by Barbara Ebel
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Before rounds the next day, Annabel opened the blinds in Lillie Carter’s room. “It’s going to be a nice day,” Annabel said. “We can still appreciate the sunshine if we let it stream in.”
Annabel sat across from Lillie. Untouched breakfast sat on the tray table a foot away from the bed.
Karla Weaver hurried in and stopped. “Hi, Annabel,” she said, “and good morning Lillie. We have a fine update for you. We’re discharging you from the medical ward to let psychiatry take over all of your care. You are stable enough and out of the woods from a medical standpoint. My attending will be by soon but the orders are already written.”
“This is super news,” Annabel said. “The psychiatry team will start seeing you more often, Lillie.”
Lillie’s lips parted with a small smile. “I suppose your group won’t be doing all of those needle sticks.”
“Rarely,” Annabel said.
Karla listened to Lillie’s lungs and heart and checked her bedside chart for vital signs.
“I guess we won’t be seeing you as much now, either,” Annabel said to Karla.
“Maybe Bob will be the one to share a patient with our service next time.”
“I bet you would prefer that,” Annabel said holding back on a sarcastic tone. “But there’s not much time left on our rotation.”
“I’ll be seeing Bob anyway,” Karla said. “I have to run. We’ll see you soon, Lillie.” She walked out and Annabel stared blankly at the food tray.
Lillie’s bulging eyes stared at Annabel. “Were you both talking about Dr. Palmer?”
“Yes, we were.”
“I can see why you are both talking about him. He’s cute.”
“Don’t you want boyfriends in the future?” Annabel asked.
“No. Not after everyone started making fun of me. No guys notice me because I’m so fat.”
Annabel closed her eyes, slowly opened them, and clasped Lillie’s hand for a second. “You’re not fat at all. We must make you understand that.” Annabel pointed to herself “Do you think I’m fat?”
“No. A little overweight. That’s all. But you’re pretty, too.”
“Lillie, I am not overweight.” She dug into her lab jacket and pulled out a small graph which she’d stuck in her pocket DSM. “I brought this to show you. It’s the bible when it comes to someone’s height and weight.” Annabel scooted next to Lillie on the bed. “See. Here is my weight and height on the x and y axis and I am in the low normal range.”
Lillie nervously ran her hand up and down her thigh and frowned.
“Let’s plug in your eighty-six pounds and five-foot-six height,” Annabel continued. “See? You are so abnormal that you are below the graph for even being underweight. Please, Lillie, consider what I say to be in your best interest. You’re already pretty. Boys will find you attractive again if you fill in your breasts and your waist and your arms and legs.”
Lillie tilted her head; a little moisture accumulated in her eyes.
“How about starting out by taking baby steps with me?”
“Like what?”
“By eating this breakfast. It may seem like a lot but I will join you. Since I am not fat and you think I’m attractive, then if I can do it, you can do it, too.” Annabel opened up the extra plastic utensils meant for the coffee. “All right?”
“I guess,” Lillie said.
Annabel scooped up some scrambled eggs. She waited for Lillie to do the same. The teen raised her scrawny hand and picked up the fork. After Lillie emulated her student doctor, Annabel bumped utensils with her.
“This is a toast,” Annabel said. “In celebration of your taking the first step to acknowledge you must get better and shake off your anorexia. You have your whole life ahead of you … not to be lived as a scrawny, ill, and tentative woman. Inside that invisible-like body there exists a budding young woman ready to take on the world.”
Annabel held her breath waiting for Lillie’s reaction and lifted the fork to her lips.
“Fluffy and moist, just the way they should be,” Annabel said after tasting them.
Lillie inched her utensil up and the eggs made it inside her mouth. She continued to watch Annabel and then chewed.
“Awesome,” Annabel said. “I’m going to chase it down with a bite of buttered toast and a sip of orange juice.”
Annabel cut the toast in half and handed Lille a piece; in another minute she followed Annabel’s motions.
“Look at you,” Annabel said when they went one more round. “Your complexion is aglow already!”
Chapter 22
Annabel left Lillie and vowed not to be just another med student popping in and out of her room. Maybe if someone paid her extra attention, particularly about her unwillingness to eat, it would or could make a difference. She thought about her younger sister, Nancy. Even though the two of them squabbled, she would be the first one to support her sister no matter what the predicament. Lillie could use that older sister type of encouragement.
Annabel rushed back over to the psych ward. She hoped Haley Morris had behaved herself overnight. Preventing someone from committing suicide, like Dr. Keeton said, wasn’t easy. If someone really wants to do something, the human imagination in a particular situation is unstoppable as well as a person’s ability to carry out a plan.
“Haley!” Annabel said, finding her sulking in a chair. “I worried about you all night. I’m happy the staff did an excellent job of keeping you under house arrest.” She broadened her smile.
Haley pouted her lips. “It is like being arrested. I even got to talk to two cops.”
“Banks and Lowe are helpful officers. You’re fortunate they’re on your case. Those kids that harassed you may get what’s coming to them.”
“That may make my situation worse. My peers are going to hate me.”
