Monday Mornings: A Novel (24 page)
Tina sat down across from Ty with a cup of coffee. She did a double take at his Froot Loops.
“They say you are what you eat. Where does that leave you?” She smiled wryly.
Ty laughed and failed to think of a snappy rejoinder. “Oh yeah?”
“Yeah.”
He picked a neon green Froot Loop from his bowl and tossed it into Tina’s coffee. The sugar-coated sphere floated in the center of the cup, a circle within a circle.
Villanueva sat down at the table with a jumbo coffee and a plate stacked with eggs, bacon, and hash browns. Ty turned to him.
“I thought you were in detention.”
“How much did you pay Park to interrupt M and M?” Tina asked Villanueva.
“I never expected you of all people to be such a cynic, Dr. Ridgeway,” Villanueva said.
“You obviously don’t know Dr. Ridgeway,” Ty said, without thinking. He looked at Tina, and they both blushed and looked away.
Villanueva took a big bite out of a Danish and eyed the two neurosurgeons. There was a spark between the two, for sure. He wondered if they had acted on this attraction. Anything was possible, but he doubted it. A guy like Ty could have any woman he wanted. Villanueva envied the younger doctor’s athletic physique and California cool. Tina Ridgeway was a very attractive woman, but she had kids, and was married. Not that being married was a showstopper. Just ask his wife’s divorce lawyer, who had gathered a full dossier of Villanueva’s moral turpitude, complete with lurid black-and-white photos of his extracurricular rendezvous.
Sydney arrived with an egg-white omelet with tomato and peppers. “Mind if I join you?”
“Please.”
“So, George, Park saved you,” Sydney said.
“Saved by Park’s glioblastoma,” Villanueva said.
“Park’s Glioblastoma, sounds like the name of a band,” Ty said.
“More bands should take advantage of our rich nomenclature,” Villanueva said. “Like ‘Palpable Mass.’ A band with a name like that could be big.”
“Nice,” Ty said. “How about ‘the Myoclonic Jerks.’”
“I like it,” Sydney said.
“‘The Suppurating Sores,’” Villanueva added.
“Glad I’m not eating,” Tina said.
“‘The Constipated Stools,’” Ty added.
“Now you guys are just getting gross,” Sydney said, laughing.
T
en minutes later, Sydney arrived on the clinical patient care floor. The senior resident Melody McHenry, blinking back fatigue, greeted her in the hallway next to the nursing station. She ran through the relative state of recovery of patients who had undergone operations in the previous forty-eight hours.
Almost as an afterthought, she added, “We had a surgical consult from pediatrics. A five-year-old with a minor hit to her head and a history of surgical repair of a volvulus arrived in the ED yesterday afternoon. Vomiting. Constipation. Lethargy. Latham did a consult last night. X-rays and KUB film showed dilated loops of bowel, possible early partial bowel obstruction. He gave the girl two 250cc boluses of normal saline, plus five percent dextrose in half normal saline at 40cc per hour. Inserted a nasogastric tube and admitted. He asked me to take a look a few hours ago, but I got kind of busy with these other patients.”
Sydney listened, her expression becoming one of concern.
“So, no one has seen her overnight? Where is she?”
“She’s on Five-A.”
“Let’s go.”
McHenry and Sydney walked back the way Sydney had come, McHenry scurrying to keep up.
“I was told by the nurses that she looked stable. Abdomen nondistended. No sign of peritonitis.”
“Did you do another KUB?”
“Um, no,” McHenry said. “I asked for an infectious disease consult. Also, I’m getting our pediatric surgical fellow to take a look.”
“What’s happening to the blood count?”
McHenry didn’t answer. She didn’t know.
Sydney began walking faster still, moving ahead of McHenry. She pushed through a doorway outside, cut across a patient drop-off bay and into another double door.
“What room is she in?”
Before McHenry could answer a nurse intercepted them in the hallway. Her grave expression matched Sydney’s.
“The girl in room two forty-five doesn’t look right.”
“Two forty-five. That’s her.”
“What’s going on?” Sydney asked.
“Real lethargic. Didn’t respond to a needle stick.” As most pediatric nurses know, it is an awful sound when a child cries while getting an IV. Silence, however, is far worse.
