by Barbara Ebel
She swiped his profile to the right. Let’s see what happens, she thought. After finishing the bowl of cereal with a banana, she curled up in bed and took a short nap.
-----
“Let’s skip our initial coffee klatch this morning and go straight to joint rounds,” Dr. Keeton announced on Monday morning.
Annabel, Bob, and Joshua got up quickly to catch up to her as she was already disappearing out the door
Selina gathered up patients’ charts at the desk and stacked them on a rolling cart. She began pushing it but Dr. Washington took over.
“Dr. Keeton,” Annabel said, walking alongside her, “Edgar Banks should be calling you and we are on for Wednesday night. I hope that’s all right.”
“Yes, that’s fine. He already called.”
Selina averted further discussion about the date and stopped outside of Victor Blake’s room. “Did everyone study this weekend and not play too hard?”
Annabel bobbed her head and Bob winced.
“Dr. Palmer, do I have to double up on teaching this morning because you neglected psychiatry this weekend?”
“I am worried about how your meeting went the other day with Mr. Wells’ wife.”
“Susan Wells has a lot to deal with but, under the circumstances, she has an objective understanding of her husband’s suicide. Our talk only heightened her awareness that we are not to blame and he desperately wanted to and could have committed suicide before or after his admission.”
Bob shuffled his foot on the floor like he was ready to kick a rock.
“Like I mentioned in the beginning of this rotation, all of us can air and work on any feelings we have about our patients or their outcomes … either individually with me or as a group. Did you at least work on your paper this weekend?”
“A little bit,” Bob said.
“And physical activity? There’s nothing like a good gym workout or sport for temporarily unburdening your mind.”
“I’m guilty of not doing much this weekend,” he said.
“Dr. Washington and I came in for rounds on Saturday. We should have invited you. Today and tonight I’ll be overseeing emergencies so let’s put you on student call.” She said it with a smile and Dr. Washington laughed.
“He can take my place,” Joshua said.
“I don’t mind,” Bob said.
“They’re trying to make you feel better,” Annabel said. “If I had known you were in the dumps this weekend, I could have called you to take a walk or something.”
“I bet you had better things to do than babysit me.”
“There should always be time for friends and some colleagues,” she said, and meant it.
Selina opened up Mr. Blake’s chart. “Let’s get to Mr. Blake and his diagnosis. You all know that schizophrenia is a chronic illness. Dr. Tilson, what do the textbooks say is the minimum amount of time that a patient should exhibit psychotic symptoms before making the diagnosis?”
“Six months.”
“Yes, and his mother’s description of past events left nothing to the imagination that his voices and most unusual behavior started six months to a year ago. Under our own eyes, we are noticing his psychosis subside, especially since now he is up to the 8 mgs of risperidone that often seems to be the magic dose.
“And as far as drug therapy, we already talked about the newer drugs and their side effects such as metabolic syndrome which we must monitor for, but those problems are nothing like what patients used to deal with when taking the older drugs. Some of them would manifest extrapyramidal symptoms like spasms and rigidity similar to Parkinson’s disease. Some families felt like they traded their loved ones from one problem to another.”
Joshua nodded. “I have already seen that. It’s wonderful to be in training as new therapies come on the market. It makes me feel so important to be the one to prescribe these magic bullets and massively impact someone’s functionality.”
“Glad you shared your thoughts about that, Dr. Washington,” Selina said. “Besides benefitting your patients, you are deriving secondary gain from your specialty.”
Victor came to the doorway and stood there wearing a question mark on his face. “I heard voices,” he said. “I wasn’t sure if they were in my head.”
Selina took one step. “What do you think?”
“I believe I heard you doctors out here.”
“It’s safe to say we can be a noisy bunch, can’t we?”
He nodded. “Not as noisy as things where I live. I don’t want to go home to some of those rackets.”
“What makes all the noise?” Selina asked.
“It’s the voices when they are arguing with each other.”
“Mr. Blake,” Selina said, “you are making progress here getting better. Our goal is for the voices not to bother you any more by the time you go home. Okay?”
“I could use the vacation,” he said.
They all grinned and when Victor realized his humor, he cracked a small but significant smile, too.
-----
The team peeked into Noah Goodman’s room.
“Our favorite medical student is still down in the dining room,” a nurse said as she passed by and rolled her eyes.
Selina looked at her watch. “Way past breakfast,” she said and waved them to follow her.
They entered the small room with round tables where they heard noise from an adjacent area. Kitchen staff stacked the morning trays on a rack to go back to the cafeteria.
“Mr. Goodman,” a nurse said, “for the hundredth time, breakfast is over and they want to clean up the room for lunch later. Plus, your doctors are going to be looking for you. Let’s go.”
“You are just jealous of me loving other women,” he said. “That’s why you’re punishing me and want me out of here. I am almost a doctor and you will be following my orders soon enough … not the other way around.”
Noah circled the table. “Come catch me if you can. You know you want me.”
She let out an audible sigh and threw her hands into the air. Noah realized the team was nearby and the woman turned and followed his gaze.