“No way. That’s where you should change your thinking. You can’t cower from them anymore. Hold your head high and let the police do what is necessary. Don’t let other people make you feel inferior. Rise above it.” Annabel changed her expression into a serious one. “Those students … their confidence comes from ridiculing others which means they’re not too special themselves.”
Haley toyed with one of her bracelets, unsure of what to think. “But everyone still has my picture.”
“Haley, pictures of nude women’s torsos are all over the place, all sizes and all shapes. They come in different colors, cup sizes, nipple differences; some carry scars, others are shiny like a baby’s butt, and others you don’t want to bump into in the dark. Smart, thoughtful, and practical human beings don’t go around making an issue of bare women’s breasts.”
“There may be truth to that but I can’t think like you immediately.”
“It took time for you to let your negative feeling take hold. So it will take time and conscientious therapy for you to turn those thoughts around and see it our way. But you can start right now.”
Haley shifted her gaze and Annabel turned her head. Dr. Keeton stood silently by the doorway.
“Oh,” Annabel said. “I’m still visiting my patients before rounds.”
“I see that. The nursing staff would have called me overnight if there was a problem but I still like to stop by suicidal patients the first thing in the morning.” She looked past Annabel, gave Haley a hand wave, and smiled at her.
“Dr. Keeton,” Annabel said, “I haven’t checked the overnight nurse’s notes or anything like that yet. I was talking casually with Haley first.”
Selina nodded. “Finish up, then, and we’ll meet in a few minutes in the lounge.” She glanced at Haley. “We’ll see you on rounds in a short while. I hope you got some sleep last night.” She turned and left.
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Annabel scurried through the rest of her patient visits and glanced at her watch. She still had a few minutes before Dr. Keeton started the team’s joint discussion and rounds so she fled down the staircase to the ground floor coffee shop. She and Bob h
ad not shared their chocolate espresso beans in days and a new supply was needed. Even though he was preoccupied with Karla, she still wanted their friendship to last.
The plastic bin next to the espresso beans was stocked with a small bagged item she had never seen before. “Are these new?” Annabel asked the woman.
“A much-needed addition,” she said and nodded.
“A lot healthier than what I usually buy but will my friend like them?”
“He’s pretty set on those coffee beans,” the red-headed woman retorted.
“I’m going to share these with him whether he likes it or not,” Annabel replied. She paid the woman and slipped them in her pocket.
Upstairs, Annabel was the last one to file into the lounge. An enticing, nutty coffee smell permeated the air and a box of assorted donuts sat on the counter.
Bob waved his hand over the see-through plastic. “Difficult choice,” he said.
“The filled custard one has your name all over it,” Annabel said.
Bob picked it up and took a bite, foregoing a plate as she watched his reaction. “Wise choice,” he said when he’d swallowed.
“Fill up on that and, for rounds, I bought us a new treat.”
“You’re killing me Smalls,” he said.
Annabel smiled. Bob quoted the most famous line from the family classic movie ‘Sandlot’ where the kids were in their treehouse late at night. “No, they’re not s’mores,” she said. “They are little like your espresso beans yet they are rich mini-antioxidants and chock full of vitamins.”
“Now you have me stumped,” he said.
Selina finished rinsing a cup as Annabel began pouring a mug of coffee.
“Thanks for the donuts, Dr. Keeton,” Annabel said.
“This crisp cool morning the ‘hot, fresh donut’ sign was blinking as I passed the shop. It’s one of those things I can’t resist.”
Annabel nodded and sipped from the mug.
“Nice discussion between you and Haley Morris earlier,” Selina said. “I could have sworn I stepped in on a professional therapist working with her suicidal patient. I believe your skills are improving.” She cleared her throat. “At least in the medical school rotation category.”
Bob strained to hear Selina’s remark while Annabel warmed her palms, holding the mug with both hands.
“Thanks,” Annabel said. “I wish I could do more with both Haley and Lillie but, of course, one reason I can’t is because of the need to maintain a professional distance.”
“Exactly. Good point.” She turned sideways to include Bob in the conversation. “Do any attendings stress that with their students … or is simply maintaining a professional distance understood?”
“No one mentioned it while we did our surgery rotation,” Bob said.
“Then I will speak up,” Selina said. “If you become too close or emotionally attached with your patients, you lose all objectivity. Some doctors are culpable of being the main source of treatment for a loved one’s illness or disease; by doing that, they change the standard of care. Molding treatment into something they think is better or on a more personal level is a big mistake.”
Annabel nodded. “We’ll remember that,” she said. “Dr. Keeton, with so much to learn both clinically and non-clinically, will we ever become like our supervising doctors?”
“You will. Medical school and residency are long and arduous paths. And after that, there is still more to learn. Many professions are the same way. I bet the two of you would be somewhere else working on important theses if you weren’t doing this.”
Joshua wiggled in next to Bob, his jet black curls tighter than springs. “I’m sitting over there waiting for rounds and you all are having a coffee klatch.” Without hesitation, he opened the lid and picked up a donut.
“Sorry about that, Joshua,” Selina said. “Grab a plate and let’s go over to discuss everyone’s patients this morning and then we’ll get going.”
