Could I Have This Dance? (11 page)

“Oh, God,” she whispered, “I haven’t slowed down enough to talk to you for a long time. I’m not doing so well on my own.”

Chapter Six

C
laire arrived at the entrance to the SICU with five minutes to spare.

The medical students, Rick Gentry and Sally Barringer, were already there, coffee in hand.

“Hi, guys.”

Sally yawned and Rick grunted. “Morning, Dr. McCall.”

“Call me Claire.”

Sally protested. “Dr. Hayes said we should use professional titles when we’re in the hospital.”

Rick imitated Beatrice’s soft voice. “It fosters professional conduct and establishes the proper authority of the house staff over the medical students.”

Claire rolled her eyes. “Believe me, we’ll get along fine, even if you call me Claire. I know I’m a doctor. You will be too, soon enough.”

“Not unless I survive this rotation,” Sally responded, pushing a rebellious strand of blond hair behind her ear.

“You’ll survive,” Claire said. “I made it. You’ll make it.”

“Sure,” Sally responded. “I’ll survive long enough to make it to my internship. And then I’ll be eaten alive.”

Just like me.
Claire nodded numbly and stayed quiet. She couldn’t seem to formulate an encouraging response.

Beatrice arrived and curled her lip at Rick. “What happened to you?”

He looked down at his blood-splattered scrub pants. “I spent most of the night holding a retractor so Jeff—er, Dr. Parrish—could do a liver resection.”

The remaining members of the team arrived together, and Rick held up a large cup of coffee for the chief resident.

The O-man smiled. “Ah, vitamin C,” he said, inhaling the steam rising from the top of the cup. He looked at Jeff Parrish, the fourth-year resident. “Heard you did a liver last night.”

Jeff beamed.

“You dog. I baby-sit the largest trauma service in Massachusetts, night after night, and what reward do I get? I’ll tell you. Forty-four blunt trauma
cases, and only two major abdominal operations in a whole month. You’ve been here two nights, and you get a liver resection.” He huffed. “This stinks.”

“It was pretty awesome. We auto-transfused twenty units.” He held up his thumb and index finger nearly touching at the tips. “We came this close to cracking the chest.”

Dan Overby raised his eyebrows. “Was this case a RANDO?”

“Yep,” Jeff said. “My first liver resection.”

Sally wrinkled her nose. “Rando?”

Parrish smiled. “Trauma-ese for Resident Ain’t Never Done One.”

“In terms of patient mortality, it’s one up from a RANSO,” Basil Roberts, the second-year resident, explained. “Resident Ain’t Never Seen One.”

“But the highest mortality is from the riskiest patient group of all,” Overby added with a ghoulish laugh. “The dreaded ASANSO. Attending Surgeon Ain’t Never Seen One.”

The students laughed.

Beatrice smiled and sorted her patient data cards.

Howard Button seemed to be writing the initials down.

Dr. Overby held up a patient census. “So he lived?”

“She.” Jeff pointed to a name on the census. “ICU bed four.”

The chief resident smiled and muttered, “A RANDO, and she still pulled through. That’s what it’s all about, folks.”

“Come on,” Jeff added. “We’ve got rounds to make.”

“Not so fast,” Overby responded, gesturing for his team to move closer. “First, class, we need to review.” His tone was condescending and overdone. “Shall we all recite Overby’s rules for survival?” He held up his index finger. “Rule number one,” he prompted.

Basil lifted a pack of crackers from his white coat pocket. “Eat when you can.”

Overby lifted a second finger.

Claire joined with the group in a jumbled unison, “Everyone teaches a tern.”

The chief resident held up three fingers.

“If you don’t know, ask.”

Overby grinned. “And four?”

Claire felt the color rising in her cheeks. She waited for the response. No one volunteered. Rick laughed. Sally shuffled her notes for rounds.

Dan made a clicking noise with his cheek. “Come now, class. You remember.” His eyes rested on Claire. “Keep the fleas …,” he prompted, his grin widening.

“Away from my patients!” The group’s response was enthusiastic, but hardly in unison, as they stumbled over the exact wording.

Claire tried to focus on her patient cards. She forced a chuckle. “Ha, ha,” she mumbled. “Ha, ha.”
I can be a good sport, guys, but excuse me if I don’t laugh all day.

