That afternoon, Ann found herself outside the office of the clerkship director Dr. Howard. She had been debating what to do all through lunch and she finally made the decision that she wanted to ask Dr. Howard if she might be able to switch to another team. She didn’t think she could tolerate a whole month of Dr. Dergan.
Ann felt awful about the fact that she had only been in the hospital two days and already she was asking to be relocated. She had never considered herself a quitter, but she hated Dr. Dergan. No, she hated working with Dr. Dergan. She wasn’t sure yet if she hated the man, although there was a lot of potential there.
Ann straightened out the wrinkles on her white coat before she knocked on the door to Dr. Howard’s office. She heard him call her to come in and she hesitantly opened the door. Dr. Howard’s wrinkled face lit up when he saw her. “Ann, right?” he said. “How was your first day?”
“Well…” Ann thought about how to phrase her complaint. Dr. Dergan and I have very different personalities…
“How is Dr. Dergan treating you?” Dr. Howard asked with a grin that had a twinge of mischief in it. “He’s great, isn’t he?”
That wasn’t the word she would have used to describe him. “He’s very…”
“I thought you’d like him because you were in the surgery club last year,” Dr. Howard went on. “He used to be a surgeon, you know.”
“I’ve heard…”
“I talked to one of the attendings in his old program and they said he was an amazing surgeon,” Dr. Howard said. “Best they ever saw. Real genius with the scalpel. Of course, after he got hurt, he couldn’t do it anymore.” He sighed. “Really a shame when something like that happens. But surgery’s loss is our gain. He’s a great attending. I’ll tell you, if I were sick and in the hospital, I’d want him to be my doctor.”
Ann tried to smile. “Well, he seems very smart, I guess…”
“Good teacher too,” Dr. Howard said, pushing his glasses up on his nose. “I paired you two up because I thought he’d be a good teacher for you, what with you wanting to be a surgeon and all. I bet he really liked it when you told him you wanted to be a surgeon.”
Ann looked down at her hands. She couldn’t ask Dr. Howard to switch her off the team after what he was saying. Besides, maybe Dr. Howard had some wisdom that she didn’t. Maybe she really would learn a lot from Dr. Dergan.
And as much as she hated to admit it, what Dr. Howard said about Dr. Dergan being a “real genius with a scalpel” had intrigued her. She admired anyone who knew their way around an OR.
“Was there anything specific you wanted to talk to me about, Ann?” Dr. Howard asked.
“I just wanted to thank you,” Ann said, “for pairing me up with Dr. Dergan.”
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Somehow Ann found the strength to go on another day, even though she woke up in the morning with dread in the pit of her stomach. Dr. Dergan had told her she’d be presenting her patient today, so Cody prepped her as best she could.
“There’s an order to it,” Cody explained. “First you say the patient’s age, then gender, then the most significant past medical history, then their presenting problem. It’s sort of like you’re presenting a mystery and you want to give people clues to the diagnosis you’re leading toward.”
It seemed to take forever to get to Ann’s patient. The team started on the third floor and since Dr. Dergan couldn’t take the stairs, the whole team would have to take the elevator with him to get to each floor. The elevator was packed with people and Ann got pushed up against Dr. Dergan’s wheelchair. She blushed slightly when she looked down and saw that her leg was touching his knee; she quickly moved and he didn’t seem to notice.
When they got out of the elevator on the sixth floor, the first patient they saw was Mr. Jameson, Ann’s patient. For a moment, Ann hoped Dr. Dergan had forgotten about her, but he immediately turned to her and said, “Go on, Ann.”
She cleared her throat and held up her notes with a shaking fist. She noticed Dr. Dergan grabbed the wheels of his chair and lifted his butt clear off his seat for a few seconds. She saw the muscles in his shoulders tighten as he performed this motion. He smiled wryly at her, “Don’t mind me, Ann. Just shifting my weight… you go ahead. I want you to present like this is a brand new patient.”
Ann tucked a loose strand of black hair behind her ear and looked down at the paper in front of her. “Mr. Jameson is a 67 year old man with a history of hypertension and gastroesophageal reflux disease who…”
Before Ann could finish her sentence, she felt the notes being tugged from her hand. “Ann, look at me when you’re talking, okay?” Dr. Dergan said. “If I wanted you to read what Cody wrote, I’d have her present the patient.”
Ann blushed and lowered her notes. “I’m sorry.”
