Copyright: This story is copyrighted to the author © November 1999 by Revan. Do not use any part of this story without my written permission. Contact: Revan3@hotmail.com
Disclaimers: See Part 1 for standard disclaimers.
This is not good. Bryn chewed her pen in an unconscious gesture, then caught herself, and peered at the bite marks. God, thats disgusting. She shoved the pen in the pocket of her suit jacket and pulled out another. Looking back at Mrs. Fiorellis lab results, she ran her free hand through her short hair in frustration.
Mrs. Fiorelli, you did not have a good night. Her patient clearly had suffered heart damage, and was having problems maintaining an adequate blood pressure. Shit. Well, at least she doesnt have an infection...yet. Though...at least Id know how to take care of that.
She finished her brief...and meaningless... primary care physicians note and was thinking magical thoughts meant to preserve Mrs. Fiorellis heart muscle when she noticed that the chair next to hers was occupied and friendly eyes were grinning at her.
"Hey, Bryn, whats up? I havent seen you in ages." It was Robert Callaghan, one of the surgical residents. She and Bob had been good friends ever since they shared a cadaver in medical school. He was now years behind her in training, having taken time off to finish a Ph.D.--in physiology? Anatomy? She couldnt remember.
Bryn smiled. "Im here every day--just hiding in the lab. They let me out twice a year to play doctor. You can always tell when...its the only time I wear these suits."
Bob laughed. "Yeah, you look like a real attending. Who are you seeing?" He glanced at the chart. "Mrs. Fiorelli? Huh...I dont remember that we got an ID consult on her." His voice turned concerned. "She doesnt have a new fever, does she?"
"No...are you one of the juniors on West Surg now? Shes my clinic patient, I just came by to see how she was doing. Not great, I see." Bryn passed over the chart.
"Yeah, Im checking on all of our patients here in the surgical ICU...Youre her internist? Wow...I heard there were some sparks yesterday about the DNR order...that was you?"
Bryn snorted. "Usually the worst Ive been able to manage is to get you surgeons riled up when I threaten to put one of your patients on an aminoglycoside antibiotic. Man, does that Chief of yours have an attitude or what?"
Bob shook his head. "Thats not an attitude...thats just Dana."
"Whats that supposed to mean? I was ready to slug her." Bryn shook her head at the memory.
"Well, its true...you either love her or hate her." Bob considered. "I think shes great...but she doesnt waste much time on the social graces."
Bryn grunted. "She could be into barnyard animals for all I care...as long as she does a good job taking care of Mrs. Fiorelli." Her voice became harsh. "Look, Bob...Mrs. Fiorellis like a family member to me. God knows I see more of her than I do of my own family. Take care of her, OK?"
"You know I will, Bryn." His eyes focused on a point over Bryns shoulder, and she turned to see Dana Sanders coming through the automatic doors and heading in their direction.
"Yeah, see you. Im outta here." Bryn collected her stethoscope and headed out, glancing at the tall surgeon as they passed. What, youre not even going to look at me? Sorry, Bob, its definitely an attitude.
Dana suppressed a flinch and felt a small shiver run down her back as Bryn passed her. Its that internist again...Mallory. What was her damn problem yesterday, anyway?
She sat down next to her junior. "Hey Bob, whats up?" When he didnt answer, she glanced over. "Hello?"
"Uh...sorry." He gave her a strange look and passed over the chart. "Its Mrs. Fiorelli...still a pressor requirement, and shes ruling in for an MI."
"Christ." Dana shook her head. "Bad protoplasm." She read through the recent notes. The next words were offhand. "You know that internist?"
"Bryn?" He glanced over at his Chief, who was staring across the SICU, her eyes reflecting the lights from a distant room. "Sure...we were med school classmates. Shes really great."
"She always have that attitude?"
"What?" Bob started laughing, and couldnt stop even when Dana turned and fixed him with a cold gaze. "Sorry, Dana...havent you ever heard of glass houses?"
"Huh?" She was puzzled, and was becoming angry, her usual reaction to a situation that she didnt completely control.
"Never mind." He got up from the desk. "I still have a few more of our folks to see." Heading over to a nearby cubicle, he stopped to put on gown and gloves, then disappeared behind the curtains.
Dana shook her head. Sorry, Bob, that Mallory was really angry about something. Maybe shes just PMSing. Or...she seems familiar...probably I pissed her off about something in the past, and she still remembers it. Wouldnt be the first time.
She stretched her legs. Theyd had a long case this morning...an abdominal stab wound, sent up from the EW, a good challenge. Just some trachs and G-tubes for the afternoon; shed take an intern through one of them, the senior would handle the other.
Time to eat. She headed out to take the elevators down to the basement. Maybe Ill get to take an hour and go for a ride this afternoon if we finish early. She was already mapping out the next few hours, and had no further thoughts about Dr. Mallory.
Bryn wasnt so lucky. She was trying to blow off the fact that she now knew that her confrontation with the surgeon was common gossip, but she understood herself well enough to realize that she was seething and it wasnt going to end anytime soon. Despite her friendly and open exterior, she was intensely private and had worked hard to keep her personal life away from Division gossip.
