? Unless, of course, that patient was planning to attend our delightful surgery residency program here in our distinguished hospital. Otherwise, I’ve never met many patients who would be con
cerned about learning to do appendectomies, have you, Jake?”

  Silence filled the room. Jake was turning red. The surgical mask hid his face, but his forehead below his surgical cap was beaming a bright rose color.

  “You know, Douglas, I don’t think I have such a husky voice. Of course, I really never hear my own voice. Maybe I should listen to you more often so I can appreciate the way I sound. What do you think, Douglas?”

  “I’m sorry, Dr. Rosberg. I can explain.”

  “Do you mean you can explain like what that patient was talking about, or are you plotting some other bullshit lie, Douglas?”

  The room remained silent but for the ventilator breathing for the patient. Dr. Rosberg took advantage of the situation to give Jake a little of his own medicine. “Sure is quiet in here, huh, Jake? Is that your stomach rumbling, or do you need to excuse yourself for a few minutes from my case?”

  “Uh, no, sir. That won’t be necessary, sir.”

  As Jake was answering Dr. Rosberg, the nurses giggled from the corner of the room.

  Dr. Rosberg glanced at the nurses and then back at Jake.

  “Oh, Douglas, don’t worry about everyone laughing at you for having a bowel movement in your shorts. Just relax and chill out. I mean, taking care of patients can be pretty difficult at times, and we all need to laugh every once in a while.”

  With that, the nurses and the anesthesiologist began laughing loudly.

  “Steve, why don’t you let Dr. Douglas and me finish the

  case today? I think Dr. Douglas could use some practice in retracting while I do the procedure, and I know you want to be on time for that lecture. Is that okay with you, Dr. Shithead Douglas?”

  Jake didn’t respond, but Steve took the cue and stepped back from the table without another word.

  Steve grabbed his white lab coat and headed toward the conference room for the lecture. As he turned a corner, he ran smack into Erica. “Hi! Sorry, I didn’t mean to run you over,” he said.

  “Hey, that’s okay. So what have you been up to lately?”

  “I just got out of the OR with Rosberg and Douglas.”

  “That sounds entertaining.”

  “Actually, I think the majority of fun is yet to come.

  Jake was imitating Dr. Rosberg in the locker room, obviously not knowing he was there.”

  “It sounds like Jake pulled another dufus move. You think that idiot would learn sometime,” said Erica.

  There was a moment of silence, one of those awkward moments where both people have a ton to say but don’t know how to get started. Then they both started at the same time.

  “How about-”

  “I was wondering-”

  They both giggled.

  Steve nervously asked, “How would you like to get together for dinner sometime? I mean a real dinner, not in the hospital.”

  Erica smiled. “Like a date?”

  Steve turned red. “Uh, yes, I guess that’s what I mean.”

  “That sounds terrific!”

  “Great,” said Steve. “That’s great. I need to get to that lecture, but I’ll get ahold of you soon.”

  “Good.” Erica flashed another smile. “I look forward to

  hearing from you.”

  Steve hurried to the conference room, grinning from ear to ear. He reached the lecture without bumping into anyone else. He took a seat next to Dennis Burrows.

  Dennis took one look at Steve and joked, “Are you that excited about the appy lecture or are you just happy to see me?”

  “Neither.” Steve leaned back and smiled as he waited for the lecture to start. He wound up missing the first half of the lecture daydreaming about Erica and dinner with her.

  Dennis nudged him in the shoulder. “Hey, wake up! Pay attention or it’ll look as if we don’t care about appys.

  Where are you anyway?”

  “Oh, I’m just thinking about something.”

  “It looks more like you are thinking about someone, not something.”

  Steve just smiled at Dennis and turned toward the lecturer. He was so absorbed by planning his date that he hadn’t even realized that the lecturer was Sally. She must have been covering for Jake while he did his esophagectomy.

  Steve forced himself to focus on Sally’s voice.

  “At this point, you need to either tie the base of the appendix or staple across the base. Whether it is an endo GIA stapler or a TA stapler doesn’t really make a difference. Of course, if the base of the appendix or the entire cecum is necrotic and gangrenous, then a TA 55 or 90 might be the best choice. However, for the majority of cases, a simple tie is all one needs to close off the appendix. If the appendiceal stump leaks or the ties fall off, you can get some serious peritonitis and sometimes even a fistula between the colon and skin.”

  “What about burying the stump?” asked one of the interns from the back of the room. “Does this provide extra protection against stump leaks?”

