Shredded (36 page)

A lab tech walks toward the front desk and stops when he sees us eagerly waiting.
There’s a snort of laughter, followed by, “I bet the two of you would fork over some serious cash for the contents of this folder.”

I snap my fingers. “Hand it over. Now.”

“Ignore her, she has no people skills,” Justin says before turning to me, calm as anything. “A hundred bucks, the next three enemas, and a round of kindergarten booster shots on the line. Still going with diabetes?”

He should know better than to doubt me when giving shots to a kicking, screaming kindergartener in the free clinic is involved. “Yes. Are you still going with lower intestinal bacterial infection?”

The folder lands in Justin’s hand, but he continues to stare at me, not opening it. He plays this part of our game so well. It drives me nuts. I used to think it was sexy, but now I can’t stand him. Or his penis. The guy didn’t even start med school until he was nineteen.
Some prodigy
.

“There’s no family history of diabetes. The kid’s only been sick for five days,” Justin repeats as if I don’t remember details of a patient exam that happened minutes ago. “He was in fucking Mexico last week!”

“Enough,” the lady behind the desk hisses at us. “If Dr. Rinehart knew you were betting money on a patient’s diagnosis, you’d both be written up.”

Everyone knows Justin and I play this game, but getting caught doing it by our boss is an entirely different thing. I lower my voice and snatch the folder from his hands, “Yeah, a posh all-inclusive resort where everything is imported from the States.”

I open the folder, scan the blood-work numbers, and keep my face completely under control as I close it and pass it to Justin before walking off. I’m all the way to the ER doors before he comes jogging up behind me, the folder tucked under his arm. He pounds his palm against the button providing access to the ER.

“I was right, wasn’t I?” he says. “You did some statistics thing in your head.”

“Nope.”

“We both know you didn’t go with a gut feeling because Isabel Jenkins only diagnoses with evidence.”

I stop in the middle of the hallway and spin around to face him. “There might not be a family history of diabetes, but there is a family history of B-cell autoimmunity.”

His face falls so fast, I almost feel guilty.
Almost
. “The uncle with lupus … shit, I didn’t even—”

“And the paternal grandfather with rheumatoid arthritis. And then on top of that, did you smell his breath? A kid who’s been barfing his guts out and not eating shouldn’t have fruity-smelling breath.” I pat him on the shoulder. “It’s all right. I’m sure those questions weren’t on the intern exam. You probably did just fine. The chief is going to have all kinds of residency
options for you … what with all the county hospitals in major cities desperate for subpar surgeons who can perform operations for half the cost of those fancy private hospitals. Like Johns Hopkins.”

Okay, that was one step too far
. It’s so hard to hold back the trash talk when Justin and I are in competition mode. He pushes me and I push him. It seems horrible, but we’re both better doctors because of our head-to-head battles. But maybe we do need to seek out a healthier method of increasing drive. That’s a goal I can add to my when-I’m-a-resident-at-Johns-Hopkins list.

Justin shoves my hand off his shoulder. “Go screw yourself.”

I want to be pissed at Justin for not taking his loss like a man and being an idiot, but at the same time,
I’m
not an idiot. Which means I’m aware of how difficult I can be. If I could figure out what to do about it, I might change, because being the difficult one does get lonely and often comes with large doses of guilt. Which is probably how I ended up naked in a locked on-call room with said idiot (also naked).

After delivering the orders for treatment meds to the nurses’ station, we both have to walk together into the patient’s ER room, where our boss is waiting for lab results.

“It’s diabetes,” I say before she can ask.

Dr. Rinehart turns around and eyes me and Justin. Justin’s busy studying his shoes like a patient just bled out on top of them.
Sore loser
.

“Dr. Jenkins,” Rinehart says to me. “You have the lab results?” Her eyes flit in the direction of the fifteen-year-old kid in the hospital bed and his mom seated in the chair in the corner of the room.

I glance at them for a split second and then focus on my boss. “Yes, ma’am. It’s type 1 diabetes—”

“Diabetes?” the mom says, then she points at Justin. “He said it was probably food poisoning.”

“He was wrong.” The grin sneaks up on me for a second, but I smooth my mouth into a straight line again.

“Wait.” The kid pulls himself to a sitting position. “I have to, like, give myself shots and stuff? I hate needles.”

