Wednesday, August 17, 2011

The Best Revenge (Chapter 2)

I hadn’t had my morning coffee yet, so when my pager starting beeping at 8AM on Monday morning, it set off a hammer pounding on my temples.  I’m useless till I get my coffee, especially on Mondays.  I fumbled for the little black box clipped to my belt until it thankfully stopped beeping.

The page had come from my resident Chloe, who was ready to round on the ward with me.  I dropped by my office, where I slipped on my long white coat and hung my stethoscope around my neck.  A lot of attending physicians opted to go without the white coat, but I couldn’t get away with that look.  Whenever I walked around without my white coat, I was invariably mistaken for a nurse, even with an ID badge clipped to my chest that said “Rachel Miller, MD” in big bold letters.  I don’t know what it was about me that screamed out “nurse.”  I think maybe I look too matronly.

I grabbed some coffee in the lounge and met Chloe on the stroke ward a few minutes later.  Chloe was a second year resident training in neurology who had been on my service for one week.  For the first few days I’d worked with her, I looked over her shoulder a lot to make sure she wasn’t making any mistakes.  But as far as I could tell, her orders were always impeccable.  When I would suggest we order an echocardiogram on a patient, Chloe would already have the form filled out and in the chart.

However, whenever I see Chloe, the first thing my eyes are always drawn to is her engagement ring, which is the size of a chicklet.  That giant diamond overwhelms everything she does or wears.  I don’t know how she could walk around with that thing without getting her throat slit.  It’s the city, for Christ’s sake.

Even aside from the giant rock, Chloe was always a picture of style.  Today she was dressed in shades of black, ranging from her gray fitted sweater to her black pumps.  If I knew something about labels, I could have remarked on her slacks or shoes, but all I knew was that they looked very expensive.  She didn’t earn much as a resident, so I’m guessing the gentleman who paid for the huge rock was footing the bills for her wardrobe.  She wasn’t beautiful, but she was blonde and attractive and I could see that men liked her.

“Hi, Dr. Miller,” Chloe said brightly.  That was the other thing about Chloe: she was always happy.  She never got stressed out when things were busy on the ward or when we were racing down to the ER to figure out of the latest stroke admission needed his blood thinned.  Even though I appreciated her positive attitude, just once I wished I could see her lose her cool.  Get angry that she had to miss a date with her fiancé because of sudden chest pain in one of her patients.  I felt like a terrible person for even thinking such a thing though.  Chloe was nice.  I didn’t begrudge her any happiness just because I wasn’t happy.

“How was your weekend, Chloe?” I said and was immediately sorry I asked.  Most people would just say “fine” but I recalled last Monday when I asked her that, I got a full rundown of all the events of the last two days.

“I was on call Saturday night,” Chloe said.  “So it was pretty busy.  But Steve cooked me dinner on Sunday night, so that was really nice.”

I’ll bet, I thought, only mildly concerned that now even my thoughts were starting to sound bitter to me.

“He made pasta primavera,” Chloe continued, “and he chopped fresh vegetables all by himself.  Isn’t that sweet?  Except he sliced his finger open when he was chopping a carrot, and he was joking around that I’d have to suture it up for him or something.  I mean, as if I have suturing materials around the house, you know?  Anyway, the bleeding completely stopped on its own and the pasta still came out great, although a little soggy because he left it—”

“That’s nice,” I interrupted her.  There was some study that found that if a patient was allowed to keep talking uninterrupted, the longest they would go would be a minute and a half.  But Chloe wasn’t a patient and she showed no signs of running out of steam.  “How many weekend admissions?”

“Two,” Chloe replied, transitioning easily into Work mode from How I Spent My Weekend mode.  “Peter Morgan and…” She checked her notes.  “Alexander Connors.”

Alexander Connors.  Alexander Connors?  Holy shit.  Holy shit.  I nearly choked when Chloe handed me a copy of the ward census and saw it written there in black and white: Alexander Connors.  Bed 11.  Last room on the right.

Gripping the census sheet in my fist, crinkling the page slightly, I continued to stare at the name that had haunted me for 22 years.  I needed to get a grip.  In all likelihood, this Alexander Connors was not the one who had made my life miserable so many years ago.  In fact, he almost definitely was a different person.  Most of the patients on the stroke service were older.  It was unusual to get someone under age fifty.  The Alex Connors I knew would be only 33 now, like me, which meant that he was an unlikely candidate to have had a stroke.  I suspected I’d be seeing a sixty year old man who happened to have the same name, but still, the whole thing put a damper on my day and threw me off.

“Are you okay, Dr. Miller?” Chloe squinted at me.

“Of course I’m okay,” I said, forcing a smile.  “Let’s round.”

The stroke service had a maximum of twelve beds, but not all the patients with a stroke diagnosis came to us.  The general medicine service could manage a basic stroke patient by themselves, but we got the patients who were complicated in some way.  We got the patients with blood pressure that was difficult to control or with some crazy coagulation disorder.  Or a bleed.