  “That is a great question,” Sally replied. “Some surgeons will place a purse string around the stump and then bury it, but the most important thing to do is to make sure the stump is completely tied off. Otherwise it will leak.”

  Sally continued to share her ideas on the best way to complete an appendectomy and answer questions from the interns. Meanwhile, Steve went back to thinking about when to schedule his date with Erica. Since he was not on call this next weekend, he thought one of those days would be a good time to get together. Then he had to decide what to do and where to go and what time to pick her up and on and on. As he was thinking about this, he heard Dennis again.

  “Carmichael, are you going to sit there all day or what?”

  Steve looked up and saw that the auditorium was empty except for Dennis and himself. He’d had no idea that the lecture had ended. “Sorry, I was thinking about something or someone or whatever.”

  The two of them walked to the cafeteria to grab lunch.

  On the way, Dennis tried to get the scoop on Steve and who was on his mind. Turning the corner into the cafeteria, Dennis ran right into Erica. “Oops, sorry about that.”

  “Hey, Erica,” greeted Steve. “This is a friend, Dennis

  Burrows. Dennis, this is Erica.”

  “Nice to meet you,” acknowledged Dennis with a big smile of approval toward Steve.

  Erica and Steve started talking about something unimportant, and Dennis took the cue to excuse himself. “Nice to meet you, Erica.”

  After Erica waved at Dennis, Steve asked, “So what are you doing this weekend? I finally have some time off for us to get together. I mean, if you still want to.” He hoped she wouldn’t notice the boyish waver in his voice. “We could go and see a

  movie, and maybe drinks afterwards?”

  “If we start off with dinner, we could probably consider it a real date. What do you think?”

  Steve just smiled.

  “Actually, that sounds great, Steve. I live in the North View condos, number 172.”

  “Great! I know where that is. I’ll pick you up about five on Friday.”

  “Good. But now it’s my turn to get some place. I have to get to afternoon rounds now, so I’ll see you later.”

  Steve caught up with Dennis in the cafeteria. “Sorry about that. What’s for lunch?”

  Dennis just smiled and said, “Now I know what was distracting you during the appy lecture.”

  They laughed and dug into the buffet.

  Chapter 16

  Steve got home and did what he always did: he let Pudge out and started to plan a small meal. But after he let the dog out, he heard a familiar beep come from his computer to let him know that he had new e-mail. He figured it would be either Sweetpea or a friend from medical school. While the message loaded, he went in search of something to eat. He scurried around the chip drawer and brought a bag of pretzels to the computer. It must have been a busy time of night because he had to wait a few minutes to get online.

  Once online, he found that Sweetpea had been the one
to leave him an e-mail. Her note let him know that she wanted to chat at 9:00 that night. He looked at his watch and noted he had another hour to get things done.

  He started by killing a few minutes with thoughts about dinner, about things he needed to do, and, of most significance, about Erica. He barely knew her, but he felt a certain attraction to her. The fact that her beautiful eyes matched her nearly perfect figure would have any normal man taking a second look at her, but there was something more that attracted him. He couldn’t really pinpoint it yet, but there was something special. It was as though they had known each other for a long time. He had a weird sense of attraction that was more than physical. It didn’t hurt that she was beautiful, but the comfort level between them was as though they had been friends for ages. The ease with which they spoke and joked with each other seemed unique. Steve had friends who were girls and girls he had dated in the past, but none of those relationships felt so at ease. He was relaxed with her. It felt like more than just friends, but maybe that was just because Steve wanted it that way. He

  wasn’t sure how she really felt.

  As he sat thinking about Erica, Steve heard his dog bark and his stomach growl. He figured he better take care of the dog first. Pudge ran in after the door opened and nearly attacked Steve. He slobbered Steve with enough saliva to fill a pail. Steve played a few minutes with Pudge before filling the dog dish. He then fed himself something quick. By the time both stomachs were filled, Steve looked at the clock and was surprised to find it was almost nine.

  Soon he was online and catching up with Sweetpea in their private chatroom. Steve discussed in grueling detail the appy lecture. He didn’t mention that he had been daydreaming about another woman but explained, basically, how to complete an appendectomy. Sweetpea asked a few questions about the operation and when he would be able to complete his first appendectomy. After those questions had been satisfied, she started to ask more specifically about his residency and coworkers again.

  “Hey, didn’t we go over all these details a few weeks ago?” Steve typed.