“Insulin,” I say. “You’ll need to regulate your body’s blood sugar levels.”

“For how long?” the kid and the mom both ask.

I stare at them blankly.
Is that a real question, or is she being sarcastic?
“Forever.”

The mom immediately bursts into tears. The kid snatches his cup of water and throws it across the room, splashing the clean white walls.

Dr. Rinehart opens her mouth to speak, her eyes narrowing at me. “Dr. Jenkins, perhaps
you should backtrack a little, start with how you came to this diagnosis.”

I take a good five minutes to go through each symptom presented and how it connects to the diagnosis, and then I move on to the family history connection. By the time I finish my report, Dr. Rinehart is rubbing her temples and a nurse is hooking up the insulin pump I ordered for the patient right before coming in here to deliver the news.

“I’m not doing it!” the kid shouts at the nurse, fighting her, not allowing another needle to enter his body. “This is fucking bullshit! None of you know what the hell you’re doing!”

My gaze sweeps the room, taking everything in—the sobbing mom, the adolescent with the flailing arms. Jesus Christ, these people are dramatic. “He’s going to be okay, you know?”

The mom points at her kid. “Does this look like okay to you? He’s sick and you’re telling me he’s gonna be sick forever. We came here so you could make him better.”

“He’s alive,” I point out. “He’s not dying. Diabetes is manageable.”

“Get her out of here,” the mom shouts to Rinehart. “I don’t want her anywhere near my son.”

I expect Rinehart to defend me, but instead she turns to Justin. “Dr. Martin, I’d like you to get the patient admitted to the pediatric floor, talk the family through the next few steps and let them know what they can expect to see with their son’s health, and then call up our support group specialist.”

“Yes, Dr. Rinehart,” Justin says.

I clamp my teeth together, my jaw tense with words of protest. As soon as we’re outside the room, heading down the hall, my mouth opens again, “You’re leaving them in Justin’s hands? He completely missed the family history and odor in the kid’s mouth.”

“I realize that,” Rinehart says. “But Dr. Martin is only human. He missed something and you caught it. The patient will receive appropriate treatment. His case is nonsurgical, so after he’s admitted we’re all done. Besides, the blood work would have provided the answers we needed regardless of whatever pre-results game the two of you were playing.”

Dr. Rinehart was the lucky doctor assigned to supervise the youngest medical interns in the history of the University of Chicago Medical Center. And I have to admit, she does have unending patience. It can’t be an easy job.

I’m dismissed with the wave of a hand, and then a nurse drops a stack of charts into my arms. I sigh and begin sifting through them, screening them for Rinehart to review later. An intern from another team breezes past me saying, “O’Reilly wants you in his office, stat.”

I straighten up. “Did he say why?” My heart is now drumming twenty extra beats per minute. There’s only one reason for the chief of surgery to call me into his office today.

My residency assignment
.

The girl shrugs and then gives me a patronizing look. “Come on, Isabel, you know you
got Johns Hopkins. There’s no way they’d let any other hospital snatch you up.”

A surge of confidence floods through me. I take the stairs two at a time up to the ninth floor, reciting the stats I’ve come up with to mathematically predict which residency program is most likely to accept me. It’s always been Johns Hopkins. That’s where my dad completed his cardiothoracic surgical residency. And that’s where I plan to be in a couple of weeks.

When I arrive at O’Reilly’s office, the door is open and my dad’s occupying one of the chairs across from the desk, his white lab coat hanging off the side.
Why is he here?
This must be good news, and the chief wanted Dad to share the moment with me.

O’Reilly looks at me, his face unreadable. “Have a seat, Isabel.”

I toss my long brown hair over one shoulder and tuck my coat neatly under me as I sit.

O’Reilly’s forehead wrinkles and he tosses a manila folder onto his desk, opening it and revealing a stack of pink pages. “I’ll get right to the point, Isabel. You haven’t been accepted into a residency spot at this hospital—”

“I understand completely.”
Johns Hopkins, Johns Hopkins, Johns Hopkins
. It’s so close I can taste the Baltimore crime-capital air.

Dr. O’Reilly’s gaze zooms in on mine. “You’re not accepted into
any
residency program.”

