Could I Have This Dance? Page 7

  “The team is divided into two halves, covering every other night in house.” He smiled at the terns. “That means you don’t leave the hospital when you’re on. The first half is led by me, and consists of myself, Basil, Beatrice, and Claire, as well as two students, Josef and Glen. The second half is led by Jeff, and consists of him, Elaine, Howard, Wayne, and the two students, Rick and Sally. Since Jeff’s team was on last night, he will lead rounds this morning. Every service works a little different, depending on what chief resident is running the show. I like to make discovery rounds in the morning, which means the terns don’t have to pre-round to find out how the patients are doing. We’ll discover that as a group when we go around. As much as we can, we’ll let the interns write their daily notes while on rounds, because, as soon as the ER starts paging, we’ll have limited time to get the daily grunt work done.” He looked at Bea and Claire. “As for you two, I’d suggest splitting the daily scut list until we get the first hit in the ER. Then one of you will be responsible for writing up the new admissions, and one of you should man the floor work until it’s all done.”

  Jeff Parrish tapped his shoe impatiently. “In the morning, we have resident rounds. In the evening, usually right before supper, we have attending rounds. During attending rounds, the interns will present the new patients, and the students will give the daily progress reports on the patients already on the service. Any questions?”

  The interns responded with blank stares.

  Dan shrugged his massive round shoulders. “You’ll get the hang of it soon enough. Don’t worry.”

  Claire forced herself to nod. Now there’s a novel idea: don’t worry. I wish I had some Pepcid AC.

  “We’ve got to get moving,” Jeff prodded. “We got five new players last night to tell you about.”

  With that, the team moved en masse through the automatic double doors into the ordered world of the Surgical Intensive Care Unit.

  Four hours later, Claire smoothed the lapels of her white lab coat and looked down at her picture ID pinned to the jacket pocket. “E. Claire McCall, MD,” she whispered, reading the name tag. This is what I’ve been waiting for, training for, all these years. She touched the pager clipped to the waistband of her scrubs and walked forward down the broad hallway leading to the med-surg nursing station, conscious that she was pulling her shoulders back in a confident pose. She slipped behind the counter and gathered the patients’ charts to review. To her right, her assigned medical student, Josef Cohen, diligently transferred the morning lab values onto a clipboard so he could memorize them before attending rounds. He was compulsive to a fault and seemed knowledgeable, but appeared quiet on rounds, only speaking when asked a question and then only quietly. Perhaps he was only shy, but his inability to speak up would certainly bias his attendings against giving him an excellent evaluation.

  “Josef, what field do you want to go into?”

  He looked up and responded with the first hint of excitement Claire had seen in him. “Surgery.”

  She smiled, wanting to give him some pointers on his form, but quelled the urge. Maybe he was only having an off day.

  Just then, a nurse appeared at Claire’s elbow. “Dr. McCall?” The nurse, many years senior to Claire, held up a patient chart and opened it to the physician’s order page. “Mr. Jones in 518 is complaining of a headache. Can I give him some Tylenol?”

  Claire took the chart from the nurse, refreshing her memory of just who Mr. Jones was. Hmmm. Fifty-eight-year-old male with a right chest tube to treat a punctured lung sustained in a fall from a ladder two days ago. His only other medical history is significant for hypertension. Interestingly, he was on treatment for pneumonia at the time of his injury.

  Claire felt her palms dampen. It would be her first official doctor’s order. She looked at the nurse, who towered above her. “Any mental status changes?”

  The nurse shook her head and took a deep, audible breath.

  “Any change in blood pressure or heart rate?”

  “No.”

  Claire looked at Josef to explain, hoping to make a teaching point. “Mr. Jones was in a fall. Perhaps his headache is due to an intracranial bleed. It could cause hypertension and bradycardia.”

  Josef shifted in his seat. “Oh.”

  Claire continued. “How does he describe the headache? The worst he’s ever had?” Without waiting for the nurse’s response, she turned again to Josef. “Intracranial berry aneurysms are associated with hypertension, which Mr. Jones has. A rupture of the aneurysm is often described by the patient as ‘the worst headache I’ve ever had.’”