“I give up,” the nurse said. “If anyone can deal with him, it’s you, Dr. Keeton.”
“I’ll take care of him and thank you for trying. Feel free to go back to the front desk.”
She walked away while a look of relief spread across her face.
“I bet you all heard of me,” Noah said. “I can write autographs for you lady doctors and the men can stand in line to take chick lessons. Besides accumulating the best electronic stuff in the world, I am a noted medical student soon-to-be famous doctor who can cure absolutely anything!” He stamped his foot like he was charging an army off to war.
“Mr. Goodman,” Selina said calmly, “don’t believe everything you think!”
Joshua tried to suppress a smile and leaned across both Annabel and Bob. “I love it when she uses that line. I find it hilarious and it’s one of her big mottos in therapy.”
“Don’t believe everything you think,” Annabel repeated softly. “I like it, too. So appropriate for many of our patients.”
“Noah, don’t you think this is a noisy room?” Selina asked. “Wouldn’t you like to go back to your room or to the recreation room with us?”
“Fall in line, then,” he said, “and follow me.”
Selina let him move a little bit ahead of them, which was easy since he walked a brisk, hyper pace. She addressed Annabel and Bob next to her. “Part of our treatment for him right now is to provide a calm and structured environment. A nice, dependable routine to his day is going to help him get on track.”
“Dr. Keeton,” Annabel said, “what was the consensus of the medical school board as far as Noah’s spot in the class or the ability for him to continue his education? Can you tell us?”
Selina turned down the sides of her mouth. “His occupational functioning now and in the future is most likely impaired. One way or another, after half the board makes their recom
mendation to the entire board, he is going to lose his seat.”
“What a shame,” Bob said.
“I can’t imagine,” Annabel said.
“The only good point,” Joshua chimed in, “is that it’s happening now and not further along like in his senior year or residency.”
Chapter 13
Bob peeked in the kitchenette’s refrigerator for any leftovers from the week before while Annabel rinsed a dirty mug in the sink.
“Doesn’t look like we can scrape up anything here for lunch,” Bob said. “I’d even settle for one of those doughnuts Dr. Keeton brought in last week.”
“That’s the spirit,” Annabel said. “At least you’re thinking about food. I’m concerned about you.”
“What for?”
“You were looking forward to psychiatry like me, but what happened to your patient has dampened your experience. Don’t let it tarnish the rest of the rotation.”
“I don’t want to talk about it anymore. I guess like our surgery rotation, it’s always going to be one damn thing after another.”
She smiled. “Fair enough. I’ll shut up but talk to me if you need or want to. Please agree because I may need you to watch my back soon, too.”
“All right.” He put the cup up on a shelf. “Outpatient clinic is in one hour,” he said, changing the subject. “How about getting lunch?”
Joshua walked in the door and stopped abruptly when he saw them. “I bring tidings of joy,” he said. “If you two haven’t eaten yet, Dr. Keeton said residents and students are invited to hospital administration on the top floor. A big meeting was canceled and the catered lunch is still sitting there. Somebody’s got to eat it.”
“Hot dog,” Bob said. “Let’s go.”
Annabel rushed after them and after riding the elevator together, they emerged to the business offices with windows and a large conference room. There were multiple white coats like themselves and Annabel recognized a few people from their med-school class.
“I think I’ll eat enough for dinner,” Bob said, scanning the trays.
Annabel tailed Bob along the buffet and took samples of shrimp, small sandwich wraps, salad, and fruit. They sat down near other students.
“So how is the internal medicine rotation?” Annabel asked the woman across from her. The student, Karla Weaver, was in her mid-thirties and was only a third-year student like herself but sported ‘PhD’ behind her name. With the older medical students, it was better late than never for them to find out what they really wanted to do with their lives.
“Full of surprises,” she said. “There is such a variety of patients! From the ones hanging onto life in the ICUs to the little medical follow-ups in clinic.”
“It’s the same way with us on psychiatry,” Annabel said. “I salivate for the day when I know as much as our attending, Dr. Keeton.”
“I heard about her.”
“She is so awesome. We are learning so much from her and she’s so good to us. She treats every patient with respect and knows the right thing to say to all of them at the right time.”
“Annabel could go on and on,” Bob said as he shook the salt shaker over his plate. “But it’s true.”
Annabel dipped a large shrimp into cocktail sauce. “We’ll clue you in to one of her favorite expressions in case you get her as your attending. You can score brownie points with her right away.”
“Sure, I’ll listen to anything you can tell me,” Karla said.
“Don’t believe everything you think,” Annabel said.
She took out a notepad and the pen clipped to her lab jacket pocket. “My brain cells are too crammed right now,” she said. “I’ll never remember it a few weeks from now if I don’t write it down.”
“Information overload,” Bob said. “You know, we won’t remember a lot of what we learned the first two years.”
“But we’ll remember some of the patients we’re taking care of and their diagnoses,” Karla said.
“That’s for sure,” Bob said in a sad tone.