At least nobody heard what I said to her. So why was she feeling so rattled?
So, its a crappy Thursday to go along with a crappy Wednesday. And the weekend wont be any better...Im on call.
Thursday...that was Grand Rounds day. She looked at her watch. Almost noon...fine. She exhaled, relieved. She could pretend to be a good citizen and sit for an hour in the auditorium, zone out on the speaker, work though her scattered thoughts, and get continuing medical education credits at the same time. All in all, a fair deal.
Getting out of the elevator at the ground floor, she dodged through the lunchtime crowds in the main hallway and headed toward the new Blake auditorium. It was definitely an improvement over the old room that had been used for medical Grand Rounds; the seats were more comfortable and there were shadows in which she could hide.
Bryn found a seat near the back and slumped down. Whats this one about, anyway? Oh...some renal thing. Her knowledge of the details of kidney function had dwindled in the years since her residency and was now approaching zero. Perfect.
As the lights went down, the slides came on, and the speaker, a distinguished nephrologist from Johns Hopkins, began, Bryn let her mind wander. So whats the problem here? OK, so she was overtired after a week on the clinical service, no surprise there; it always was a shock to get used to the hours, and the fatigue always made her depressed.
Still...maybe she was more stressed that she thought about the fact that she would be out of grant money in seven months, and she absolutely had to get that NIH grant or she could kiss her promotion goodbye? Nah...her research had been going well enough, shed get the money somewhere. She dismissed that possibility and moved on.
Come on, Bryn. Right, right. She grunted. Her psychology was so transparent even she, a big believer in the power of denial, couldnt hide from it. Face it, your birthday was last week. At least thirty-four wasnt any milestone number; that would have been too damn painful. It didnt help that she didnt have any family. At least last year Maureen made me that nice dinner, with the cake...
Maureen. Fuck. Why had that one crashed and burned? Fizzled out is more like it. Yeah, just like the others... Bryn sighed. So what had happened? Maureen was smart, and funny, and good-looking, had that fantastic job in the newsroom for Channel 11, and was always, always, nice to her. Theyre all always nice to me. And then they all want me to move in.
Why dont I feel as close to them as they say they do to me? Why do I always feel...distanced? As if there is a part of myself that is separate ...looking in from the outside?
Bryn laughed at herself. Cosmic questions. She flexed her shoulders. I just need to get some exercise; I havent been to the gym in a week. Some endorphins should do the trick. Ill go running on Saturday morning, no matter what.
With the big questions conveniently filed away, she got up with the rest of the departing audience and went in search of some lunch before joining Cam and Roger for their afternoon rounds.
Even knowing that she had to train didnt make it any easier when Bryns alarm clock went off at 6:30 on Saturday morning. She rolled over and pulled the blankets up over her head.
Jesus, why did I decide to do this, anyway? It was getting hard to remember. She had committed to raising two thousand dollars for the pediatric oncology service, in return for which she would get an entry number for the Boston Marathon in April. Finding friends and companies willing to sponsor her was the easy part. This part sucks.
She had run Boston before, but always unofficially, as a pirate at the back of the pack. Since she had gotten into martial arts over the last three years, her mileage had decreased and the long weekend runs that she had started again were still...painful. She never could understand why anyone would hold a major marathon in the spring, right after the unfriendly Boston winters, when nobody in their right mind would be able to train enough, anyway. Mustve been chosen by some New England puritan type. Bastards.
With that cheerful thought, she got out of bed, put on her sweats, and started stretching. Ouch. Finally, she headed out, her apartment key on a string around her neck and her beeper on her waist, though she knew that Cam wouldnt call before nine unless it was absolutely necessary. He knows Ill kill him if its not a freaking emergency.
Whoa. Her breath frosted in the cold November morning as she turned down Concord and plodded through a sleepy Harvard Square, with only a few huddled street people in the Coop doorways. By the time she made it to the cycling path along the Charles River and heading west, she was warmed up and definitely more cheerful.
Four miles later, she made the turn-around near Watertown Square and started back towards Cambridge. She always liked this part; it bordered on parkland and was a little wooded, and the traffic wasnt as noisy as it was closer in to the city. She was daydreaming, and almost didnt hear the "On your left" until a racing bike practically grazed her, causing her to stumble and slow.
Idiot. Bryn stopped to catch her breath and glare. Suddenly, her heart skipped a beat. Was that ...that damn surgeon? She wasnt sure, the bike had gone by so fast. Ive never seen anyone ride that fast on this path...whos she racing? She had barely glimpsed dark hair under a helmet, a racers physique, and a brilliant yellow racing bicycle.
Maybe it wasnt her. From what I can tell, she never leaves the hospital, anyway. Bryn took a deep breath and made her legs start moving again, back to Cambridge, home, and another day in the hospital.