  The nurse checked her watch. “No, it’s not the worst headache he’s ever had. It’s just a tension headache.” She flipped the chart back to the physician’s order page.

  “How about fever? Or a stiff neck? He could have developed a meningitis. Meningitis is associated with headache.”

  “Dr. McCall, he isn’t febrile.”

  “Any visual disturbance? A migraine headache can be associated with visual changes, and migraines don’t usually respond to Tylenol.”

  “It’s only a tension headache. He gets them all the time at work.”

  Claire stared at the order sheet. The headache could be some rare reaction to a medication that he’s on. She flipped to the medication list. Hmmm. He’s only on Tylox for pain, and Unasyn for his pneumonia. I don’t think they cause headache. “I suppose giving some Tylenol would be okay,” she responded with more confidence than she felt. She couldn’t quite dispel her worry that Mr. Jones might be suffering from some intracranial tragedy related to his accident. “Josef, could you look at Mr. Jones for me? Look in his eyes. Make sure there isn’t any papilledema … you know, signs of brain swelling.”

  Now Josef audibly sighed, but stood obediently to find an ophthalmoscope to look into Mr. Jones’s eyes.

  Claire continued her careful inspection of Mr. Jones’s chart. “Let me just make sure that Tylenol won’t interact with his other medications.” Is there any known reaction between Tylenol and his antibiotic? Not that I know of, but I’ve never been asked before. She looked up to see Dan Overby coming up the hall. She remembered Dan’s rule number three: If you don’t know, ask. She caught his eye. “Dan?”

  Before she could ask about the drug interaction, the exasperated nurse turned to the chief resident. She lifted the chart from Claire’s hands and addressed Dr. Overby. “Mr. Jones in 518 has a headache. May I give some Tylenol?”

  “Sure. Six-hundred-fifty milligrams every four hours as needed,” he responded as he wrote the order. “He’s also on Tylox, as I recall, so be careful not to give the Tylenol within a few hours of the Tylox. They both have acetaminophen, you know.”

  The nurse tossed a quick sanctimonious smirk at Claire before marching off.

  Dan inhaled deeply. “Aah. The first day of surgical training. A new beginning. A new dawn.” He looked down at Claire. “What was it you wanted?”

  She winced. “Nothing.”

  Dan shrugged and walked off toward the elevators. “By the way, a drug rep brought some donuts to the surgical residents’ lounge. Better get some calories while you can.”

  Claire felt her face redden and was glad to see her jolly chief resident disappear behind an elevator door. My first doctor’s order was for an over-the-counter drug that mothers all over the world give to their children every day … and I was too scared to order it!

  Josef returned from Mr. Jones’s room. “No papilledema. No signs of any intracranial problem. Mental status, vital signs all check out okay.”

  She looked up but didn’t meet his eyes. “Thanks for looking.”

  The medical student leaned forward and spoke softly. “You know, you can trust Lucille,” he said, referring to the nurse. “She’s been here a long time.”

  Claire nodded, and thought of Dan’s second rule: Everyone teaches a tern.

  Josef continued, “If you put yourself through that every time a nurse asks you for Tylenol, you’ll be i
nsane in a week.” He paused and put his hand on her shoulder.

  She resisted the impulse to shake it free.

  “You wouldn’t be here if you weren’t smart, Dr. McCall,” he said, “but don’t let your brains get in the way of making a no-brainer clinical decision.”

  Trying not to show her embarrassment at being corrected by a med student, she attempted to salvage her image. “A missed intracranial hemorrhage would have had disastrous consequences for the patient.” Not to mention providing a quick exit for me … right off the pyramid.

  She looked straight ahead and grabbed for the next chart on her list. Now please leave so I can find a hole to crawl into!

  After supper, the trauma team logged three hits—or three new players, as Dan called them. A motorcycle crash during evening rush hour provided the first business. Then, just after midnight, a two-vehicle head-on prompted the team back into action, consuming Beatrice and Claire with write-ups, IVs, and tracking down and recording numerous X rays and lab tests.