Claire forged her way through the day’s work with renewed determination. She was a tern. She was there to learn. She would accept criticism and use it to get better. She wouldn’t make the same mistake twice.

And, as she worked, she mulled over her own situation as a lonely intern in a powerful surgery program. The way to survive, she convinced herself, was to become a team player. Support the residents above her, teach the students below, and link arms with the interns around her. She wouldn’t be the one to back-stab the other interns. If she couldn’t be a compassionate friend to the other terns, the year was destined for pure torture. Isolate yourself and die. Forge friendships with the other interns, and you’ll have a chance.

She’d decided yesterday, during her soul-searching at Foster Park, to reach out to Bea Hayes. It was a no-brainer. The only two women in the intern group should be friends. Claire would lay aside her first impressions and make an honest attempt to see things through Bea’s eyes. She could rise above her own competitive impulses and help Bea to make it, too.

After morning rounds, there were X-ray and lab reports to gather, two chest tubes to pull, and six discharge summaries to dictate. Claire and Beatrice split the work and finished just before rounds with the attending on call, Dr. Stan Fowler. Pulling together, the two women seemed to make an efficient team.

Dr. Fowler was forty, nearly bald, and enjoyed his reputation as a pit bull. The interns had all been warned:
He never lets go except to get a bigger bite.

The team walked into the ICU in pecking order. Dr. Fowler led the way, with the chief resident, Dan Overby, on his heels. The second-year resident, Basil Roberts, was next, followed by the interns, Beatrice Hayes and Claire. The students, Josef Cohen and Glen Mattingly, brought up the rear.

They approached the first bed, occupied by Sid Johnson, a twenty-two-year-old male, five days out from a gunshot wound to the abdomen. He was Josef’s patient, so he started the presentation. “Mr. Johnson is five days status post small bowel resection, splenectomy, left nephrectomy, and
colostomy for injuries sustained in a gunshot wound to the abdomen. Over the last twenty-four hours, his T-max has been 101.6 Fahrenheit. His other vital signs have been stable. He has been—”

Dr. Fowler interrupted. “What are the most common causes for postoperative fever?” His eyes darted around the group. The chief resident was calm. This was clearly not a chief level question, at least not yet. Typically, the attending starts at the bottom of the pecking order. He squinted at the name tag of the blond student at his right. “Dr. Mattingly?” All were aware that he was according the students a special honor to address them as
doctor.

“Infection.”

Fowler nodded. “What type?”

The student shrugged and offered, “Infection in the surgical wound.”

“I’ll accept that, but what’s the most common postoperative infection?”

Glenn stayed quiet. The attending looked at Josef. “What would you say, Dr. Cohen?”

“Pneumonia.”

“Wrong. That’s another possibility, but not the most common.” He looked at Beatrice. “Enlighten the students, Dr. Hayes.”

“Urinary tract infection.”

“Correct.”

Beatrice smiled.

“Why don’t you explain the most common causes of fever in the surgical patient, starting with the first day post-op?”

As Beatrice answered the question, Claire reviewed all the possible causes of post-op fever. Eventually, the question would be bumped to her, if the other intern failed. After a few moments, Beatrice paused.

The attending surgeon prompted, “Any other causes?”

Beatrice hesitated, looking at the floor.

Claire jumped in to assist. “I can think of two more, both possibilities caused by our interventions. One is line sepsis. The other is drug fever.”

Fowler nodded. “Very good.”

Claire relaxed a notch—until she caught the expression on Bea’s face. Her teeth were clenched and her eyes bore in on Claire’s. After Josef was allowed to continue his presentation, the attending examined the patient and gave instructions for the team. As they moved to the next bed, Claire felt a tug on the back of her lab coat. She turned to see Bea’s reddened face.

Bea motioned her to move away a few steps, then spoke with quiet tension. “Try not to interrupt, Claire. That was my question.”

Claire shrugged and returned a whisper. “I was only trying to help. I thought you were done.”

Bea rolled her eyes. “Don’t try to be so helpful. Try keeping your mouth shut.”

Claire watched as the team moved on toward the next patient. She stood by herself momentarily, stunned by the reproach. She choked back an uncivil response and shook her head.