This is going to be a really, really, really bad day. Bryn looked at her beeper glumly. It wasnt even noon and they already had four new consults, and now Cam was paging her again. If this is another consult Im going to scream.
She dialed the number. "Hi, this is Dr. Mallory from ID...I was paged?" She heard the unit secretary on the other end asking who wanted ID. Cam picked up the phone.
"If this is another consult Im going to kill myself."
There was a pause at the other end as Cam digested this news. "I hope youre someplace where the bloodll be easy to clean up then...Ive actually got two more, and it might be three but Im going to try to curbside one of them, or at least turf it until tomorrow."
"Ugh." Bryns heart sank, then calmed as she turned on her resigned for the duration mode. "Guess Ill be seeing you at the evening meal. Im only one behind you, Ive already seen those first two. OK, whats up?"
"Nothing that needs seeing right away; I just wanted to let you know what was coming in. Im just going to keep plowing through them in the order theyve been called in for now. Ill page you when Ive seen the next one, OK?"
"Great...youre on Ellison 14? Ill meet you there if I finish this one before I hear from you. Bye."
Bryn shook her head and continued writing, her hand already starting to cramp up.
Eight hours later they had an additional two more new consults, and Bryn was on autopilot. No one reads my long notes, anyway, right? Too bad these are all real cases...Ive never seen such a collection of sick people. She finished her note on Mr. Draganis, whose cavitary lung lesion was tuberculosis until proven otherwise, and stood up and stretched. She had to head back to the medical ICU to check on the results of the echocardiogram on Mrs. Quill; she was convinced the patient had an infection of a heart valve with a big surrounding abscess. She had even bet Cam an ice cream cone on this one. She hated to lose a bet.
At nine oclock she met Cam in the basement cafeteria for the evening meal. I still cant turn down free food. At least this meal has improved since I was a resident here. She surveyed her tray. It was hot, and there was more than one color, and identifiable vegetables. Actually, it was pretty good.
She looked up as Cam returned from one of the house phones. "Dont tell me..."
He grinned. "Sorry. This sounds straightforward, though; a woman in the EW with what sounds like a bone infection--osteomyelitis--at the site of recent spinal surgery."
"So why are we being consulted at 9 p.m. on Saturday night from the EW for something so simple, for gods sake?" Bryn was fed up.
"They want advice on antibiotics...Ill go scope it out and give you a call, you can probably see her tomorrow. Will you take a rain check on that ice cream that I owe you?"
"Fine; I need the time to see some of our follow-ups, Ive hardly done any today." Bryn looked at their team list and grimaced.
She had seen two of their sicker patients and was about to go visit Mrs. Fiorelli when her beeper went off. The EW. She dialed the number, and asked the nurse for Cam.
"Hey, whats up?"
"Bryn, this is a mess down here...a really sick woman. Youre going to have to see her, Im afraid. Not only is she sick, but its a political mess, too...Ill need your clout."
Bryn was intrigued. This could be interesting. She always enjoyed throwing her weight around. "Great, Ill be right down. Where are you?"
"Yeah...thats part of the problem. See you soon."
Bryn took the stairs down to the first floor and wended her way through the maze of the emergency ward. The EW had been completely rebuilt since she was a resident and she had never really figured it out; she generally just wandered about until she ended up in the right place. Shed never been to the minor orthopedics area before, however, and finally had to ask a passing transport guy the way there.
She found Cam at a nearby desk, working on his note. He launched into his presentation, and she was grateful for his succinct style. "Mrs. Reilley had surgery for disk pain in her lower back a month ago...she was admitted to an outside hospital last week with fever and pain at the site, they took some films and cultured her wound, then sat back and waited...
Bryn raised an eyebrow and let out a breath. "No antibiotics?"
"Nope." Cam rubbed his eyes. "Unbelievable...anyway, today it grew out Staph aureus, no surprise there, and her local surgeon must be going away for Thanksgiving because he shipped her up here." He looked at Bryn, shaking his head. "Here shes 102, sweating, headache, confused, with a stiff neck...."
"Say no more." Bryn interrupted. "I got the picture." Meningitis. "So...what antibiotics has she gotten?"
"Well, before they transferred her she got a dose of vanco...here shes been written for naf and ceftaz. I was just going to see if theyve actually been hung, however."
"No, thats the problem...I dont think the ortho guys who are in charge have figured out how serious this is. I keep telling them that she needs to be in an acute room and needs an MRI now but Im not getting anywhere. I thought you could help."
"Yeah." Bryn was energized. Here she could actually do something. "Let me see her...where is she?"
"Over there." Cam pointed to the room. "Here are the notes from the outside hospital." He handed over a sheaf of papers to her. "Heres what Ive written so far, and these are the labs we have back."
Bryn scanned the papers and then went into the room. "Hi, Mrs. Reilley, Im Dr. Mallory from the Infectious Disease Division. The doctors here in the EW asked us to come by to help out with your infection. Youve already met Dr. Miller, who works for me, and hes been telling me all about you."
While she was talking, she was looking over the patient...Toxic. 50-something. Need to move fast. "Whats bothering you the most right now?"