  Because Dan was a firm believer in the “see one, do one, teach one” philosophy, he carefully instructed Claire while inserting a chest tube on the motorcycle victim, then walked her through the same procedure for another patient later that night, with Claire using the scalpel.

  Proudly, she entered the patient’s name and medical record number in her procedure logbook. In one twenty-four-hour time period, her emotions had ranged from humiliation to pumped. She had attempted four IVs, started three, and changed one arterial line on a patient in the SICU. From what she’d seen of Beatrice’s skill in sewing up a scalp laceration, Claire, at least in her own mind, held a clear advantage in the area of technical skills. Later, when she saw Beatrice blow an IV that a student eventually started, she recognized the same distasteful pride resurfacing. This is ridiculous, she chided herself. I’ve got enough to worry about without constantly comparing myself to the other interns … and it’s just our first day!

  Claire survived attending rounds with Dr. McGrath, head of the trauma surgery service, and avoided any first-day snafus. She was intimidated by but warming to Dr. Dan’s rough exterior, and tried to keep an open mind about his peculiarities. By the next morning’s rounds, she teetered on a precarious emotional edge, thrust there by her own anxiety, sleep deprivation, and excitement over her first minor procedures. With her med students’ help, she had survived her first night of trauma call, and had the haggard appearance to prove it.

  Only one more patient, and she could revive herself with a shower. There was light at the end of the tunnel. At the end of morning rounds, she would hand the pager to another intern and be free. She had held her own. She could do this. One day down. Only 1,825 to go.

  Josef began the presentation, while Claire became a quick scribe to write the daily progress note. “Mr. Adams is a forty-four-year-old white male admitted with closed head injury and a sternal fracture. He is hospital day two on observation for myocardial contusion.” The medical student paused and fumbled through the bedside nursing data before continuing. “His blood pressure has been stable. His ins total 2800 cc’s and his outs were 2100 cc’s.”

  “Wait a minute.” Dan Overby held up his hand. “Go to the nurse’s recording of the heart rate.” His eyes were riveted to the patient’s overhead cardiac monitor. “How long’s his heart rate been this high?” The monitor registered 162.

  “Looks like two hours.”

  “Who was told about this?”

  “I was,” Claire offered, ready to take credit for her management. “I had the nurses get a twelve-lead EKG, but I couldn’t tell whether he was in sinus tach, paroxysmal atrial tachycardia, or atrial flutter.”

  She sensed Dan’s eyes boring in on her face. “So?” he asked. There was tension in his voice.

  “If you don’t know, ask,” Claire responded by quoting Dan’s third rule of survival. “I consulted cardiology to sort it out.” When she saw Dan’s clenched jaw, she fumbled forward. “Basil was tied up in the SICU, and I knew you’d just gotten to bed, so …”

  Dan turned to the patient and laid his stethoscope on his chest. After a few moments of quiet conversation with the patient, Dan placed his right hand over the patient’s neck and began to massage the area beside his voice box. In a few moments, the rhythm abruptly reverted to a slower, regular rate of eighty-two.

  Satisfied, Dan looked at the group. “This man was in P.A.T. Carotid sinus massage helps distinguish the rhythms. Just make sure you’ve got resuscitation equipment handy before you try it,” he added as he strode from the room.

  The group followed. Once in the hallway, Dan’s collectedness dissolved. He gave curt instructions to Jeff Parrish to cancel the consult, before turning on Claire. “Never, never call a medicine consult on my patients without talking to me! Especially not the first week of July! You’d probably get an intern who knows even less than you do!” He turned and walked away a few steps before pivoting. “Rule number four: Keep the fleas away from my patients!”

  Speechless, Claire winced, stifling the urge to cry. She wanted to dissolve into the floor.

  Josef watched the big man disappear down the hall. “I think he likes you.

  Basil shrugged and slapped Claire’s shoulder in a good-ole-boy gesture. “Hey, that’s the way we learn.”

  “Tomorrow, six A.M.,” Jeff snapped, dismissing the team. “My squad will take it from here.”