We started at the beginning of the hallway with the patients I knew already.  Chloe had already seen all the patients herself, so she was prepared to tell me all the issues that had cropped up.  Mr. Anderson’s diabetes was out of control, for instance, which wasn’t surprising considering a nurse told me he had wheeled himself to the cafeteria yesterday to purchase a donut.  With sprinkles, of course.  Sorry, but just because the donut has a purple filling, that doesn’t mean it counts as a diabetic fruit exchange.

Once we finished up with the old patients, Chloe moved on to the new admissions, one of which was the unfortunately named Alexander Connors.  We hesitated outside Mr. Connors’s closed door and Chloe pulled out her notes.  “Ready?” she asked me.

I nodded, thinking that for lunch I would treat myself to a nice chocolate brownie.  I deserved one.

“So this is Alexander Connors,” Chloe began, “he’s a 33 year old man with no past medical history who—”

“What?” I interrupted her.

The patient was 33 years old?  Had I heard right?  That was the same age I was.  The same age Alex would be if...

Oh god.  Oh no.  Please no.

Chloe frowned at me.  “What’s wrong?”

“You said he’s 33 years old?” I said.

Chloe nodded and shrugged.  “Yeah, pretty young.  Although we’ve had younger.  Remember that 28 year old woman we discharged last week?  Oh, and during my internship, I saw this one guy who was only 17 and he had a giant…”

I wasn’t listening to Chloe.  The door to the patient’s room was slightly ajar and I nudged it open further with the tip of my worn shoes.  I could just barely make out the face of my new patient.

Damn.  It was him.  It was The Alex Connors.  The same Alex Connors who made my life miserable 22 years ago.  The same Alex Connors whose voice I still heard telling me I looked ugly every time I searched in my closet to find something to wear on a date.  It was the same guy, right here in my stroke unit.

Shit.  Shit, shit, shit.

Alex looked a lot different.  Obviously.  He wasn’t an eleven year old kid anymore, which was evident by the stubble across his chin and the chest hair peaking out from under his standard-issue hospital gown.  His face was both completely different, yet eerily similar.  His jaw was more square, more masculine, but he still had the sprinkling of freckles across the bridge of his nose and the reddish brown hair, now more brown than red, that almost curled at the tips.  He was still recognizable as the guy who ruined my life all those years ago.  I gasped slightly, but quickly composed myself.

“Is anything wrong, Dr. Miller?” Chloe asked me.

I shook my head and forced a smile.  “No.  Please continue.”

“Mr. Connors had stroke of his anterior spinal artery,” she said.  “On Friday afternoon, he was biking up a really steep hill with his friends and he started to feel back pain and weakness in his legs.  He got off the bike and collapsed.  They took him to the emergency room here, where they diagnosed the stroke.  His blood pressure has been in the normal range and we’re not sure what caused the stroke.  Right now, his deficits consist mainly of weakness in both legs.”

“Right,” I said.  My mouth felt dry and I longed for my bitter coffee.  “So why did he have the stroke?  Have they done coagulation studies?  Checked for diabetes?  Lupus?  HIV?”

“We drew everything,” Chloe confirmed.  “All the results are still pending.  Nothing so far has indicated a cause of the stroke.”

“Oh,” I said.

We stood there for a minute.  Chloe finally spoke up: “Dr. Miller?  Do you want to go inside?”

Not really, but it was clear I didn’t have a choice in the matter.  I stepped back to let Chloe go in ahead of me.  Alex Connors jerked his head up when we entered and managed a crooked smile.  “Hi,” he said.

Now that I could see him in full view, I could tell how pale he was and there were dark circles under his familiar gray eyes.  He looked like he had been to hell and back.  But what killed me above everything else was that even looking as haggard as he did, he was still awfully cute.  If I was just meeting him for the first time today, I knew my heart would have gone out to him.  I always felt for the young people who ended up on my stroke unit.  But when I looked into his familiar face, I could still hear the words echoing in my ears: Rachel is so ugly.  Even 22 years later, it still stung just as much as it did when I was a kid.  

“Hi, Mr. Connors,” Chloe said.  “I’m Dr. Wexler.  Do you remember me from this morning?”

“Of course I remember… I only met you an hour ago,” Alex said, shaking his head.  “My brain isn’t screwed up too, is it?”

Chloe laughed sympathetically.   “No, of course it’s not.  Anyway, I’d like to introduce you to my attending, Dr. Miller.”

Alex laid his eyes on me.  At that moment, I knew with a hundred percent certainty that he had absolutely no idea who I was.  And why should he?  As much as he had an impact on my life, I’m sure I had absolutely no impact on his.  And I had pretty much the most common name in the world.  Rachel Millers were a dime a dozen.