The sweating patient was clearly in pain. "My head...terrible headache." Her voice was slightly slurred.
"When did it start?"
"Last night...I feel a lot worse today, I told my son I wanted to come to Boston. Somethings not right."
Good pickup, lady. Bryn asked a few more questions, then did a rapid exam. The patients neck was clearly stiff, her back wound was ugly, and she had lost some strength and sensation in her lower legs. "Do you have any allergies to any medications? Ever have a reaction to any antibiotics?"
"No...not that I can recall."
Bryn looked at the flow chart. It was past time for another antibiotic dose. She turned back to the patient. "Mrs. Reilley, you have an infection, which started in your back...we have you on the right antibiotics, but I think you will need to have that infected area cleaned out. Im going to talk to the surgeons, and Ill see you again soon, OK?"
"Yes, dear, thank you."
Bryn grinned. She was always being called "dear." She was sure the ortho guys wouldnt agree when she was done with them.
She bullied the nurse into hanging the next antibiotic dose, then found the orthopedic surgeons in the cast room, going over some films. "Hi, Im from ID...Ive just seen Mrs. Reilley. You guys taking care of her?"
A husky ex-football jock turned around. "Yeah...whats up?"
"She needs an MRI to look at the area right away and then Ill bet shell have to go to surgery to have her paraspinal abscess drained."
The surgeons looked at her. "We have her scheduled for an MRI...theyre backed up."
"You need to get it now."
"But...we have this patient with an open fracture, shell have to wait."
Bryn was getting angry, and although she kept her professional demeanor her voice got louder. "You dont understand...she has meningitis, and clearly has signs of spinal cord compression." Shes going to be paralyzed if you dont move fast. She fantasized throwing ex-football jock against the wall. Oooh...fun.
"Whats going on here?" The chilly voice was unmistakeable. Bryn turned to see the Chief Resident standing in the doorway. The effect on the junior surgeons was so abrupt as to be almost comical. Shit...theyre practically saluting. She moved past the Chief and out of the room. Im not going to criticize them to their faces. The surgeon paused, then turned and followed her into the hall.
Green eyes burned. "Theres a very sick patient languishing in Minor Ortho, and Im trying to get some action on her."
Bryn took a deep breath. Why did she always feel like screaming at this surgeon? The chief had barely said a word...it was just that damn attitude that she projected. She tried to stay calm, but by this point she was pissed, and it colored her voice.
"Look, this lady has a paraspinal abscess and meningitis, and the Ortho guys have been spending their time telling me that they cant move on her because they have somone with an open fracture, for Gods sake!"
"How did you get that diagnosis?" It was definitely a challenge. "She was referred in with osteomyelitis."
"Uh...history and physical exam?"
The surgeons lips twitched. "You mean...you folks actually examine the patients...and talk to them?"
"Incredible, isnt it?" Bryn shot back with equal irony. "Next thing you know, well be making housecalls." She jerked her head toward the room. "You want to see what toxic looks like?"
She waited while the chief went into the room. There was low questioning, and she saw the surgeon repeating parts of the exam. If anything, the patients neck seemed stiffer. Shit.
Dana came back out. "Right. I agree with you." She was as impassive as always. "Did you run this by your attending?"
Bryn was so astounded she just laughed. "I am the attending."
"Sorry." It didnt sound sorry. "The junior gave me the wrong story. We usually dont see the ID attendings in the EW at 11 p.m. on a Saturday night." It was clear that "usually" meant "never."
Bryn shook her head. "Ive just been insulted on so many levels I dont know where to begin."
There was a brief silence as the two women measured each other.
Bryn sighed. "Look, youve got these guys so..." Nope. Wrong. Cant say that phrase here. "...so under control, how about you get her to radiology for a scan and to the operating room before midnight, OK? Ive already hounded the nurse into hanging her next antibiotic dose." She pointed to the bag.
"I can do that."
As Bryn turned to leave, she heard, softly, "Love to know what you were really going to say."
The blond slowed, allowing herself a slight grin. Suddenly, a memory returned. "You really should be more careful with that bike of yours...you nearly blew me off the path out by Watertown this morning."
The intake of breath from behind her was gratifying. "Ill remember that...and dont you worry, Dr. Mallory." The voice changed to a drawl. "Well fix this lady right up for you."
Bryn nodded, then left, suddenly supremely confident that Dr. Dana Sanders would most certainly keep her word.
Sunday morning at nine a.m. found Bryn in the Micro conference room, pouring a cup of coffee and looking at the sports coverage in the Sunday edition of the Boston Globe. She loved the Microbiology Department; and had made a point of cultivating friendships among the techs; besides the fact that she thought it was the best clinical lab in the country--if not the world--someone always brought in doughnuts on Sunday morning.
Mary came in. "Hi, Bryn...youre on the consult service?"
"Hell, yes...we had a dreadful day yesterday, was it busy here, too?"
"Pretty busy...not too awful." Mary picked through the remains of the doughnuts.