Joshua shook his head after swallowing. “A plate won’t be necessary,” he said as he followed her.
With her notes in front of her at the table, Selina began. “Dr. Tilson, Victor Blake comes in this afternoon for solo therapy so make sure you’re with me after lunch.”
“I don’t know which I find more interesting,” Annabel said, “when you talk to him alone or when he’s in group therapy.”
“Yes, both are vastly different and broaden Victor’s path to handle his schizophrenia. He’s made tremendous progress.”
“I miss him,” Joshua said, pausing to examine the filling in the last bite of his donut. “I enjoyed all his talk about snakes.”
“Me, too,” Bob said. “Someone once said that every great story begins with a snake; well, all our good rounds began with a Victor snake discussion.”
“Exactly,” Joshua said. “When he began with his reptile stories, I always thought of what I’d heard once. ‘If you see a snake, just kill it - don't appoint a committee on snakes.’”
Annabel eyed them both. “I’m a source of snake sayings, too, because I had a grandfather who was an encyclopedia on ‘idioms.’”
Bob elbowed her. “We’re waiting.”
“Even if a snake is not poisonous, it should pretend to be venomous.”
“Good one,” Joshua said.
Selina pushed back her chair and crossed her knees with a smile.
“I’m not finished,” Annabel said. “Always carry a flagon of whiskey in case of snakebite and, furthermore, always carry a small snake.”
Bob and Joshua laughed and a smile crept across Selina’s face.
“I have one more that someone said somewhere and my grandfather heisted. I hope it applies to Victor.”
“We’re waiting,” Bob said again.
“I'm not about to go out and buy a snake for a pet. I may have faced a few fears but I’m not insane.”
“Hmm,” Selina hummed in thoughtful absorption. “Lucifer himself would be happy to hear this discussion, but let’s move on to more pleasant topics. Like the fact that our anorexic patient is medically stable enough to transfer to our ward.”
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Selina rose after their discussion on each of their patients. “Let’s see our bipolar patients first.”
“Her hair is extra shiny and straight today,” Joshua said as they sped to catch up to her.
“She must have had a hairdresser’s touch-up yesterday,” Annabel said, “or she does it herself.”
“Are you kidding?” Joshua asked as they scrambled out the door. “I can see someone working on her hair in one of those big black swivel chairs while she uses every minute to read the newest psychiatry journal.”
Annabel glanced up at his hair. “Is yours natural or how the hell do you get it like that? Mine is a little long with a natural wave but yours is like a labradoodle.”
“I’ve been told I resemble the hot, curly-haired dude on ‘Game of Thrones’ but never like a dog.”
“She’s got a point,” Bob said.
“What about your hair?” Joshua asked Bob. “You sit in a barber’s chair for that, too, but I bet you’re not reading the ‘Annals of Psychiatry and Mental Health.’”
Bob patted the long layer on the top of his head. “It’s the perfect look for a young doctor.” He grinned. “You’re dead right, though. I don’t sit there with the ‘Annals,’ but with the ‘Basics of Psychiatry.’ I wish it weren’t so elementary.”
“Don’t worry,” Joshua said. “If you don’t go into this specialty, most of what you will remember is coming from our patients, Dr. Keeton, and that book.”
They all stopped behind the nurse’s desk as Dr. Keeton focused on a patient’s chart. Annabel pulled out the chocolate blueberries and held the bag waist high in front of her.
Bob raised his eyebrows. “Oh, nice.”
“Those will work for me, too,” Joshua said.
She tore open the bag and dished some into their hands.
“Come on,” Selina said as she walked aro
und the counter and they followed her again … straight outside Noah Goodman’s room. “You can give us Noah’s update today,” she said to Annabel.
“Mr. Goodman’s behavior since yesterday is less erratic with staff, his hyperactivity is milder, and the tremors are under control or absent. His speech isn’t pressured, he is oriented times three, and shows no sign of the depression aspect of bipolar illness.”
“Lithium is taking hold,” Selina said, “and is doing its job as well as the propranolol we put him on to subdue the tremors. Excellent. Is he still making personal, flirtatious remarks to you?”
“They are toned down, Dr. Keeton.”
Selina’s one eyebrow went up.
“This morning he said ‘If I were a cat, I’d spend all nine lives with you.’ That’s better than they’ve been.”
Bob and Joshua tried to keep from smiling. Selina was keeping rounds serious.
“Yes, better. Now, where do we go with Noah Goodman from here?” She tilted her head at Joshua.
“With his medication now therapeutic as well as having him in this calm, structured environment, he is practically stabilized from his acute episode. We should make arrangements for insight-oriented psychotherapy and support. His whole life is in disarray and he needs to begin working through that.”
“Him more than most bipolar patients just diagnosed with their first flare-up,” Selina said. “He has the medical school and career failure to contend with.” Her expression grew sorrowful and she shook her head. “He is a typical example of what makes psychiatry so taxing. We gave him this terrible blow of a diagnosis, straighten him out, send him home on prescription drugs, monitor him as an outpatient, but he is the one faced with the most formidable job. Day in and day out, his life is now forever altered. The possibility of a normal life is shattered.”