So much for camaraderie in the trenches.

In general, Claire learned, the chief residents were classified as either “walls” or “sieves.” A “wall” is a resident who refuses patient admissions. Patients have to be critically sick or dying to deserve an inpatient spot on a wall’s service. The patients, if they are admitted at all, will be “turfed” to another service. A “sieve” is a resident who admits all comers, regardless of the nature of the patient complaints.

For an intern, having a wall above them means a certain amount of protection from being overworked. A sieve above you almost guaranteed countless hours of scut work and sleep deprivation.

Dan Overby was a classic sieve. His extreme level of competence in internal medicine made him a ready target for patient transfers from other medical services. His pride in his own ability prevented him from ever saying no to a patient admission, even one that seemed nonsurgical. Every area of medicine seemed to fall under the umbrella of the O-man’s expertise.

The attending physicians loved him.

The interns endured him. On the nights when the trauma service had a moment to breathe, Dan would surf the ER, looking for general surgery cases.

By eleven P.M., after eighteen hours of call, Claire was beginning to think she might see the inside of a call room. She was just leaving the ER when she heard his voice.

“Hey, Claire.”

She turned to see the chief resident with his finger pointing to a name on a large washable marker board. He picked up a chart from the rack. “I smell a case.” He smiled. “An intern case.”

She walked toward him and held out her hand. She was tired, but never too tired for a chance to operate. “What’ve you got?”

“Thirteen-year-old boy with right lower quadrant pain.”

She brightened. “Appendicitis?”

“You decide. You’re the doctor.” He lowered his voice. “If you wait for the new intern on ER call, you may have to wait another two hours before
they figure this out. If you help them out by seeing a patient before they ask, they’ll look out for you.”

Claire accepted the chart and walked to the ninth cubicle. She knocked on the door and entered. Inside, a young man reclined on a stretcher, surrounded by what Claire assumed was his family. She counted three adults and two more children in the cramped examining room. She made eye contact with a woman sitting on a stool beside the patient. “Hi. I’m Dr. McCall, with the department of surgery.” She held out her hand.

The woman, wearing a Boston College sweatshirt and blue jeans, took Claire’s hand. “Surgery? Does Jeremy need surgery?”

“That’s what I’m here to find out.” She looked at the boy on the stretcher. His eyes were wide and his hands were resting over his lower abdomen.

“When did you get sick, Jeremy?”

He looked at his mother before answering. “Yesterday.”

“Does your stomach hurt?”

He nodded without speaking.

Claire could feel every eye in the room watching. She tried a more open-ended question, attempting to get more than a word out of the boy.

“Tell me in your own words what has been going on.”

He looked at his mother again.

“Go ahead, Jeremy. The doctor needs to know,” his mother coached.

“I got sick at school, after lunch. I think it was the pizza.”

Claire studied him for a moment. Open-ended questions obviously weren’t designed for this thirteen-year-old boy. “Where did the pain start? Can you show me?” She lifted his shirt to expose his abdomen.

“Here.” He pointed to his navel.

“Has it moved? Point with one finger to the spot it hurts the most.”

He moved his finger down, pressing and wincing as he looked for the worst location. He stopped in his right lower abdomen and pointed. “Here.”

Claire recognized the spot as “McBurney’s point,” from the classic description of appendicitis. She pressed gently on the spot and watched his face. She quickly lifted her hand.

Jeremy grabbed her hand. “Ow!”

“What’s your favorite food, Jeremy?”

“Ice cream.”

“If I could get you a bowl of ice cream right now, would you want it?”

He shook his head. “I’m not hungry.”

Claire suppressed the urge to smile. So far this boy was textbook. She was about to reel in her first abdominal surgery case.

She completed the interview and the exam and ordered a complete blood count and a urinalysis. If his white blood count was high, she would call the O-man and lay claim to her first appendix.

She felt her heart quicken as she slipped a small book from her lab-coat pocket. She opened
The Surgical Resident’s Companion
to a section on appendicitis and reviewed the operative procedure.

Thirty minutes later, armed with the lab work to confirm her suspicions of the need for surgery, she presented the case to Dan. He, in turn, examined the patient, and called the attending on call, Stan Fowler.