"Anything interesting that will come back to haunt me later?" Bryn had discovered a long time before that the Micro techs could tell her about the cases she was sure to be consulted on later in the day.
"Hm...yes, there was just a fluid collection from under someones skull that had gram-negative bacteria growing this morning...bet youll hear about that one."
"Oh, yeah...look like anything in particular?"
The tech shrugged. "Just a stool bug. Not a good thing to have in your head, though." She found a chocolate honey-dipped. "Yum."
Bryn finished her coffee and thought about where she should head first. The SICU...I never did get to see Mrs. Fiorelli last night. "Bye then...Im sure to be seeing you later." She smiled at the tech, who nodded back.
She entered Mrs. Fiorellis room in the ICU and was surprised to find nobody there. Do I have the wrong room? She felt the familiar clench of panic hit her stomach. She better not have died last night...
Bryn grabbed a passing nurse. "Wheres Mrs. Fiorelli?"
"Who? Oh...64A...down at CT, I think." The nurse looked unsure. "Renas taking care of her...over there." She pointed to a red-headed woman down the hall.
Bryn walked over. "Hi, Im Bryn Mallory...Mrs. Fiorellis my clinic patient. Whats up with her?"
The nurse sighed. "Well, she was finally doing better...her blood pressure was holding and they got her extubated last night, but then she stopped breathing and was reintubated, and this morning shes not moving her right side any more. So...theyre scanning her head."
Bryn grimaced. "Oh, man."
"I know...shes had a rough road of it." The nurse looked at her sympathetically. "Her familys in the waiting room, if you want to see them."
"Oh, good...sure." Bryn had been meeting with Mrs. Fiorellis daughters almost every day. They had little to add to the nurses summary, and Bryn couldnt do much more than tell them shed go and review the scans and let them know what was happening later in the day.
She took the elevator down to the second floor and made her way through the maze of hallways to the dimly lit Neuroradiology suite. She was looking for a radiologist to corner when her eye fell on a spinal MRI already up on one of the computer screens.
Damn...its Mrs. Reilley. She was looking at it when one of the neuroradiologists came over.
"Thats been a popular one...everyone and his brother has been by to see that since last night." The radiologist shook his head. "Youre from...?"
"ID." Bryn pointed. "Is that the paraspinal abscess?"
"Yes...and this whole areas infected...a big phlegmon. See?" He adjusted the signal, and the inflamed area lit up. "There wasnt a lot to drain...she went to the OR last night."
"Wow. I saw her in the EW last night...Im going to go check on her next. Tell me...Im looking for another study, a head CT...Fiorelli. Do you know if its been done yet?"
"The SICU patient? Shes in the scanner now...should have some cuts for you in a few minutes."
Bryn nodded. "Ill wait." She sat down at a nearby terminal and logged on, calling up her patient list and checking labs while she waited. A few minutes later, she looked up to see the radiologist, now surrounded by four other doctors, looking at a head CT.
Shit...its the surgical team. Even from across the room she could make out the evident findings of a big stroke. Oh, Christ.
The surgeons were discussing the case. "Shes really going down the toilet," said one of the seniors, shaking his head.
Bryn found herself suddenly angry. Not that she hadnt used those very words a million times herself, but... "Watch it," she said into the silence. "Mrs. Fiorellis a friend of mine."
The team turned, startled. Bryn found herself pinned by brilliant blue eyes. "Youll have to admit, Dr. Mallory," came a cold voice, "this is not an optimal outcome."
"Thats for sure," said Bryn fiercely. She got up and walked over, studying the scan. "But she owes me a haircut in her beauty shop, and Im planning to collect."
"Cant say your odds look good," observed the tall surgeon.
Bryn was upset, but she was damned if shed give the Chief the satisfaction of seeing her rattled. She dropped her eyes so as not to reveal any further feelings, and left the room.
Bryn was working on the ice cream cone that she had won from Cam while they ran the list at the end of the evening meal. "Two nights in a row...this is unbelievable."
"Yeah." Cam nodded, scraping up the last of his pumpkin pie. "We had so many good cases...itll be hard to decide what to present tomorrow."
"Um." Bryn considered. The ID Division had case rounds every Monday morning, where the clinical teams presented interesting cases from the previous week. "Well, Draganis for sure...and Mrs. Reilley. Boy, doesnt she look great today? What a turn-around. What do you think?"
"I agree. Ill make sure to get a copy of Mrs. Reilleys MRI for rounds, its amazing. Anyway, thanks for all of your help this weekend."
Bryn looked up, surprised. "Huh?"
"Really...you didnt need to stay so late, but it was sure nice to keep seeing a cheerful face."
"Cheerful? Are you nuts? I guess you didnt hear all the internal expletives." They looked at each other and laughed. "So...whats left?"
"Theres just that straightforward one, Mr. Novan...the guy I think has a C. diff infection again. Hes on White 7. Funny, though...the first toxin titer was negative. You can see him tomorrow."
