19. David
19
DAVID
The minute I finished the lecture on the new mnemonic device we'd be using at times to diagnose patients, we got a hot case. A young boy presented with hallucinations and lacerations to his hands after breaking a mirror at home. I pored over the tablet, as did each of the interns. The case was strange. The boy was being treated for cancer, and while taking his pills, he hallucinated that the school bully was there mocking him. He punched the mirror and tried to strangle the bully, but it was his own reflection.
"Here," Dr. Cooper said, pointing at the tablet in front of her on the table. "He has terminal cancer, Dr. Park. Why are we doing this? It's just the cancer. Probably spread to his brain now."
Dr. Cooper's callous treatment of our patient's future was frustrating. "Because we treat all patients with the same amount of care and attention to detail." I looked at Lauren, who seemed upset or distracted. I knew she'd lost both of her parents and at times, certain cases came into the hospital that triggered some pain for her, but she'd never said anything.
"It's got to be a tumor in his brain. What else would cause psychological symptoms like that?" Dr. Cooper continued down her path of thinking, but I was watching Lauren.
"He's on fourteen different chemotherapy drugs." Dr. Holt shook his head. "It's just a side effect. Some hallucinations aren't entirely unheard of."
"No, keep thinking." I was distracted, something I promised myself and Lauren I wouldn't be when it came to patients, but something was bothering her.
"Then it's neurosyphilis." Dr. Baine nodded his head as if triumphant, and I had to resist rolling my eyes.
"He's nine years old, Dr. Baine. Nine-year-olds don't have sex." Dr. Holt corrected him for me, and I added my thoughts.
"We've ruled out infection too, so let's stick to what we know. His O2 stats are dropping slowly. It's almost impossible for one person to develop two different types of cancer simultaneously?—"
"Not to mention the chemo would have killed it," Dr. Cooper said, interrupting me.
"He has bleeding in his eyes. I think what we're looking for is a brain bleed or a clot. We need a contrast MRI." Dr. Holt offered his assessment, and I almost agreed instantly, but Lauren bolted to her feet and out the door so fast it made my head spin. She never even said where she was going.
"Where'd she go?" Dr. Cooper asked, scowling.
"Focus on the patient," I ordered, though my mind went with Lauren too. I turned to them and again scanned the patient's file on the tablet. "I agree with Dr. Holt. I think we're looking for a blood clot in the brain."
"But Dr. Park, chemo doesn't usually cause blood clots. That would be the only reason. A completely secondary condition occurring concurrent to the cancer seems unlikely." Dr. Cooper stood and hugged her tablet to her chest.
"But blood clots are a side effect in some people. He's on fourteen different kinds of chemo, Ginny." Dr. Baine used such informality, it broke me out of my trance, and I watched a suspicious expression pass between them. But Dr. Holt stepped in, and I let myself ignore the overly personal interaction.
"Deep vein thrombosis is the most common, but CVT explains the symptoms. We need that MRI quickly. If he has a clot and we don't catch it now, he'll stroke." Dr. Holt's concern looked like him restraining himself from running out of the room.
"I agree. Go…. Get the MRI, start him on heparin right away. Let me know the instant we have anything." I nodded at the door, but Dr. Holt was already gone.
I stood there watching them file out wondering where Lauren dashed off to. It wasn't like her to leave without saying something, let alone running away. I didn't hear her phone ring or even vibrate, for that matter, so I had no clue what it could be.
When she finally came back about ten minutes later, her eyes were puffy and her nose red, though it looked like she had attempted to hide that. She pushed the door open and walked in and straight to her place at the table.
"Sorry, what are we doing? Where are the others?" She picked up her tablet and acted ready to jump into the action, but I sat at the head of the table and patted the glass top.
"Sit," I told her, and she listened to me, but her true emotions were masked behind a professional fa?ade. "Are you okay?" I asked, leaning forward so she didn't have to speak too loudly.
"I'm fine."
"What happened?" I asked, and I noticed she had her cellphone in her hand. I wondered if something had happened with her brother, if her phone was on silent and I didn't notice her looking down at it or something.
"Nothing happened. I don't really want to talk about it."
Lauren was good, hiding whatever it was that made her cry. The professional demeanor she took on was impressive, but I felt a bit hurt by it. We were alone, and yes, we had promised to keep things professional on the clock, but it was just the two of us. I doubted anyone would be suspicious of a relationship going on between us if she told me why she was crying. I suddenly regretted my choice to not tell the board. I felt an overwhelming urge to know what hurt her and help her not feel sad anymore.
"You know you can talk to me about anything, right?" I reached for her hand, but she shied away.
"Dr. Park, we discussed this. We have to remain professional at all times during work." Her shoulders squared and she set her jaw. "Now please tell me what I need to do to help our patient. I believe it's a blood clot in his brain somewhere that we missed. Dr. Holt was right."
My own words came back to bite me. I had been the one to insist that we keep things professional throughout this one-year internship and not tell the board until after the year was up. Lauren nearly begged me to go public and love her openly. Her professional smile drove daggers into my heart, and I wondered if I had ruined things with her by putting her off, if she felt like I was just leading her on.
I wanted to ask her what was going on, but I figured she would just stonewall me about that question too. Especially since she stood and acted ready to walk out.
"I believe you're right." I figured the only way to keep things calm here would be to make sure I followed my own advice. If she wanted professional, then I had to be professional, though I'd save the lecture she deserved for walking out during a differential diagnosis for later. "I sent the team to get the patient started on blood thinners and do a contrast MRI. It appears the previous one was inconclusive. I believe you have some experience with this. Make sure we get the best radiologist to read it."
"Anything else?" Lauren was already on her way out the door before I even stood.
"Go on," I told her, and took my own tablet in hand. I felt frustrated with myself and a little frustrated with her too.
We had been so close over the weekend. Having no one around to keep us from being comfortable in our own skin, we had bonded. It wasn't just the sex, either, though that was incredible. I loved the way she leaned into me, held my hand… The way she rested her head on my shoulder when she was tired, and the way she snorted when I told jokes over dinner. Even now, it had me smiling.
I walked to my desk and sat down in thought. If she pulled away, it would destroy me. Just thinking of how she might have been hurting had made it impossible for me to focus. I knew dating a subordinate was so risky to begin with, but now we'd crossed into some dangerous territory. Now my heart was on the line. If Lauren wanted to go public, maybe I'd have to suck it up and do it. She was the one who stood to be scrutinized, not me.
I never wanted to feel like this again. She needed me, and by my own decision, I couldn’t be there for her.
I hoped that she'd talk to me tonight when it was just us.