The Placebo Love Effect (Residents in Romance #2)

1. Miley

B eep, beep, beep, beep .

Fuck, one of the five pagers tenuously clipped to the waistband of my scrubs is going off, begging for my attention. I’m never going to get to the OR at this rate.

I’m on call covering all the other anesthesia residents and holding all their pagers. My scrub bottoms sag so much from the collected weight that I’m surprised they haven’t fallen off completely. I’m what they call a black cloud, someone who always attracts busy shifts with difficult situations. That’s why every time I’m on call, I end up spending more time doing things outside of the OR instead of where I should actually be, inside.

We still use old school pagers. Even drug dealers have entered the 21st century, but not the anesthesia residency at New York Hospital. I am in my third year of postgraduate training. I first did a preliminary intern year in internal medicine, and then started my anesthesia residency, which I’m half-way through as a second year. Since I did my intern year here as well, I’m familiar with the hospital, but anesthesia is so different I might as well be on another planet.

During my prelim year in internal medicine, I had never once stepped foot in an operating room, and then all of a sudden, I was supposed to be living in them. Before last year, I didn’t even know where the ORs were. I literally could not find them on my first day. Once I finally did, I walked in relieved, only to be yelled at that I wasn’t dressed properly.

Before going into the area that houses all the operating rooms, you have to put on scrubs, booties, a head covering, and a mask. I had just walked right in, bypassing the station that holds all the supplies, and missing every sign saying “proper attire beyond this point.” Oops.

Beep . The pager reminds me I have not yet addressed its demands.

I look at the offensive device again and silence it with a quick jab to the off button. I shudder, recalling how my nightmares echo the same tone. Sometimes I hear it even when it’s not going off, like phantom pager syndrome.

“Annabel Lee, E472857, consent for anesthesia”

At least our pagers provide succinct text and not just a call back number. We are slightly more technologically savvy than '90s drug dealers.

I sit down at the nursing station and open the equally offensive electronic medical record system our hospital uses. The people who design these things clearly do not actually take care of patients.

I type Annabel's medical record number into the search bar and see she is currently in the emergency room, room 21. Instead of heading to the OR, I guess I’m heading to the ER. Again . Annabel is on the OB service, which I find suspicious. I am not covering OB tonight, there’s another resident covering epidurals. Also, pregnant patients usually go straight to labor and delivery, not the emergency room. I wonder what’s going on with her.

A quick perusal of her chart tells me she needs general anesthesia and not an epidural. Shit. I hope I can keep it together for her.

I see an incoming text from my Chief resident.

MASON

I’ll cover your case in OR 2

And let Dr. Hernandez know you’re in the ER

You can come in on this case when you’re done, or stay with your new ER case

I sigh. Obviously, I’d rather be in the OR, I like my patients asleep—SAFELY asleep—but an important part of the process is talking them through it. I’m not always the most personable and sometimes people, including patients, can find me a little—okay fine, a lot abrasive, but I’m working on it.

“Miss Lee?” I ask as I enter the room.

“Yes sweetheart, that’s me,” comes her reply in a thick Southern accent.

I fight to keep from rolling my eyes at the nickname. I’m a professional, after all.

“I’m Dr. Chen and I’m here to talk to you about anesthesia for your surgery,” I say, hoping I can get through this conversation without a breakdown on my part.

“The OB doctor told me I need surgery. Is that really true? Y’all not making this up?” she asks tentatively, elongating all her vowels.

I force a tight-lipped smile, taking in her teased-up blonde hair. Like they say in Texas, the higher the hair, the closer to God, I guess.

I open my mouth to reply, and all I can manage is, “I’m afraid so, and I’m sorry.” There really aren’t any words that are sufficient for what she is going through.

“We had this trip to New York planned forever—I’ve been so looking forward to it!” She looks over at her husband in confirmation. He is sitting in a plastic chair on the side of the bed, holding her hand, stroking his thumb over her knuckles. “I’ve never seen a Broadway show before. I was in Times Square, gawking like a typical tourist. I was staring up at a big billboard, and suddenly my vision started swimming.”

“Do you remember what happened after that?” I prod, keeping my eyes on her monitor. I see that her blood pressure reads 110/60, which is good, her pulse is 80, and O2 sat is 99%. Her vitals are stable, which is the most important thing about this conversation right now.

“I thought I was havin’ a heat stroke or somethan’. I mean, it’s hot, hotter than I expected, but it’s nothing compared to Texas, so I remember thinking maybe I’m just so overwhelmed by the sensory overload of Times Square.” She chuckles lightly. “The next thing I remember, my husband is hovering over me. I had passed out!” she says, still in disbelief.

I listen tentatively, reminding myself to nod to show I hear her and understand.

“I tried to get up, but he wouldn’t let me.” She gives him a pointed look. “See, we just found out we’re pregnant! I thought he was just being super cautious. I kept saying that I’m totally fine, but he had already called 911!”

“Honey, you passed out… cold,” her husband remarks, but she waves him off.

“My friends have all been on babymoons when they were five and six months pregnant, so we thought this would be totally safe. I hadn’t even seen my OB yet for the first ultrasound. That’s scheduled for the week we get back from this trip. The OB doctor here told me the baby is not where it’s supposed to be?” she questions, hoping that will change the outcome. Her eyes are pleading with me, hoping I have different news for her. “Something called an ack-tope-ic?”

“That’s right,” I say cautiously. “You have what is called an ectopic pregnancy. The fertilized egg implants outside the uterus, in your case, it is in the fallopian tube.” It’s best to keep it clinical. I hear the telltale sound of her blood pressure cuff inflating again. It cycles every few minutes.

“Can it be moved to the uterus?” her husband asks. I turn my attention to him, his eyes on her as he squeezes her hand, like he’s the one holding on for dear life. It’s sweet seeing them like this. I wish I had better news for them. I take a deep breath.

“That’s really a question for the OBGYN team, but they do want to take you to the operating room for a procedure,” I hedge. I know it’s not the usual protocol to relocate a fetus, but it’s not my area of expertise and I want to stay in my lane. “I can ask them to come and speak with you about the details. I’m here to talk to you about anesthesia, which will be needed for any procedure they deem necessary for you,” I say, trying to redirect the conversation.

“I didn’t even know a pregnancy could be in the wrong place,” her husband interjects. He appears equally flummoxed as Annabel, whose nose scrunches.

She suddenly grabs her lower abdomen and yells out in pain.

“Annabel, are you ok?” I ask, hurrying to her side. I reach up to the monitor to manually cycle her blood pressure cuff. It inflates on her arm as her eyes drift closed.

“Annabel, stay with me,” I say sternly.

She nods once, and her eyes flutter open for just one second before closing again.

“What’s happening?” Her husband stands, bending over his wife in panic.

There is no read out from the monitor and her blood pressure cuff starts cycling again. Shit, that is never a good sign. That usually means it’s too low to pick up. Finally, a number pops up, 70/40. Fuck. We need to go to the OR now .

Attached to the side of her bed is the IV pole, her fluids dripping in leisurely. I grab the bag and squeeze as hard as I can. The more fluids I get in her, the less her blood pressure will tank. She cannot code here. I will not let it happen. The fetus may not be viable, but her life can be saved.

With my other hand, I take my phone out of my scrub pocket and call the OB resident.

She picks up after two rings.

A muffled “Hey Miley,” comes over the tinny speakers of my phone.

There’s no time for pleasantries.

“I need help getting Annabel Lee to the OR STAT, she perfed.”