"Thats weird... Maybe its something else." She shrugged.
Despite Cams assurances, Bryn found herself heading toward White 7. Ill just take a look at the guy...I can leave a note tomorrow.
There wasnt much in the chart; some brief surgical scrawls and Cams consult note, which made up more than half of what there was to read. Mr. Novan was a sixty-four year-old man who had had surgery on his colon six weeks before; during that hospitalization he had developed a Clostridium difficile infection in his intestine, with fever and diarrhea. Now he was back with similar abdominal pain, and some loose stools. Cam had recommended starting him on antibiotics for C. diff again.
Fifteen minutes later, Bryn left the pleasant gentlemans room and shook her head. This is the advantage of being the attending...you come by hours later, the labs are back, the exam has changed, and you can look good by making the diagnosis.
She turned to the nurses at the desk. "Whos the house officer covering Mr. Novan?"
They looked up at the marker board. "Um...the interns Elizabeth Tanner. Want us to page her?"
"Yes, please." Bryn started writing. When the phone rang, she picked it up.
A pleasant voice spoke. "Dr. Tanner, answering my page."
"Hi, this is Bryn Mallory...Im the ID attending, I just saw Mr. Novan. Look, I dont think he has C. diff...actually, Im worried about his abdomen, and I wanted to know if youd see him now to tell me if his exam has changed." Thats a nice way of saying hes a lot sicker than you thought.
"Huh...yeah, Ill be right there."
Bryn looked at the phone. What do you know, a helpful surgeon. But, an intern...probably too young for me. She smiled at herself. Youre bad.
Five minutes later, Dr. Tanner arrived. She was exhausted, young, and pretty, and had a ring on her left hand. Yeah, yeah. Bryn passed her the chart. "I think my fellow was thrown off by that history of the C. diff infection...in fact, he might have an abscess at his old surgical site."
"OK, let me see him." The intern set off down the hall. When she returned, she slumped into the chair next to Bryn. "Yes, let me call my junior. Theres definitely more pain and some rebound now that wasnt there before." She picked up the phone and dialed.
Bryn was finishing up her recommendations when she heard the echoing sound of surgeons clogs.
"Oh...I thought Bob was coming." The intern was clearly unnerved.
"He was busy...The EWs a zoo. Whats up?" The low voice was already tugging at Bryns hidden soul.
She looked up from her note. "Oh, god...you again?" Bryn groaned inwardly. She was still angry from their last confrontation, but didnt know if she was up for another battle.
Dana just nodded, her face unrevealing, while the intern looked shocked at Bryns irreverence. What...cant believe anyone has the balls to talk back to your Chief?
"Elizabeth says you dont think Mr. Novan has recurrent C. diff." Why did the words sound so scathing?
The tone made Bryn bristle. "Either his exam has changed or my fellow really missed the boat. I called your intern to recommend different antibiotics." She was ready to argue the point, but the chief stood up without another word and disappeared into the patients room.
"Shit." The intern was muttering under her breath.
Bryn smiled at her. "She always like this?"
The younger woman rubbed the back of her neck. "Nah...this is her good mood...shes positively manic tonight. You should see her the rest of the time." They both giggled.
Dana came back a few minutes later. "His exam has clearly changed." She remained expressionless as she took the chart and studied the notes. "Well watch him on antibiotics...get another scan to see if theres something drainable, and see if he cools off. Id rather not operate again if we dont need to. Youll write for the antibiotics?"
Bryn was angered by the assumed command. Listen to me, bitch, Im not your scut boy. Do it yourself. She took a breath. "Ive discussed my recommendations with Elizabeth. She can write the orders."
Dana nodded. Did she get the point? Bryn wasnt sure.
"Weve got to stop meeting like this." The internist barely heard the low words.
What...shes actually got a sense of humor? I wouldnt have guessed.
Bryn raised an eyebrow. "Yeah...were practically living together."
Dana shook her head. "That would be a big mistake...we fight enough as it is." She grinned at the blond doctor before shoving the chart back in the rack and leaving the nurses station.
Did she just...smile? Bryns stomach dropped. Does she have any idea how gorgeous she is when she smiles? Man...
Elizabeth was looking at her, a speculative grin on her face. "Oooh...youd better watch out. God knows what might happen if Dr. Sanders actually likes you."
Bryn laughed. "Yeah...god forbid, I might even start liking her. Anyway, thanks for writing the orders."
The intern shrugged. "I know...shit rolls downhill."
Even the success of their presentations at Monday morning rounds wasnt enough to lighten Bryns mood. Cam had done a first-rate job, managing to obtain copies of not only Mrs. Reilleys spinal MRI but also Mr. Draganis impressive chest X-ray. Howd he get the radiology folks to make him copies on a Sunday night? Incredible...he must have passed out Celtics tickets. The rest of the ID staff and fellows had had a field day with the differential diagnosis of Draganis large, fluid-filled lung cavity.
