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  Robby focused on Marlin. “So, no, Dr. Mack. We do not blame this on anesthesia, no more than we can blame our cholecystectomy surgical technique on Mrs. Hardy’s death.”

  Annabel marveled at Robby’s soft-spoken manner and ability to straighten out Marlin without seeming confrontational. Her eyes lingered on his handsome features while Bob was also asking a question.

  “Is it really true there are ten OR sayings?” Bob asked. “Can’t you tell them to us now? I mean what if they show up on the department’s first test?”

  “Very funny, Dr. Palmer,” Robby said. “However, if you pay attention, you all may know them by the end of the rotation.” He pushed off from the desk and stood tall. “Okay, team. If there aren’t any more wisecrack questions, let’s get going on rounds. And welcome to the first sleepover day as doctors in a hospital.”

  With Robby in the lead, they filed out of the room.

  “That was a gloomy update,” Annabel said to Bob.

  He nodded as they walked side-by-side down the hallway, trailing the others. “We better get used to it. Modern medicine and surgery pulls patients away from death’s door but it doesn’t always work that way.” He fumbled around in a lab coat pocket and pulled out a small cellophane bag. After dumping a few dark candies into his hand, he tried to pass them to her.

  “No, thanks,” she said.

  “No, really,” he said. “I wouldn’t give a girl plain old candy this early in the morning. These are dark chocolate-covered espresso beans. They’ll lift your spirits.”

  “Clever. I think I will.” She took a few and put them in her pocket except for one which she popped in her mouth.

  “At midnight tonight,” he said, “we both may be happy I carry these around.”

  Annabel smiled and they hurried their pace to catch up with the others.

  -----

  When the team gathered around Mr. Newman’s bed, he grinned. “Don’t tell me you’re all going to stab me,” he said.

  Robby’s eyes softened and he took Mr. Newman’s arm to look at the IV site. “No. We may look like we’re ganging up on you, but we’re not. After we discuss your case, I’ll send Dr. Tilson and Dr. Wallace back in here. You still need to finish your course of antibiotics so we do need to insert a new IV. As you know, this is a teaching hospital …”

  “Okay, okay, doc. Since they’re so pretty, I’ll grin and bear it.”

  Robby glanced at Brandy and then Annabel; his eyes lingered on Annabel and she felt butterflies in her stomach.

  “I don’t want to agree with your assessment,” Robby commented, “because I must treat my trainees, males and females, alike. Since we don’t go around calling our male students or residents handsome, I can’t agree that the girls are pretty … although they are. The whole team looks good.”

  “I see,” Mr. Newman said. “Otherwise you’d be sued for sexual harassment. That’s a shame, doc. I mean in my day, we called a pretty girl a pretty girl.”

  “In the work place, however,” Robby said, “things are different. Half of medical school admissions these days are females. You can see there has to be equal standards.”

  “Okay, I’ll buy that. Just send back one of your teammates with a warm heart and a soft touch.”

  Robby shook his head, pulled his stethoscope off his neck, and grinned. “We’ll end this conversation. Let me place this on your abdomen.”

  Mr. Newman pulled the covers away and kept silent. When Robby finished and instructed him to start a soft diet, the team departed.

  Brandy Wallace patted Annabel on the sleeve and softly said, “You’ll do fine.”

  -----

  Almost three hours later, Annabel weeded through the shelves in the supply room while Brandy gave her instructions.

  “You’ll learn the difference in catheter sizes over time. The size will depend on the function of the IV and on your patient’s veins, whether they are decent or not. A 20-gauge should be fine for Mr. Newman’s purpose.”

  Annabel picked one out and also selected alcohol wipes and a tourniquet.

  “You are being optimistic,” Brandy said. “Do you think you’re going to get your first IV in on the first attempt?”

  Annabel frowned, went back to the box, and picked up two more catheters.

  “A hep-lock to plug the catheter,” Brandy said, “and get some gauze in case you make a mess. And you’ll need tape. Something’s got to hold it to your patient.”