Annabel passed him a strawberry to make him smile. “And I’m not going to forget this dreamy lunch. We lucked out today.”
Joshua brought back a slice of pie. “It’s almost clinic time, you two,” he said. “Don’t eat so much; you’ll get a sugar high. That will cause your pancreas to pour out the insulin and later on you’ll get a sugar low and a slump.”
“Look who’s talking,” Annabel said. “Although it takes a medical person to explain it the way you just did - why we shouldn’t eat so much in the middle of our work day.”
But on the way out, she wrapped a chocolate chip cookie in a napkin and stashed it in her pocket.
-----
The first patient in the bustling clinic waiting room followed a man to the back and her mother also tagged behind. Dr. Keeton caught a glance of them as they went into an examining room. She poked her head around the corner of the back entrance as Annabel, Bob, and Joshua all arrived.
“I hope we’re not late,” Joshua said. “We went for that food you told us about.”
“Thanks for that,” Annabel said. “We’ll take up the slack for department leftovers anytime.”
“I figured,” she said. “Why don’t you come into this first room with me and Bob can go with Dr. Washington to room 2? The waiting room is full this afternoon so let’s keep a swift pace.”
The tech came out of the room and handed Selina the patient’s chart. She opened it, noted the vital signs, and frowned. “Do me a favor and go back in,” she said to him. “Weigh her and measure her height. She may cooperate more with you than when she sees a doctor walk in.”
“Be happy to, Dr. Keeton,” he said.
Selina waited until he came back out and nudged Annabel to follow her. They opened the door to Mrs. Carter, a nicely dressed woman with her teenage daughter, Lillie. The woman’s gaze went back and forth to Selina and Annabel while the sixteen-year-old sat with less awareness in her large, bulging eyes. Her lackluster hair drooped along the sides of her cheeks.
“Mrs. Carter and Lillie,” Dr. Keeton said, “it’s nice to meet you both. This is a medical student working with me today, Dr. Tilson. So what brings you to the clinic today?” She suspected the reason by looking at Lillie and seeing the concern written all over her mother’s face.
Annabel took in the situation slowly and found it difficult not to study the youngster. The skin on her face was drawn over bones and the ends of her arms and legs dangled out of her clothing like toothpicks. She wore a green checkered blouse - a regular size like Annabel’s - but the body inside of it was several sizes under and the girl’s pants were way too large.
Why would this girl be here? Annabel wondered. She must be in the final stages of some deadly illness or she’s receiving chemotherapy and is shrinking away to nothing.
“I came here today only because my mother made me,” Lillie said. “Both my parents are worried about nothing. I’m fine except for feeling blue once in a while but they’re making a big deal because they think I lost weight.”
“Have you lost weight?” Selina asked.
“Well … I lost five pounds months ago because I was getting too fat. One day at school a guy referred to me as ‘chunky.’ He was right. My hips and butt had gotten bigger.”
“Did you go on a diet?”
“Duh. Of course.”
“Lillie,” her mother said. “You don’t have to be rude to the doctor.”
Lillie gave her mother a sardonic expression. “It’s you who’s being disrespectful of me, Mom. I’m not a child any more who you can tell to eat her vegetables or finish what’s on her plate.”
“Lillie,” Selina said. “Did you continue on with a diet after you lost that initial weight?”
“I’m still overweight so I watch what I eat.”
“When was the last time you had your period?”
“Months ago. But I’m not pregnant. Then I’d be really fat!”
“You mentioned sometimes you fee
l blue. Do you think your feelings are more like a depression?”
“Not so much.”
“Have you thought recently about hurting yourself?”
“No way.”
“Any medical problems in the past or any surgeries?”
Lillie shook her head and Selina glanced at her mother.
“She’s had no problems except for a few allergies each fall,” Mrs. Carter said.
Selina walked over to Lillie. “Take a few deep breaths,” she said, placing her stethoscope on her chest. While she listened to the front and back of the youngster’s chest, Selina placed her other hand on her. In the front, she palpated protruding ribs. Selina then felt her prominent scapula, the flat and triangular bone on her back. Her lungs, surrounded by nothing but ribs and skin, sounded clear. After listening to her heart and momentarily closing her eyes with concern, she stepped back.
“Lillie,” Dr. Keeton said, “I am going to order some tests which are no big deal. The most invasive one will be the tech getting some blood but that’s less pain than getting a shot. It would also be best if you go over and stay in the hospital for a few days.”
“What? There’s nothing wrong with me. That’s not gonna happen.”
“You think about that and I’ll be back in a few minutes.” She looked at Mrs. Carter. “May I speak with you?” She put her hand on the doorknob.
Mrs. Carter nodded and picked up her handbag. She followed Selina out the door and Annabel tagged along as they went into Selina’s office.
Annabel stood as Selina went behind her desk and Mrs. Carter sat down. Papers and files were stacked on either side on top except for a clearing in the middle. Selina leaned forward.
“She’s bad, isn’t she?” Mrs. Carter asked. “I should have brought her in before.”
“We’ll talk about that. When did she start dieting?”
