He Cheated With My Supervising Physician (He Cheated With... #7)

Chapter One

MRS. GUTIERREZ WANTS to talk about her knees again.

“It’s grinding,” she says, rotating her ankle in a slow circle on the exam table. “When I go down the stairs in the morning, it grinds.”

“Crepitus,” I say. “We talked about this in October. The cartilage is thinning, but nothing’s changed structurally.”

“It sounds different now.”

“Different how?”

She considers this. “Angrier.”

I like Linda. I like that she describes her knee in emotional terms and brings me homemade tamales at Christmas even though I’ve told her she doesn’t need to.

I adjust her naproxen dosing and order a follow-up X-ray because the X-ray costs me thirty seconds and keeps Linda from feeling dismissed, and that trade is worth making every time.

What I’m not good at, today, is being in two places at once.

Sharon’s Friday schedule is blocked again.

Administrative, the calendar says, one to five, no patients and no documentation trail.

Sharon Fossi is a board-certified internist with a patient panel of four hundred and a tendency to overschedule herself Monday through Thursday, so when Friday afternoon disappears, those patients don’t vanish. They roll downhill. They roll to me.

I’ve been a nurse practitioner for eighteen years, twelve of them here at Ridgeline Internal Medicine. I carry my own panel of six hundred patients who need me to be running on time. When Sharon takes a Friday, I absorb her overflow on top of mine, and the afternoon turns into triage by exhaustion.

“You’re getting an X-ray and we’ll compare it to October,” I tell Linda. “If there’s structural change, I’ll refer you to ortho. If there’s not, we’ll talk about PT.”

“My daughter says I should do yoga.”

“Your daughter’s not wrong.”

She laughs, and I help her off the table and walk her to the front desk, where Marta is already queuing the next patient and giving me the look that means I’m backed up and she has no power to fix it.

“Room three is ready,” Marta says. “Mrs. Bautista. And Dr. Fossi’s two o’clock is here too. Fasting lipids.”

“Sharon’s two o’clock.”

“She’s not here.”

“I know she’s not here.”

Marta lifts one shoulder. We’ve had this conversation before.

She doesn’t editorialize about the physicians, because she’s been running the front desk for seven years and knows where the lines are, and I don’t push the point because complaining about Sharon to support staff is unprofessional even when it’s warranted.

I see Mrs. Bautista. Annual wellness, medication reconciliation, a blood pressure that’s running ten points high, which means we need to talk about the lisinopril dosage and whether she’s actually taking it or just keeping the bottle visible when her daughter visits.

She tells me she takes it every morning, but the pill count in her refill history says she filled a ninety-day supply a hundred and twelve days ago, and I do the math without doing it out loud because embarrassing a seventy-year-old woman about her compliance doesn’t make her compliant. It makes her stop coming.

“Let’s try a different approach,” I say. “A lower dose, twice a day, with breakfast and dinner. Easier to build into a routine.”

“My dinner is at five-thirty.”

“Five-thirty works.”

She agrees, and I adjust the prescription, and every medication I prescribe flows through the prescriptive authority agreement that Sharon Fossi signs.

Sharon’s name on the document that allows me to practice.

Sharon’s name on the renewals, the controlled substances, and the prior authorizations.

The state of Texas requires that agreement, and Sharon is the physician on record, so without her signature I don’t prescribe, I don’t adjust, and Mrs. Bautista’s blood pressure stays ten points high.

After Mrs. Bautista, I see Sharon’s two o’clock. Dale, retired postal worker, whose fasting lipids are finally where I want them after three years of adjustments I made and Sharon signed off on. He walks in, sees me, and visibly relaxes.

“Oh good, it’s you,” he says. “The other one never remembers I’m allergic to statins.”

The other one is Sharon. His physician of record. The name on his chart. Dale has been coming here for five years and he doesn’t remember her name, because Sharon sees him once a year for thirty seconds and I see him every quarter and know his labs by heart.

By three-fifteen I’m charting at my desk with a cold half-cup of coffee and a yogurt I opened at noon and forgot about. My phone buzzes.

Grey: Won’t make dinner. Client thing ran long. Sorry. Leftovers?

I type Okay and set the phone down. This is the shape of a Tuesday text from my husband, except it’s Friday, and the distinction doesn’t register as much as it probably should.

Grey sells surgical navigation systems for Meridian Medical Technologies.

He works long hours. I work long hours. We exist in the same house with the comfortable distance of two people who’ve been married for twenty-two years and raised the harder parts already.

Caleb is a sophomore at UT Austin. Molly is a senior at Johnson High, buried in the chaos of college applications, and she’ll eat whatever I put in front of her while scrolling her phone.

At four-ten, Marta drops a fax on my desk. “Cruz Occupational Health called about this twice. They sent a referral three weeks ago and nobody responded.”

I pick up the fax. It’s a records request from a Dr. Dawson Cruz for a workers’-comp patient named Herrera who needs a primary care clearance before returning to full duty.

The referral was addressed to Sharon because the patient was on her panel, but the patient saw me for his intake because Sharon was out.

On a Friday. The records request sat in Sharon’s inbox because Marta routed it to the attending of record, which is Sharon, because the prescriptive authority agreement runs through her, and the paperwork follows the physician, not the person who actually saw the patient.

I pull up the chart, attach the records, and fax them back with a note apologizing for the delay. Three weeks on a workers’-comp clearance can cost someone a paycheck, and that’s not a delay I’m comfortable attaching my name to even when it’s not my fault.

Then I look at the calendar.

I don’t look at the calendar because I suspect anything. I look because the Cruz referral sat for three weeks, and I want to know if this is a one-time lapse or a pattern. I pull Sharon’s schedule for the last six months and scroll backward through the Fridays.

January. Administrative, one to five. The Friday before that, the same block.

The Friday before Christmas she actually worked, but the two Fridays before that are both blocked.

November is the same. October has three out of four Fridays blocked administrative.

September, the earliest month in the window, has two.

Five months of recurring Friday afternoon blocks. No patient encounters. No documentation. No committee notes, no CME credits logged. Just four-hour gaps where a physician with a full panel disappears and her patients become mine.

Molly is eating cereal when I get home. She’s sitting on the counter with her feet on a chair, her phone propped against the toaster, watching something with the sound off.

“There’s chicken in the fridge,” I say.

“I had chicken yesterday.”

“You had chicken strips from Raising Cane’s yesterday. That’s not the same chicken.”

She gives me the look that says she’s aware of the distinction and does not care, and I let it go because she’s seventeen and some battles cost more than they’re worth.

I heat up the chicken for myself and eat standing at the counter while Molly tells me about a calculus test she thinks she failed but probably didn’t, and then I go upstairs while Grey’s side of the closet stays exactly as he left it this morning.

Shoes lined up. Ties on the rack. The life of a man who’s careful about the things that represent him.

Five months of Friday blocks that produce nothing. Patients rerouted. Referrals that sit. The clinic running at eighty percent on Friday afternoons while Sharon goes somewhere she doesn’t document and doesn’t explain.

I don’t have an answer yet, but I have the question written down, and in eighteen years of clinical work, the question has usually mattered more than the answer.