“Hello, Dr. Miller,” he said.  He gestured in the direction of the chair next to his hospital bed.  “This is my fiancée Eva.”

Somehow in all the excitement, I had failed to notice the woman sitting at his bedside.  Eva.  Alex’s fiancée.  I couldn’t help but stare at her.  She was somewhat attractive but not supermodel beautiful or anything.  In fact, she looked like she could have stood to lose a few pounds.

“Everyone says such good things about you, Dr. Miller,” Eva spoke up, managing a tense smile.  “We just know you’re going to get Alex all better.”

I looked back at Alex, lying in that hospital bed.  Would you like another chair for your giant ass?  My face burned, remembering everything Alex had said to me over twenty years ago like it was yesterday.  My hands involuntarily balled into fists.  I could see that Alex was staring at me, waiting for me to say something.  There was a small part of me that was sorely tempted to point out that his girlfriend might need another chair for her giant ass, but instead I cleared my throat and put on my most professional face.  “I don’t get people better,” I said in a cold voice that was starkly different from the usual gentle tone that my patients loved.  “There’s nothing we can do here to make you better.  That’s up to fate.”

I didn’t look at Chloe, who I was sure was gaping at me.

“Well, the whole family has been praying for Alex,” Eva said.

I snorted, then quickly tried to convert my snort into a cough.  I needed to be professional here.

It occurred to me at that moment that I was going to have to examine Alex.  I didn’t want to touch him, but I performed a physical exam on every single patient and I couldn’t make an exception for him, just because I hated him.  “Is it all right if I examine you?” I asked, hoping he might somehow refuse.

“Go for it,” Alex said.

I approached the bed and stopped when I was about a foot away.  Alex was looking up at me and I was certain he had to recognize me, but I saw no sign of that in his face.  Up close, I could see his hair was greasy from not having showered in several days.  As I tugged down his hospital gown to listen to his chest, I noted that he looked like he was in decent shape, although not that good.  He clearly wasn’t somebody who spent every day at the gym, but he had sort of a natural firm muscle tone in his chest.

I started off by resting my stethoscope over the left side of his rib cage.  I tried to avoid touching him directly as I did that, but it was almost impossible not to allow my fingers to graze the dark hairs on his chest.  I closed my eyes for a moment and listened to his heart thumping reassuringly.  No sign of any arrhythmias.  I moved the diaphragm of the stethoscope over his lungs and instructed him to take deep breaths.  He complied.  His lungs sounded excellent.  I could always tell the smokers from the nonsmokers by listening to their lungs, even the young ones.  It seemed like Alex Connors had led a relatively healthy lifestyle.  He wasn’t an athlete, but he hadn’t done anything to earn him a stroke at age 33.

Next I performed a full neurological exam.  First I scrutinized his face, asking him to lift his eyebrows and show me his teeth to make sure his face was symmetric.  I examined his arms next and I could see from the way his biceps popped out that his strength was intact there.

I saved his legs for last.  “Can you move them at all?” I asked him.

Alex shook his head.  “Not really.”

“Not really or not at all?”

He lowered his eyes.  “Not at all.”

I put my hand on his quadriceps to see if there was even a slight muscle twitch, but there was nothing.  Eva was looking on with her brows knitted together.

Sensation was somewhat diminished in his legs but still intact.  The anterior spinal artery innervated the motor tracts of the spinal cord, so most of his deficits were motor.  He could still feel me touching his legs and could tell whether his feet were in the up or down position.  Still, the deficits in strength were so severe and complete that it didn’t bode well for his recovery.

Of course no examination of a spinal cord injury was complete without a rectal exam.  I really, really didn’t want to do a rectal exam on Alex Connors.  Not that I ever wanted to do a rectal exam, but this was the least I ever wanted to do it in my life, and that included the 80 year old obese nursing home patients.

“Dr. Wexler,” I said.  “Did you do a rectal exam?”

“Yes,” she said and I breathed a sigh of relief.

“What did you find?” I asked.

“Sensation intact,” she said.  “But no voluntarily tone.”

I looked at Alex, whose cheeks had turned slightly pink.  “Can you tell when you have to have a bowel movement?”

He was full on blushing now.  “I can tell,” he said, glancing at his fiancee.  “But I can’t… you know, control it.”  He added quickly, “That’s going to get better, right?”

“Maybe, maybe not,” I replied.  “If not, there are several brands of adult protective undergarments.”

Alex raised his eyebrows.  “Adult protective…?”
“Diapers,” I clarified.

Alex’s face turned several shades paler.  Eva, on her part, looked even more shocked and horrified than he did.  I followed the tube snaking out from under Alex’s covers, which belonged to a catheter in his bladder.  I guessed he wasn’t going to have much better luck trying to pee, but I could save that fun for another time.

I would never admit to anyone that after over twenty years, it felt really good to finally see Alex Connors squirm.

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