Theyre all just happy that they arent the ones that have to go into his room twice a day and have him cough all those TB bacilli on them. She grinned, fingering the particle respirator in her pocket that they all carried now. Not like when I was a fellow...back in the days of the giants. These guys are all such wusses.
Her self-imposed levity only made her concern over what she would find in the surgical ICU this morning worse. Her forboding grew as she hurried through the hallways, taking the connecting passages between the Bigelow and Ellison buildings.
Whens the last time I felt this attached to a patient? Jesus, I probably shouldnt even be taking care of her.
She knew that wasnt true...but it was also true that she almost never had a problem maintaining an empathetic, but detached, perspective. Its just bad timing...too much else going on. She took the stairs, not wanting to wait for the elevators. And that surgeon...shes driving me nuts. God, if I have to deal with her again today...
She punched the plate on the wall that opened the automatic doors into the SICU. Wham. Thats...satisfying. Bryn glanced around the large ICU, noting the soft whirring and beeping noises, the quiet nurses moving in and out of the glassed-in, separate rooms.
At one of the large work areas she found Mrs. Fiorellis chart. She flipped to the last note. There was no mistaking who had written it; the handwriting was as distinctive as the person who had produced it.
Well, at least her handwriting is legible. Oh...fuck.
Her blood pressures too low...no urine...her lung functions terrible. Bryns eyes stopped at the last line. "Prognosis grim." That was the surgeons kiss of death. Well, she sure couldnt disagree. Shaking her head, she went to say goodbye to Mrs. Fiorelli.
Five minutes later, she emerged from the room to find Bob Callaghan sitting with his Chief, discussing Mrs. Fiorellis care. Bryn sat down next to them, drawing quick glances, but not interrupting their conversation. She only half-listened to Danas instructions to the junior surgeon about managing fluid volume, the patients acidosis, and ventilator adjustments.
Finally, Dana was done. She turned to Bryn. "What do you think?"
Bryn was surprised to have been asked. "I think you should stop."
"What?" It was clearly not what the surgeon was expecting.
Bobs eyes darted back and forth between the two women. He pursed his lips, then moved away, busying himself at a computer terminal out of earshot.
"I dont think you should do anything else...actually, Id cut back."
The surgeons face grew still. "I dont give up."
Bryn sighed. "Lets look at the big picture here, OK? Every organs failing, shes got a huge stroke..."
"If shes alive, I wont stop." The tone was final.
Bryn was suddenly furious, and it made her voice break. "Even if by some miracle she were to survive, she wouldnt want that quality of life. She wouldnt want this to be prolonged. What in the world do you think youre doing?"
Dana didnt budge. "Sorry."
Bryn got up, realizing that shed better leave before she did something that shed regret. "Well, I wont be writing any orders here...but I think youre totally wrong."
Dana watched her leave, then leaned back in the chair, stretching out her legs and closing her eyes. Shes impossible. She ran her hands through her hair in frustration, then sat up. Forget it. She leaned over and picked up another patients chart, reading the recent notes and losing herself in the details of another case.
It was Thursday again, but Bryn had skipped the weekly noontime Grand Rounds. Even I cant daydream deeply enough to make another talk on calcium metabolism bearable. She finished checking the days X-rays and headed to the Neuro ICU to see some more follow-ups before her two oclock rounds.
She got into one of the Ellison elevators and had pressed the 12th floor button before she realized the identity of the only other passenger in the car.
Fuck. The tension made Bryn feel sick. She finally spoke.
"Im going to Mrs. Fiorellis funeral tomorrow...Im driving, you want to come?"
Dana, who had been standing quietly in a corner, flinched. "I dont do funerals."
Bryn was searching for a suitably snide reply when she glanced at Dana and found that the surgeons jaw was clenched, her eyes filled with tears.
Holy shit...whats this? Out of nowhere, Bryn was rocked with the unshakeable conviction that at this moment she was supposed to take the surgeon in her arms.
Right...shes got about eight inches and fifty pounds on me. I think...not.
Dana looked up, braced to find the usual...attitude...in Dr. Mallorys eyes. She was startled to find instead sadness and a deep compassion.
"Im sorry," whispered Bryn.
"So am I," admitted Dana, barely in control. Twelve fucking years, and Im still not over it.
Ill never be over it.
Dana turned and faced the door. When it opened on the fourth floor she got off, not looking back.
Bryn was celebrating. It was November 30th, her last day on the clinical service until her next block in the summer. She had taken Cam and Roger out to lunch, and was just racking up a few more follow-ups--a couple extra bucks in my bonus wouldnt hurt--before leaving for the night.
Her beeper went off. Shit...well, they cant hurt me too much now, whatever it is. 8-6995: the EW. She called the extension and asked for Cam.
His voice was apologetic when he picked up the phone. "Im sorry, Bryn, but I wanted to catch you before you left for the night...this persons going to be discharged from the EW, and I didnt want you to have to come all the way back in from home to leave a staff note."
"Thats OK." She chewed her pen. "Anything interesting?"
"Well...sort of cute. Are you free to come down here? Im just about done."