  Claire stood numbly observing the medical students heading toward the cafeteria. Tomorrow? If I decide to return. Right now I’d rather die than face that man again.

  Chapter Five

  Claire stared at the red light and tapped the steering wheel, whispering the phrase of an old song. She did it almost by rote. It was a phrase she’d whispered many times before, hoping for comfort when there was none to be found. “Everything’s gonna be all right. Just you wait and see. Everything’s gonna be all right.”

  The phrase peeled off a scabbed-over memory, and immediately, she was transported to a time of earlier humiliation. She’d relived this one dozens of times before. A smell could bring it back. Burning popcorn. The sour smell of old beer. Or humiliation, like her experience with Dr. Dan.

  Sixteen-year-old Claire had heard her father before she’d seen him, his irregular footfalls landing on the wooden back porch without rhythm, the erratic stumbling of a man in love with rum. He entered, his body swaying, never still even when he attempted to sit. He moved like a man swimming through the air, hands and legs in constant motion, his feet feeling and testing before actually coming to rest for any given step. It appeared as if each movement were practiced three or four times before he could follow through and get it right, or almost right. Claire winced when she saw him, conscious of the anxiety he provoked. In the previous year, since he’d lost his job at the mill, a change, a cloud had enveloped him, slowly overtaking anything she’d loved in him. He grew dark, moody, flying off into irrationality, screaming at the least problem.

  Clay, her twin brother, was making popcorn. He was practiced in trying to appease his old man.

  Claire helped her father to a chair in the den, inhaling the odor of his sweat and alcohol. Clay brought him a bowl. Popcorn with salt, no butter, just the way he liked it.

  In a minute, the bowl was on the floor, their father cursing loudly about the burnt taste.

  When Clay disagreed, their father exploded, throwing first the bowl and then a kitchen chair through the front window.

  Claire followed Clay out onto the front lawn, where he retreated from the conflict. Broken glass and popcorn littered the sidewalk. Methodically, she cleaned up the mess and stapled plastic over the front window.

  She found Clay hiding in the old tree house that overlooked the mountains. There, she stroked his head and whispered, “Everything’s gonna be all right. Just you wait and see. Everything’s gonna be all right.”

  And even then, Claire had known it was a lie.

  She stiffened, shook her head in disgust, and tried to concentrate o
n the traffic signal in front of her. She was over this. There was little to be gained by obsessing over the past. Use it as a stepping-stone. The past, even our worst humiliations, can be used to strengthen us for future greatness. At least that’s what her counselor back in Brighton had said. “You’re over this, Claire. Don’t let the memories of your father’s abuse paralyze you. Put it behind you. Put him behind you. Use your wounds to realize your potential. You can do anything.”

  She turned left onto Devonshire Boulevard and counted the traffic lights. At the fifth, she turned right, then immediately turned right again, up the alley, and skirted behind the Safeway until she reached Thompson Street. She’d stumbled onto this shortcut by accident, during her house hunt. From there, she crossed the street at a diagonal and entered her driveway.

  She plodded into the house and took inventory of her first day as a real medical doctor. She hadn’t been able to bring herself to give a Tylenol order for a man with a headache. She’d been guided by a shy medical student whom she was supposed to be helping, and had been ripped apart by her chief resident for calling a medicine consultation without asking. She hadn’t slept, hadn’t even seen a call room; her makeup was long gone, her stomach empty, and her life lonely in a big city far from anyone she cared about. She looked in the bathroom mirror and started to cry.

  She was still crying when she checked her phone messages ten minutes later. She had one call. It was her mother. “Your father’s back in AA. Finally.” There was a pause with a clicking sound. Claire could see her mother’s polished nails tapping against the kitchen counter, something she’d done as long as Claire could remember. “I think he’s serious this time.” She paused again. “But he’s still so jerky. He’s having more and more trouble with his walking. But don’t suggest taking him to a doctor. Lord knows he won’t accept that. He keeps saying how sorry he was about your last visit. He really would like to see you again.” A pause, with more fingernail clicking. “Call when you get in. Bye.”