Chapter 10
“In summary, after the devastation of Burkholderia cepacia on the cystic fibrosis community, modulator therapies like Trikafta have been a game changer. For ninety percent of cystic fibrosis sufferers who respond well to Trikafta, their lifestyle has been revolutionized in lifestyle, fertility, and survival. Patients who respond well no longer face lung transplants, endless hospital stays, and, ideally, can expect a normal lifespan. Thank you for attending. Any questions?” Clarissa finished her eight a.m. presentation to the assembled group of seventy plus pediatric residents in their eighth floor conference room.
Judging by the sleepy faces of the residents, she could have performed a magic trick and set the room on fire before any of them asked a single question.
She understood wholeheartedly, since she was counting the seconds before she could bolt from the hospital—which would be immediately after morning lecture ended.
With her not being on an inpatient hospital service, she was much better off than everyone else.
She didn’t have to stay until lunchtime.
Hours guidelines said you could only do a twenty-four-hour continuous call, other than the vague additional four hours they tacked on as ‘additional patient care responsibilities.’
Unlike most of the residents staring into that bleak future, her post-call night included naughty time with a buff anesthesia chief.
“No one?” Clarissa moved to shut down her PowerPoint.
“About the cepacia, can you tell me about the origin of the antibiotic resistance?” one of the infectious disease doctors, Dr. Burkness, asked.
He would. ID doctors lived for details like those, and he loved confirming the resident had done actual research about their topic beyond Google. It also prolonged everyone’s suffering by dragging out lectures if the resident was unprepared.
“Yes, Edinburgh-Toronto ET12 clone was isolated and explored in the 1990s through the works of the Edinburgh-Toronto CF center and doctors Govan, Hughes, and Vandamme,” Clarissa answered, having found the original 1996 paper.
It showed how little the rest of the group was paying attention since no one responded to the last name.
“What would you do if you had a CF non responder who grew it in a sputum sample?” he pressed on.
“Other than review the patient’s last two years of antibiotic use and place them in contact isolation? I’d immediately page Infectious Disease,” Clarissa answered truthfully. B. cepacia ET12 was resistant to every antibiotic on the planet.
“Anything else?”
A total jerk move. He was in his sixties, so he’d have personal experience with treating those patients. The CF protocols had changed before she’d graduated medical school.
“Yes, I’d make the nurses watch Five Feet Apart on repeat in their break room but remind them it’s actually ‘six feet apart’ and make sure they know it ‘Ends with Them.’ Otherwise, I’d invite Justin Baldoni and Blake Lively to visit them.
” Clarissa’s comment finally elicited laughter from the front row of younger residents for a reason that went above Dr. Burkness’s head.
Simone had picked that one last year for roommate movie night. Five Feet Apart was the first move directed by Justin Baldoni. The science in the movie wasn’t accurate, nor was the drama, and Justin Baldoni had few issues than It Ends with Us.
ID did at least give her a nod.
“Any more? No? Have a great day, everyone.” Clarissa grinned, as there was a near stampede out the door and back to the hospital.
Sighing, she was going to do the same, having gotten very little sleep. After the twenty minute video call with Valkyrie StormFlyght, she’d received numerous pages all night long from the same night nurse who constantly wanted updated orders on Benadryl and Tylenol.
Before she could make her exit, she realized the three chief residents, Diamond, Addison, and Olivia, hadn’t left. They’d lingered behind by the breakfast table. Only anesthesia had pediatrics beat in motivating their residents to come to educational sessions with food.
“Great presentation,” Olivia said with the sort of enthusiasm one mustered for a pap smear.
“Uh, thanks.” Clarissa wasn’t sure why they were taking a sudden interest in her today.
“Lots of detail.” Addison echoed, which would have meant more had she not been checking her emails on her phone the entire talk. “Can’t wait to see what else you put together.”
Was this their passive-aggressive way of referring to her second required presentation?
“My next one is about airway scoring for pre-op assessment.” Clarissa waited to see if they reacted to her statement since she wasn’t sure if they did or didn’t know about Roan.
Apparently not, based on their total lack of reaction. Perhaps since only the department chiefs signed off on her relationship paperwork, Dr. Gallo’d opted to be discreet and not inform the chiefs.