"Sure...Ill be right there." She looked at the chart that she had just opened. Mr. Morda had been in the hospital for six weeks; the next attending would just have to manage without todays note from her. She grinned.
The EW was a zoo, with the residents and nurses looking especially harried. If thats possible. Bryn found Cam perched on a stool, talking with one of the medical residents. Well, shes pretty...do I know her? She smiled at herself. Guess I do feel like celebrating. Its been a pretty shitty month.
She sat down next to Cam. "Hey there." Nah, shes straight. "Whatcha got?"
Cam laughed. "Youll never believe this one. College guy felt sorry for a sick raccoon that was rooting around in his garbage in Somerville, so he decided to feed it...the animal chomped on his hand."
Bryn shuddered. "Idiot." She had seen a patient die from rabies in the hospital a few years before. It wasnt pretty.
"Yeah, can you believe it? Anyway, the animals gone...cant be found. The pit crew seems to have done everything right, as far as I can tell...washed it out, a lot...rabies immune globulin, vaccine, all in the right amounts and locations...hes got appointments for the rest of the series. Heres the details." He handed over his note.
Bryn read it over. "This looks good. You just need my blessing, right?" At Cams nod, she got up. "Where is he?"
"Actually, around the corner...Ill introduce you."
Bryn was following Cam into another section of the EW when she was distracted by a sudden commotion at the main doors. She saw a young guy, blood coating his shirt and trousers, and frank panic distorting his face, frantically pushing a wheelchair which held the slumped form of another, equally young man.
It was the second figure which caught Bryns total attention. Ive never seen a person that color before. The young mans face was completely, absolutely grey, in an unearthly shade, not belonging to anything that was human, or living.
Bryn and Cam pressed back against the wall as the triage nurses ran to intercept the crazed driver, some lifting the injured man onto a stretcher and wheeling him into one of the trauma rooms while others began questioning his friend. Bryn found herself drawn to the scene, standing away from the action, so as not to get in the way, but unable to leave the drama completely.
Her eyes traveled around the room, taking in the surgeons as the EW trauma team descended on the patient, removing his clothes and inserting large intravenous lines into his groin as he was rapidly intubated. Fluid was hung, and blood was called for. It wasnt clear that he had a pulse.
Unclear of the decision-making, Bryn saw one of the seniors call for a chest tube, then insert it through the chest wall within moments. Ah...hes been stabbed, they think his lung has collapsed. She watched as blood poured out of the tube. Oh, man.
Suddenly, as if from nowhere, Dana was in the room. The scene stilled, the organized chaos calming, the frantic activity turning into controlled routine. Bryn heard a few low orders, then saw a large kit being opened, tools being handed to the Chief, and Dana cutting through the mans sternum. She could just see a pool of blood where his heart should have been.
"Its a ventricular laceration," one of the interns muttered to another as they passed Bryn, carrying some units of blood into the room. All eyes were on Dana as she found the hole in the patients heart, stuck her finger into it, and reached for a loaded needle holder.
"Ive got the cardiac boys." One of the seniors was calling to Dana, holding a phone to his ear.
"Good...tell them to get bypass ready, theyll need to do a definitive repair upstairs." Her voice was calm, unhurried. With precise motions, she placed the sutures, then turned to one of the other doctors in the room. "Lets get some more volume."
Bryn looked at the monitor. The heart was beating, and there was a measurable blood pressure. Amazing. Two large, clean-cut men in scrubs walked into the room. Oooh...the big boys have arrived. The cardiac surgeons. They walked up to Dana, who briefly described what she had done.
The cardiac surgeons nodded, then turned and began barking orders. Bryns gaze returned to Dana. She was struck by the sense of total control that emanated from the surgeon. Dana looked one last time at the patient, then turned away, stripping off her bloody gloves and discarding them in a bin.
One of the interns was talking to a junior. "Whats this guys prognosis?"
Dana turned to him. "Hell do fine...the dirtballs always do."
"Huh?" the intern was unnerved by the Chiefs attention.
"Someone with a knife wound to his chest...probably isnt one of our more upstanding citizens." Dana motioned to the body. "Ill guess a gang fight...or a drug deal gone bad." She shrugged, and went over to the anesthesiologist, to review the procedure notes.
Bryn found herself fascinated...almost obsessed with watching the surgeon. Wow...whats going on in there? Id really like to know. She found herself staring, willing her gaze to unearth something that she felt she could almost touch, but which had been deeply hidden.
As Dana finished her note and turned to leave the room, her eyes met Bryns. Oh...
Blue joined green, and ignited...into understanding, and pain, passion and acceptance.
In that fraction of a second, Bryn felt a connection so profound that a breath later, when it was gone, she almost cried out from the pain of its passage.
"Wow," Cam whistled, his voice shattering the moment. He shook his head. "What an amazing save."
"Yes..." said Bryn, automatically. She was suddenly lightheaded, shaken to her core. Her mind was far away.
The next words were whispered to herself.
That was the most incredible thing I think Ill ever see.
Continued in Part 3
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