I stare at him, my jaw slack, mouth hanging open. “Wait … 
what
?” From the corner of my eye, I can see that Dad hasn’t moved or reacted. He’s staring down at his hands. Did he already know?

“Your score on the emotional readiness portion of the exam wasn’t high enough to grant you a license to practice medicine without supervision,” O’Reilly explains, his voice flat.

Emotional readiness exam?
“You mean that psych evaluation you made me and Justin take?”

“Yes, that would be the one. And scoring in the adequate range is a condition you and Dr. Martin agreed on when I allowed you into this surgical program despite your age,” he says, even though he’s fully aware of my inability to forget facts and details like these.

What the hell was wrong with my answers?
I play back every bit of the hour-and-a-half-long session with the psychologist and find nothing I said that would deem me incapable of handling the job.

“The consensus among all the hospitals that considered you for residency programs is that you don’t have the ability to see consequences, to understand the impact your actions have on others, and though we have no incident to report of you making a poor medical decision for a patient—”

“Exactly,” I interrupt.

“—it’s still a big risk none of the programs, including this hospital, are willing to take,”
O’Reilly finishes. “You would be in charge of five interns, overseeing their education. You’re not ready for that, Isabel. You’re eighteen years old.”

“Eighteen and three-quarters.” My chest is tightening. I can’t breathe. No, I’m breathing. But struggling.

“Given your age and short trip through med school, there was always a chance you wouldn’t be ready for this next step.”

A chance, yeah. But I never thought it would happen. “That’s it? I’m done? I can’t be a doctor? Why the hell did you let me get this far if I couldn’t keep going?”

Dad wraps his arms around my shoulders. “It’s all right, honey. Take a breath.”

I inhale and exhale slowly before lifting my eyes to look at O’Reilly again. “Is this because of what happened today? The diabetes kid?”

He points to a stack of pink papers. “That’s just one of many similar reports.”

“Does it say anywhere in that report that Justin wanted to diagnose him with food poisoning? Please tell me he didn’t get into any programs, either.”

O’Reilly looks down at his hands.

“He did, didn’t he?” I shake my head. “God, that’s fucked up.”

“Isabel,” Dad warns, releasing me and turning his attention to his boss. “What are her options, then? Another year as an intern?”

“This hospital has already filled its intern quota for the fall,” he says. “You can apply to other programs, but I’m sure it would be the same situation. I can recommend her for a position in lab research. There are a number of facilities in the Chicago area—”

“I’m a surgeon. I’m not going to work in some lab, cutting up rodents.” I shake my head in protest. “I’m the best intern at this hospital and you know it.”

“You’re the most knowledgeable intern in the surgical program,” O’Reilly agrees. “But there’s a lot more to being a doctor than knowledge and diagnostic ability. Your practical surgical skills are above average, but not the best.” O’Reilly leans back in his chair, drumming his fingers together. “Perhaps this is simply an issue of lacking typical life experiences for someone your age. At least that’s one of the theories Dr. James presented in her evaluation. She pointed out that the majority of eighteen-year-old females are either just beginning college or starting out in the work world and have no real concept of their long-term plans. Dr. James believes your certainty may be a mask for avoidance of important age-related milestones.”

What a bunch of bullshit
. Even O’Reilly doesn’t sound like he believes any of that. I scowl at the memory of the pinched face, pressed pants suit, and perfectly in-place hair that came with Dr. Winifred James, Ph.D. She doesn’t even have a real medical degree.

“I’ve spoken to the AMA,” O’Reilly adds, obviously uncomfortable with the topic of female adolescent milestones, “and they’ll allow you to retake the emotional readiness test, but
not before at least six months have passed. That gives you a little downtime to do some thinking and experiencing.”

“What am I supposed to do for six months?” My whole life I’ve been on the fast track, never waiting for those age-related milestones. I’ve never had downtime. I’m not even sure I know what it means.

O’Reilly and Dad drone on about options for me and my destroyed future, but I can’t listen. All I can do is think about that stupid psych evaluation and getting my hands on it.
Dr. Winifred James, Ph.D., what else did you write about me?
I need to know where I went wrong. I need to know how to pass next time. But getting hold of it would be completely illegal and require a great deal of hacking—something I’m fortunately very capable of.