  Annabel rolled her eyes. “Good thinking,” she said. She stashed a few things into her pocket.

  “You have been practicing on oranges, haven’t you?” Brandy asked.

  “A little bit.”

  “That’s all you need beforehand, just to get the feel of plunging past resistance like skin.”

  The two women went into Mr. Newman’s room where a morning game show blared from the other patient’s TV.

  “Uh-oh,” Mr. Newman said, leaning forward. “I’ll let you tamper with my veins if you discharge my roommate who is grating on my nerves.”

  “Since he’s not our team’s patient, we can’t help you out,” Brandy said softly.

  Mr. Newman swung around to the side of the bed. “It figures,” he said and extended his arm.

  “I’ll take out the old one once I have a new one in,” Annabel said.

  “Dr. Tilson watched closely while I put in an IV yesterday,” Brandy said. “She’ll do fine and so will you.”

  “Easy for you to say.”

  Annabel took his arm, wrapped the tourniquet around it, and looked up and down from his forearm to his hand. She flicked a vein to make it pop up, rubbed it with an alcohol wipe, and then unwrapped a catheter from its package.

  “Aim in and up and along until you get a flash of blood, then you can push the catheter out from the needle,” Brandy instructed.

  Annabel did as she was told but a dark welt appeared and expanded. “Oops,” she said.

  “Take it out and apply pressure with a gauze,” Brandy said.

  Annabel pulled off the tourniquet, used the gauze, and taped it to his forearm. Mr. Newman looked more patient than she thought he’d be and she took the opportunity to scout out his hand. A big vein popped out at her and she repeated her ritual. But this time the IV acted like a dart missing its mark and Mr. Newman not so subtly cleared his throat.

  “Sorry, sir,” Annabel chirped. She looked up at Brandy.

  “One more try, if that’s okay with Mr. Newman,” she said.

  “I’ll close my eyes and say a prayer this time,” he responded.

  Annabel opened the third IV package. Now she knew why Dr. Wallace advised her on bringing extra supplies. She didn’t want Mr. Newman changing his mind so she quickly repeated her steps, found a vein below his elbow joint, inserted the catheter dead center, and effectively slid it up the vein. As she looked at the flashback of blood, she then fumbled from inexperience.

  “Pull that needle out and your hep-lock is ready right here,” Brandy said, moving it slightly to Annabel.

  Annabel capped it successfully. “Don’t move, Mr. Newman,” she said as she applied the pieces of tape she had ready. “Oops,” she said again. “I didn’t bring the heparin or flush for it.”

  Brandy reached into her own pocket. “I have you covered. Next time, you’ll remember everything you need. Time is precious and you won’t have the extra minutes to redo tasks you should have prepared for to begin with. And another word of advice. ‘Oops’ is not a good expression to say aloud in medicine … especially in front of patients.” She looked at Mr. Newman. “Wouldn’t you agree?”

  “Yeah, somebody hears that and they’ll think the doctor meant that they stabbed an artery, or did surgery on the wrong leg, or gave a patient a wrong drug. Honey, keep ‘oops’ to yourself.”

  Annabel finished gathering all the wrappers and stood up. “I see your point. I will retire that expression from my vocabulary. Thanks, Mr. Newman, you’ve been a sport and I appreciate it.”

  As the two of
them left the room, Annabel put the dirty needles in the sharps container and the rest of the garbage in the can.

  Brandy stood against the doorway. “Now you’re ready as far as IVs go. You saw one, did one, and now can teach one. You also learned another OR saying that Dr. Burk doesn’t have to repeat for you.”

  “What’s that?” Annabel asked.

  “See one, do one, teach one.”

  -----

  Annabel and Ginny Young both grabbed trays and started sliding them in front of the food selections.

  “Lunch time is over, ladies,” the woman behind the counter said. “Better make up your minds quick because we’re taking this chow away.”

  Not only did the vegetables look like they’d been wilting in the summer heat, but the meat loaf and chicken looked like road kill. She didn’t have time to deliberate and the salad bar had already been cleared away so Annabel ordered the breaded chicken and mixed vegetables. The woman was generous with her portions because the food was destined to go unused anyway.

