9
Present, Columbus, Ohio
The next week, I train Ethan. We’re in the ultrasound department, where the rooms are so small that the bulky ultrasound machine and the patient in a rolling hospital bed barely fit. Whenever Ethan, the ultrasound technician, Jill, or I maneuver around the room, we call out our movements so we don’t bump into one another.
“On your right. Watch your toes,” says Jill, as she rolls her stool closer to the patient.
I have a plan for today. After giving it serious thought over the weekend, I’ve decided to take a different approach with Ethan. He defended me to Patrick so I might owe him, which is an uncomfortable thought. I make a mental promise to be extra kind to pay him back.
My “niceness plan” crashes into burning flames ten minutes later.
I’m teaching Ethan how to do an ultrasound-guided paracentesis, a procedure to treat ascites, a condition where abnormal fluid accumulates in a patient’s belly, making it swell up like a balloon. To treat this, we use a long needle to insert a flexible tube into the patient’s abdomen. The tube acts like a big straw and sucks out the extra fluid.
Ethan’s being an ass and resisting my instructions.
“I already know how to do this,” he grumbles, frustrated as I explain the procedure for the third time. “I was on a GI rotation for a month and did like a hundred of these.”
He sounds like a whiny three-year-old. I want to smack him on the butt and not in a sexy kind of way. “I’m sure you did these before, but not with the ultrasound machine. The GI doctors do them blind.” I count to ten slowly and continue. “In GI, they stick the tube in anywhere. Here in radiology, we use ultrasound to help us. It’s better because we can see inside the patient. We can locate the biggest pocket of fluid to target. That way there’s less chance of complications.”
“We never had complications in GI when we did it without ultrasound,” Ethan shoots back.
Thank goodness the patient is too out of it to hear us bicker. It can’t be very confidence-inspiring to watch your doctors argue. It’s already bad enough that Jill’s in the room with us. Her eyes bounce back and forth like we’re the best tennis match at Wimbledon. Gossip travels quicker than wildfire in the hospital, which means everyone will know that Ethan and I are proverbial oil and water.
“Well, you’re not in GI anymore. You’re in radiology, so act like a damn radiologist already!” I shove the ultrasound probe into his hand. I angrily grab that hand and place it on the patient’s distended belly.
Gray and black images pop up on the ultrasound computer screen. To the untrained eye, it looks like a swirling snowstorm of monochromatic pixels. To me, it looks like the inside of the patient’s body. I can clearly see his internal organs and the abnormal fluid.
The images shift as I guide his hand along the patient’s skin. I’m pressed up against Ethan, who sits in a chair while I stand behind him, staring at the screen over his shoulder. When I talk, my breath stirs the hair on the nape of his neck. Goosebumps break out along his skin, and he shivers.
Is the air conditioning too strong?
Ethan’s protests fade as he takes in the picture before him. He leans forward, staring at the screen with an expression of wonder.
“See those gray pulsing tubes? Those are the intestines. They’re moving because of peristalsis, which helps the food pass through,” I explain as I move his hand lower on the patient’s abdomen. “Now look down here. At these big black spaces. That’s the fluid. When the patient lies on their back, gravity pulls it down low.”
“Wow. That’s cool.” Ethan’s impressed, his eyes wide and jaw slack. “I’ve seen ultrasounds of the gallbladder and stuff like that before, but it was just static frozen images. Not in real-time like this. This is like the difference between looking at a photo versus watching a movie.”
I relax, letting the joy of my work sweep me away. “I know. It’s pretty neat, isn’t it? It’s like being Superman and having X-ray vision. We get to see right into the center of people.” Lots of days medicine is a grueling job, but moments like this make all the sacrifice worth it. Ethan twists in his seat to look at me. We exchange wide grins with each other, both high on the miracle of modern medicine.
I point at the screen. “Right there. That’s where we’ll get the best result.”
After we pick the spot, I instruct Ethan on how to cleanse and numb the patient’s skin. With my hands over his again, I help him guide the needle through the abdominal wall and into the fluid. We attach the tube to a suction bottle. Immediately, clear yellow liquid pours in. When that bottle is full, we replace it with another. We continue this process until the patient’s belly deflates like a punctured tire.
“Seven liters total removed,” I say, proudly holding up the last fluid-filled bottle.
Ethan stares at it in awe. “It’s crazy that someone can walk around with all that sloshing inside of them.”
I nod in agreement, pulling off my glasses, the ones I use when I need to see something close up. “Mr. Adams is going to feel better when he wakes up and realizes this is all gone. He’s going to breathe easier. That big belly pushes up on his chest, making it hard to take a deep breath.”
After bandaging the tiny wound from the tube, we exit the patient’s room. The incessant beeping of monitors surrounds us as we walk through the ICU.
“You were really great in there,” Ethan says, his eyes shining.
“Well, I’ve had lots of practice. Being a doctor is basically my whole life.” Usually, that thought makes me happy, but somehow speaking it out loud to Ethan makes it sound hollow. I realize with a start that if I lost this job I would have nothing. It’s become my whole identity, the thing I wake up for in the morning.
My phone dings in my pocket as we exit the double doors of the ICU. When I look at what’s on the screen, a shudder runs through me.
Ethan can’t see this.
I angle the phone away from him, hiding the text. It’s from that same person, the one I don’t know. I had thought about blocking the number after the last disturbing message but decided against it. I hoped it had been a fluke, that Las Vegas picture. Maybe it was a random one-off, a coincidence. Apparently, I was in denial. Today’s text is an image of a gambling chip, the kind you use to bet in a casino. The Statue of Liberty in its center and around its red edge, it reads $5 New York-New York Hotel and Casino, Las Vegas, NV.
My shock must be obvious because Ethan is asking, “Tiffany? Everything okay?” He places his hand lightly on my upper arm, the warmth of his touch burning through the sleeve of my lab coat.
“Oh, yes. Fine.” I quickly adjust my expression, slipping my calm, professional mask on. I’ve slowed my walk while I looked at my phone. Now I speed forward, moving so fast that Ethan has to stretch out his long legs to keep up. We enter the elevator on our way down to the Radiology Department.
My mind whirs, obsessing over the text. What does it mean? Who could have sent it and why? There’s a sinking sensation, a feeling of dread, as I consider the possibilities. I’m so lost in my thoughts that it takes a second to recognize Ethan’s talking to me.
“About earlier, with the ultrasound patient…” He clears his throat and stabs at the first-floor button. The elevator jolts, making my stomach drop, and begins its descent. “I should have listened to you. It’s just kind of hard,” he mumbles, staring down at his feet. “I spent almost two years in internal medicine. I had enough experience that I knew what I was doing, the diagnoses and how to treat them. Now I’m back to square one. I’m glad to finally be in radiology, but it’s frustrating to start all over again.” His eyes slide up to mine, then skitter away. “Anyway, sorry.”
His apology is the last thing I was expecting. I hadn’t given much consideration to how it must feel, being the “new kid” again. Hate to admit it, but I’m impressed by his honesty. “It’s okay. Nobody’s perfect,” I reassure him, wanting to ease his tension.
Somewhere in the shadowy hallways of my past, neon lights flicker, gunshots ring out, and glass shatters, reminding me exactly how not perfect I am. Ethan has no idea about the mistakes I’ve made.
No one does.