Sydney and McHenry went into the room, the nurse a step behind. Sydney picked up the chart at the end of the bed and took out her stethoscope. The girl was thin, with brown skin that appeared somehow chalky. She looked tiny in the big bed. Sydney held the stethoscope to the girl’s chest, checking her watch as she did.
“One ninety-two.” She flipped through the chart. “The blood count had a shift to the left.” Sydney gave an accusing look at the senior resident but said nothing. “We need an OR. Now.” McHenry rushed from the room.
Sydney turned to the nurse. “Have somebody find this girl’s parents, someone to give us consent, and have them meet me at Inman Seven. Start antibiotic therapy and get her to Pre-Op.”
Sydney walked fast down the corridor, through a tunnel, and then up one flight to the reach the ORs.
Within the hour, the girl was intubated and lying unconscious with her gut opened. Sydney scrubbed in with the pediatric surgeons and located a foot-long section of dead bowel. When they heard the girl had lost consciousness as she was being moved from the bed to a gurney, the doctors were sure they had the right diagnosis. Sydney placed clamps on either side. Before she could start removing the foot-long section, the drone of a flat-lining EKG interrupted her. The anesthesiologist dropped her book and jumped up. She checked the leads on the EKG, saw that they were still connected, then reached onto the cart and grabbed a small vial.
“Point one m-l epinephrine bolus.”
She took a syringe, drew the drug from the vial, and squeezed the clear liquid into the IV port.
Sydney began chest compressions, and the anesthesiologist started trying to put in a central line.
“Let’s defib,” Sydney said.
The circulating nurse picked up the defibrillator, removed the blue drape from the girl’s chest, and placed the paddles against her skin.
“Clear.”
The shock jolted the small body, but the EKG continued its steady beep.
Sydney and the anesthesiologist took a half step back. The anesthesiologist grabbed another syringe and drew liquid from another vial.
“Adding point five milligrams atropine.”
Sydney and the anesthesiologist continued with the CPR, with Sydney doing the compressions and the anesthesiologist pushing the medications. The pediatric surgeons placed damp sterile towels over the young girl’s abdomen.
The nurse rubbed the paddles together as the device recharged.
“Clear.”
She returned the paddles to the girl’s chest and hit the button. Again the small body jolted upward.
This time, the EKG began beeping a regular beat. Sydney let out a long, slow breath. She waited to see if the girl’s heart was back.
The rest of the operation went without complications. Sydney left the OR and without changing her scrubs, went up to Hooten’s office. She walked past Hooten’s startled receptionist into the chief of surgery’s office.
Hooten was on the phone.
“Morgan, I need to call you back. There’s something I need to attend to. Dr. Saxena?”
“Harding, I’m worried about complacency at this hospital. I just had a little girl who almost died because of a casual attitude toward diagnosing what turned out to be an emergent situation.”
“You’re the attending, Dr. Saxena. I suggest you put the fear of God in whatever residents or interns are responsible.”
“This isn’t the first time. And it’s not just my service. Ordering tests and asking for consults are easy at a hospital like this. We need our young doctors to take responsibility. We need them to behave more like country doctors.”
“Very well. We’ll have a mandatory seminar this coming Saturday for our junior staff. You will give the talk. I trust you will be sufficiently blunt.”
“You bet I will.” Sydney turned to go. “Thank you, Harding.” As she started to leave, Hooten called after her.
“Remember, between the idea and the reality. Between the motion and the act, falls the shadow.”
Sydney laughed. “T. S. Eliot.”
She walked out. She and Hooten shared an intense desire for perfection, and they had both been dual English–Biology majors.
Hooten picked up the phone and punched a number from memory.
“Sorry for the interruption, Morgan. You were asking me whom I’d recommend as my replacement when I retire. I think I know the perfect doctor. I’ll tell you about her the next time we meet for lunch.”
T
ina was back at The Free Clinic. She’d reached the point where she looked forward to her time treating the indigent so much, she resisted returning to the hospital. She’d come to think of the
Free
in
Free Clinic
as her own freedom rather than the cost of the care she provided. Tina rationalized her time away from her paying job as the hospital underwriting care for the underserved who lived nearby. Weren’t hospitals supposed to do that anyway?