  At the end of the line, Annabel picked out a roll, butter, and an iced tea. The two women settled at a table by the window and then Ginny pulled out her cell phone.

  “You’ve been checking that a lot today,” Annabel said.

  “I didn’t know checking my text messages was that obvious. My three-year-old got sick at day care and my husband had to go get her. He’s not too happy because he’s on a big job with a contractor and had to break away.”

  “I don’t know how you do it. Sounds like one big juggling act. How’s your daughter?”

  “It sounds like she’s picked up a stomach virus. Once one of them gets it, then they all get it. The attendance there today is down to half.”

  “You seem set on going into pediatrics. I don’t know what I want to do, but I have a dim view of going into peds.”

  “I feel that way about some specialties. Imagine going into pathology”

  “I don’t think it would be that bad. At least you wouldn’t catch stomach bugs from little kids.”

  “Ha! But you’d go home with bleary eyesight every night after being stooped over a microscope all day.”

  “But you’d get to go home on time and wouldn’t be on call,” Annabel said and then laughed.

  Ginny snickered. “We could go on like this all afternoon.”

  “I agree.” She took a bite of her roll and cut the rubbery chicken into small pieces.

  “You have less potential time than I do,” Ginny said. “When I just passed through the office, Dr. Burk and Dr. Mack had been called to see someone in the ER. You’re up for the first admission with Dr. Mack, so eat fast.”

  Annabel frowned. It wasn’t easy eating this stuff slowly let alone trying to hurry. When her pager beeped fifteen minutes later, she had finished and Ginny patted her hand across the table. “Good luck with your first hit. Leave your tray. I’ll bus it for you.”

  -----

  When Annabel arrived in the ER, a nurse directed her to a draped cubicle. “Dr. Burk came and went, and they told me to send you in there,” she said.

  Annabel pulled the curtain and stepped inside where a thirty-two-year-old female named Sharon Douglas clutched at the right side of her abdomen and wiggled around on the stretcher. She had dyed-blonde hair and her orange nail polish matched the streak of orange on a long bang.

  “This is Dr. Tilson,” Marlin told the patient. “She’ll be joining us.”

  “I’m having … severe pain,” the patient stammered, “I hope you can do something about it, too.”

  Uncertain, Annabel just nodded.

  “”Where was the pain yesterday?” Marlin asked.

  “It’s been right here,” she said, pointing to her right lower quadrant.

  “When did it start?”

  “Yesterday.”

  “Do you have a fever?”

  “Yesterday. I’m sure of it.”

  “Are you eating?”

  “I feel too sick”

  “Have you had nausea or vomiting?”

  “I think I could throw up. I told you, I still have my appendix.”

  “So you did. Can you lie still so I can examine your belly?”

  She nodded and pushed the sheet down to her lower abdomen. Marlin moved her gown up and listened with his stethoscope while she grimaced; she said ‘ouch’ before his hands began applying light and deeper pressure to her belly.

  “It’s your turn, Dr. Tilson,” he said. Annabel stepped forward and mimicked Dr. Mack’s examination. She also listened to the patient’s lungs and heart.

  “We’ll be admitting you and ordering tests,” Marlin said when Annabel finished.

  Mrs. Douglas nodded. “Thank you.”

  Annabel and Marlin stepped out. “You can go back in and ask her more questions,” he said, “since you came in after me. Let’s sit over here and discuss what we’ll order. Do you think patients tell you their diagnosis when you talk to them?”

  “I don’t know,” she confessed.

  “The fact is, that by listening and observing closely, that may be the case.”

  “So she’s hinting at appendicitis,” Annabel said.

  “Yes. But what else should you think of with abdominal pain in a female?”

  “I suppose many things such as a problem with an ovary, or diverticulitis, or bad premenstrual cramps …”

  “Pelvic inflammatory disease,” he added. “There are more possibilities. Some tests will help delineate what’s going on. We need a CBC and electrolytes, and a urinalysis, even an ultrasound and abdominal X-rays.” He kept moving towards the desk and grabbed an order sheet from a paper cubicle. “I’ll leave you to your patient and to your history and physical.”