“Don’t apologize. Just stop reading to me.”
Ann felt like she might cry again, but instead she took a breath and continued her presentation. It seemed to take forever and she noticed that nobody seemed to be paying much attention to her. She finished going through the history of present illness, past medical history, surgical history, then she was on to medications. “He’s on hydrochlorothiazide, metoprolol, protonix, simvastatin, and Zocor…” Ann heard some snickering and looked up from her notes, “What?”
“Simvastatin and Zocor are the same drug,” Dr. Dergan said. “Simvastatin is the generic. Okay Ann, what’s your physical exam like?”
“Um… well, his head was atraumatic norphocephalic, his extraocular muscles were intact…”
“Positives and pertinent negatives only, Ann,” Dr. Dergan sighed. “We don’t want to be here all night.”
“Right,” Ann said, taking a deep breath. She wanted to scream at him: It wouldn’t hurt to get some positive feedback! She supposed she didn’t deserve any positive feedback though.
She went through the physical exam without any further interruptions. She noticed the team was looking very bored and she wished she could be finished with this presentation. “His labs are: sodium of 142, potassium of…”
“Jesus Christ, Ann!” Dr. Dergan interrupted. “Please, for the love of god, don’t go through the entire chemistry panel. Just tell me the hematocrit and anything else that’s abnormal. Okay?”
Ann stumbled through the rest of the presentation and Dr. Dergan didn’t ask her any questions at the end of it. He just sighed and said, “Okay, that’s fine.”
“I’m sorry,” she said.
“I said it was fine,” he said.
As the team moved on, Cody patted her on the shoulder, “Good job, Ann.”
“Good job?” she hissed. “Dr. Dergan was falling asleep!”
“Well, for a first presentation, it was fine.”
There was that word again: fine. It frustrated Ann because she knew that if she wanted to become a surgeon, she had to be more than fine. She had to be brilliant, like Dr. Dergan was.
The last patient on the floor was Mr. Holtz, a demented nursing home patient with a left lower leg skin infection that was organizing into an abscess with the help of warm compresses. Dr. Dergan pulled on gloves and palpated Mr. Holtz’s leg. “This feels really fluctuant,” he commented. “I think it’s ready to be incised.” He looked up at Ann. “Have you ever done an incision and drainage before, Ann?”
“No…”
“Well, today will be your first then. Sheldon, can you get us a scalpel, lots of four by fours, some 1% lidocaine, and a syringe and 25 gauge needle to draw it up, and anything else I’m forgetting?”
Ann’s heart was pounding in her chest. She had never done anything like this before and she didn’t think she had done anything to earn the sort of trust Dr. Dergan seemed to be imparting on her. She was surprised that he didn’t seem to be the slightest bit concerned about this. Thank god Mr. Holtz was too sedated to know what was going on.
Sheldon drew up the lidocaine and handed the syringe to Ann. She held it in her hand, hesitating in front of Mr. Holtz’s leg. “Okay, now I want you to make a wheal with the lidocaine,” Dr. Dergan instructed her. He was leaning forward as much as his chair would allow.
Ann had poised her hand to inject the anesthetic when Dr. Dergan caught her wrist. “Whoa, Ann… I said make a wheal. Do you know what a wheal is?”
Ann shook her head.
Dr. Dergan sighed and gently took the syringe from her hand. “Okay, just watch me.”
Ann remembered what Cody had said about how Dr. Dergan couldn’t move his fingers, so she was wondering how he’d manage with a syringe. He steadied the syringe in his left palm, securing it between his palm and his thumb. He rested his right palm against the plunger, which also seemed to keep the syringe steady. In one swift motion, he pushed the needle through Mr. Holtz’s skin at an angle that was nearly parallel and the old man grunted slightly. He jammed his palm against the plunger and the lidocaine flowed into the leg, making a little bump of anesthetic. She was impressed by how quickly and easily he had done the injection, even without the use of his fingers—he really was very talented. “That’s a wheal, Ann,” Dr. Dergan said. “Of course, your technique of holding the needle will hopefully be a little different than mine, but I’ve got to work with what I’ve got.”
Dr. Dergan finished injecting the lidocaine, then he turned to Sheldon. “All right, give her the scalpel.”
Sheldon pulled the plastic off the tip and placed the scalpel in Ann’s hand. As she closed her fist around it, she felt a sudden rush of adrenaline go through her. Here she was, holding the scalpel, ready to make an incision. This was what she had always dreamed of.