Tina wasn’t shirking at Chelsea General. She still taught medical students, went to clinic, and performed surgery, but she didn’t do anything extra. She was fulfilling her obligations…barely. And at Chelsea General, that was the exception, not the rule. Chelsea General was the place where doctors ran cutting-edge clinical trials or instituted groundbreaking reforms to guard against things like hospital-acquired infections. Chelsea General was the Everest most doctors dreamed of climbing. Not for Tina. Not anymore.
Somehow, the frequent furloughs she granted herself from the hospital to work at The Free Clinic made Tina’s beauty more radiant. They seemed to relax the muscles in her face imperceptibly. The double takes she got from men and women alike during the normal course of moving through the world increased, along with her happiness. Not that she was looking for the attention. Even in the threadbare surroundings of the clinic, Tina looked glamorous in her white lab coat and heels. Standing in the small examination room, she looked more like a model on a photo shoot playing a doctor than an actual doctor peering down the throat of a child with a phlegmatic cough, which she was at that moment.
“Say ahh,” Tina instructed. Tina was just noticing the blisters along the inside of the cheeks when she heard the chime of the clinic’s front door. The child had the Coxsackie virus, better known as hand, foot, and mouth disease.
“Let me see your hands,” Tina said to the little girl, gently holding her wrists and turning them palms-up.
“Can I help you?” she heard her assistant DeShawn ask.
“I need to see a doctor.”
“Have a seat.”
“I said, I need a doctor.”
Tina stopped her examination and listened.
“Sir, could you please take a seat,” DeShawn said. “We have a first-come, first-served policy here. She’ll be out as soon as she can.”
“She. Who is this bitch? This doctor bitch.”
“Sir, please.”
The Free Clinic was small, and Tina, her young patient, and the patient’s mother could hear every word. Tina’s first thought was
hostile attribution bias
—the mind-set that when things didn’t go your way, it was because people were out to get you. Classic paranoia. But then Tina noticed her patient with her mouth open. She was looking at her mother, fear in her eyes. The mother didn’t know what to say. She looked at Tina. Tina flushed.
“One moment.”
Tina stepped out of the examination room to see a man about thirty-five years old standing with his arms crossed giving DeShawn the evil eye. His short brown hair looked as though he used his fingers as a comb, and he wore an old green fatigue jacket. Some sort of serpentine tattoo sprouted from beneath the neckline of a faded white T-shirt.
“Sir, can I ask you to please watch your offensive language.”
“Offensive language,” the man parroted.
“I’m a big girl. I can take it, but there are children here.”
“A big girl.” The man eyed Tina up and down. He looked like a starving man sizing up a porterhouse steak. “You are, aren’t you? I bet you can take it.”
DeShawn stood.
“Sir, I’m going to have to ask you to leave.”
The man locked in on DeShawn. He was much smaller than DeShawn but he was wiry, his jaw was set, and he looked like he wouldn’t mind taking a punch or two to get in a few of his own. DeShawn had been a bouncer at a local club, and usually that was enough to command order at The Free Clinic.
Tina stepped forward.
“I’m Dr. Ridgeway,” she said extending her hand. Her gesture seemed to catch the man off guard.
“K. C.,” the man said, almost reluctantly. He was enjoying the confrontation. He shook Tina’s hand.
“K. C., we’re going to get to you as soon as we can.”
“Forget it. I gotta go.” The man took a couple of steps toward the door. “I’ll come back when your boyfriend’s not here.”
“K. C., DeShawn is not my boyfriend. He works here.”
“You gotta boyfriend? I bet you need a boyfriend.” He sized Tina up again. “I could make you happy.”
“Mr.—K. C.—I’m a doctor here. If you’re interested in free treatment, come back.”
“I’ll come back. Count on it.”
K. C. opened the door and left.
T
y sautéed tofu with blueberries, red peppers, pineapple, and ginger, and looked out the window of his penthouse apartment. Rain was hitting the window in sheets, blurring the lights of the buildings nearby. Ty had always enjoyed being alone. It was one reason he’d never wanted to maintain a relationship for more than a couple of months. No matter how beautiful or witty or thoughtful his companion, sooner or later, usually sooner, he began to feel suffocated. He would escape to the hospital, where he could immerse himself in his work and avoid the woman who was at that point plotting how to reform his incorrigible bachelor ways.