  “And one more thing,” he said before walking away. “Be sure to hunt down any results later that may be ready for late afternoon rounds.”

  Chapter 5

  Annabel talked with Sharon Douglas in the ER one more time to ask about allergies, medications, and previous surgeries. Even though her patient still complained about ‘ungodly’ nausea, the emesis basin sat unused. And her vital signs reflected no temperature. But based on what Annabel knew about appendicitis, even an index of suspicion should be taken seriously.

  Off to the side at a little desk, she wrote out her history and physical - or H&P - careful to use decent penmanship and not let it turn into chicken scratch like most doctors. After the main descriptions, she came to its important synopsis: the ‘A’ and ‘P’ part which stood for Assessment and Plan. After thinking about everything she and Dr. Mack had discussed, it seemed as if ‘appendicitis’ was the main working diagnosis and she wrote: Assessment: R/O Appendicitis

  She figured the R/O, which stood for ‘rule out,’ should go there since the diagnosis was not a complete certainty. Then she wrote the last part, the ‘Plan.’ For that, she copied the test orders that Dr. Mack had written as well as ‘NPO,’ which meant not to give the patient anything to eat or drink. As Annabel knew, that was because of the possibility Sharon Douglas would go to the OR for an appendectomy and anesthesia wouldn’t want anything in her belly. If Robby did plan on that, Annabel looked forward to watching the operation.

  -----

  It was 6 p.m. and the office looked like the team had been hard at work. No one had bothered to close any textbooks, throw snack wrappers away, or put empty chart papers in any kind of order. A pair of clogs even littered the floor and when Annabel walked in she noticed Brandy Wallace rubbing her feet as she sat on the small couch.

  “I was just going to page you and Da’wan,” Robby said to Annabel. “Dr. Pittman is in the building.”

  Annabel turned to see Da’wan step in. His hair twists were totally in place and he looked like he did at 8 a.m. “Did I miss anything?” he asked.

  “No,” Robby said. “We’re going to round with the attending since we’re free of admissions at the moment.”

  Annabel had checked for Sharon Douglas’s test results an hour ago but some of them were not
ready. Disappointed, she knew that was out of her control.

  As Robby waved at them to follow, Brandy slipped into her clogs and walked out with Annabel. At the nurse’s station, Dr. Pittman stood waiting and gave them a friendly smile. “Good evening,” he said. “Any admissions so far?”

  “We’ve had two,” Robby said.

  “Let’s concentrate on them first since the students will be following them right from the start. Time to do a little teaching.” His deep voice resonated around the area.

  “Let’s start with Dr. Mack’s patient at the end of the hallway,” Robby said. “We can present here.”

  “I’d like to hear first from the students,” Dr. Pittman said.

  “That would be Dr. Tilson,” Marlin said. “She’s the student assigned to our first patient.”

  Dr. Pittman took out a pad and pen from his sport’s jacket. “What’s the patient’s name?”

  “Sharon Douglas,” Marlin said.

  While Dr. Pittman made a note, Robby looked at Annabel. “Would you like to begin?” he asked. “Tell us the basics of your H&P. Pretend you’re a seasoned M.D.”

  Annabel’s heart had sped up and it echoed in her ears. Wondering if the whole world would be listening, she took a tiny breath and told herself this wasn’t a test. They were all in this together and, after all, they were students. They weren’t supposed to know how to do everything … yet.

  “Okay” she stammered. “Mrs. Douglas is a thirty-two-year-old female with no significant medical or surgical history who presented to the ER with complaints of severe lower right abdominal pain which started yesterday. She has been nauseous with a decreased appetite and she believes she ran a fever before coming in. She’s not allergic to any meds.”

  Annabel felt her anxiety dissipating the more she focused on the patient’s H&P and her presentation. Brandy stood directly across from her and gave her encouragement with a little nod.