Dr. Dergan must have seen the look on her face because he smiled. “You like that, huh?”
Ann nodded.
“Okay, so cut that abscess open, doctor.”
Ann bent over Mr. Holtz’s leg and gently palpated the mass of pus that was underneath his skin. She lifted the scalpel blade, preparing to cut. She saw that her hand was trembling badly.
“Control your hand, Ann,” Dr. Dergan instructed her. “Even I’m steadier than that.” When she continued to shake, he gently took her wrist between his palm and thumb to steady her. His unexpected touch made her entire arm tingle.
Ann glanced up at him one more time, took a deep breath, and buried the scalpel blade in Mr. Holtz’s skin. At first nothing happened and Dr. Dergan instructed her to go deeper. Finally, a gush of yellow material flowed out of the incision. She heard a round of applause sound off in the room. When she lifted her head, she saw Dr. Dergan was grinning at her.
“Excellent work, Ann,” he said.
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Joel asked Ann if she could stop by his office sometime that afternoon. He didn’t know what he was going to say to her exactly, but he couldn’t get the look on her face when she first held that scalpel out of his head. Her excitement transmitted to everyone in the room. When she first told him about her career plans, he certainly had his doubts, but now he could see in her eyes that she was a born surgeon.
And Joel wanted to help her.
God knew, that girl needed help. Aside from making that perfect incision in Mr. Holtz’s leg, she hadn’t done a damn thing right all morning. Her presentation was all over the place and her knowledge base was lacking, but there was something there that could be salvaged. He was sure of it.
Are you sure you’re not just doing this because she’s cute?
Joel felt a little uneasy at the thought. The problem with being a young attending was that the residents and med students were very close to his age. A few of them were even older than he was. Considering how many women were entering medicine these days, it was impossible not to encounter some attractive ones in the course of working. Yet it seemed very unethical to have those kinds of thoughts about a med student he was training.
And god, wouldn’t she be disgusted if she knew that her wheelchair-bound attending thought she was attractive. He felt embarrassed at even the thought of her finding out. He was aware of the fact that his pants didn’t hide the atrophy in his legs and that his gut bulged from under his shirt. He noticed the way she jumped away from him when she realized her leg was touching his in the elevator. Not that this was any different from the way everyone else responded to him.
Ann arrived at his office around three, clutching her notebook to her chest. Her white coat was already cluttered with pens and notes, and there was a yellow stain on her left sleeve. He couldn’t help but notice that the fingernails on both her hands were nibbled down to nubs. Her black hair hung loose around her anxious face, somewhat messy yet inexplicably sexy. “Hi, Dr. Dergan,” she said.
You can call me Joel, he wanted to say. But it seemed unprofessional since nobody else on the team called him by his first name. “Hi, Ann. Have a seat.”
She nearly tripped over herself while trying to sit down. As soon as she was seated, she started tapping her left foot. Joel recalled that he used to sometimes tap his feet when he was nervous, although he couldn’t anymore.
Joel decided to cut to the chase: “Ann, I’d like to help you to become a surgeon.”
Her eyes widened. “Really?”
For some reason, Joel thought back to the weeks after he was first injured. He remembered lying there as Kyra sat on his bed and picked up his paralyzed hand. Joel, she had said, there are still things you can do with your life. You can still work as a doctor. She had always come in with those pep talks, but all he was thinking about was that he hoped she wasn’t sitting on his catheter tube.
“Really,” Joel said. “I think you’ve got a lot of potential and I’d like to help you.”
“I don’t know what to say,” Ann breathed. “Um… what did you have in mind?”
“Ann, I’m sure someone told you that I used to be a surgery resident,” he began. She nodded. “If there’s one thing I know, it’s how to match in a surgery residency.” He hesitated. He didn’t want to lay it on too thick and make her feel obligated to accept his help. “Look, I can’t be your advisor because you need to have an advisor who’s a surgeon. But if there’s any guidance I can give you, I’d like to try to help you out.”
I wonder if she thinks I’m pathetic. Some poor crippled schmuck who wanted to be a surgeon but couldn’t.
“Wow,” Ann said. Her slightly round face was flushed. “Thank you so much. I really didn’t expect… well, thank you, that’s all.”
Joel smiled. “My pleasure.” I hope this isn’t a mistake.