What had Tristan said on occasion about the military? “That’s need to know information and you don’t need to know.”
“Great.” Diamond didn't pretend to care and plowed onto the subject they must have been here to discuss. “Do you have any questions about your call schedule?”
“My call schedule?” Clarissa stammered at their pivot. “I'm not on service, so I'm going home.”
“Not today.” Diamond pointed toward the computer. “The schedule for the rest of the year.”
“Oh, that. Right.” Clicking around through the residency website, Clarissa found the monthly call schedule. Gallo had assigned her a brutal schedule for the rest of the year since she’d been moved to lighter rotations for a few months after her attack. “Found it.”
“You didn't check it before today?” Addison said.
“I was added late.” Clarissa didn't want to mention that she'd prefer not to know the torture waiting for her.
April was NICU, May was the PICU, and June was Hospitalist team.
Each one was an every fourth night call, and she'd have to stay the full thirty hours.
Gallo had told her these were mandatory rotations, even though it was more than the required to graduate most pediatric programs. “Seems okay. .. wait. This can't be right.”
She twisted her head around to take in the projection onto the screen where her PowerPoint had been. It was possible she was reading it upside down and backward. “I'm leaving the NICU post-call and coming back the next day on call for the PICU?”
More clicking to June. “When I switch to hospitalist team, I take call the third night, not the fourth?”
The sheer audacity of this blatant residency hours rules violation was stunning. They had basically added an entire week of call onto her schedule.
“It's not a rules violation,” Olivia said before Clarissa could protest.
“How is it not?”
“Those are different months—April, May, and June. The hours rules apply to per individual month. The condensed call nights only occur at the change of the month. Totally legit,” Addison explained in a practiced tone.
“This happens when trying to synchronize so many residents, vacations, babies, illnesses.”
“Also, people had to make up for you when you were sick,” Olivia added on with a less than sincere smile. “You got two extra call-free months on your December and January electives. Dr. Gallo also didn’t make you do another full heme-onc month.”
I.e.,—Count yourself lucky to have such a supportive residency program. We indulged you enough for getting roofied by a baby-kidnapping drug dealer over Thanksgiving. Time to pull your weight by sacrificing more.
“I see.” Clarissa, a much better fake-smiler than the chiefs, gave her best pretend grin. “Guess I'd better go home and bank up on sleep.”
Diamond nodded with approval. “We just needed you to be aware of this, and how it is not a rule violation. So, you shouldn't try to report it. Because you'd be wrong, and that accusation would be unfounded.”
Those witches didn't bother to wait for her response before beating it out the door, bombshell dropped.
Clarissa flipped around the schedule, the flaws larger than life, hating the three of them with the fire of a thousand suns. The fact they had the nerve to approach her meant they understood perfectly well they were morally wrong yet had no qualms about going about their business.
Morally wrong but technically correct. Cedarville College would have had a stroke over this ethical dilemma, being that it was stacked against a resident to report their own program for work hours violations.
Even an 'unfounded accusation,' could suspend the residency program, hurting the resident and the rest of their colleagues far more than the residency program.
Whistleblower protections did nothing if a resident didn't have a program to graduate from.
She was boxed in with no real options. Reporting the program wasn’t a choice. Her chiefs weren’t on her side, and she couldn’t complain to Gallo, as he’d assigned the rotations.
Her fist thumped on the lectern, and she counted backward from ten, same as they did in anesthesia right before they put the patient under with propofol.
There was nothing she could do.
Her roommates would be angry on her behalf, except they were in the exact same position she was. If anything, they'd suggest she tell Roan, since they perceived him as a hospital mover and shaker.
Another winning option. Part of Roan's hesitation to date her was the problems of mixing business with pleasure.
He'd told her when it came to her, logic failed and his responses were disproportional.
Her chief boyfriend storming her department would improve nothing for her and make her look less than capable if she depended on him to fight her battles.
Worse, it would remind him once again that she wasn't close to his equal. She bet his residency hadn't been fun, nor had his fellowship, but she was pretty sure he hadn’t complained when the schedule wasn’t fair to him.
Her phone beeped with an incoming text message.
It was Tristan, again.
From what she could tell, he was still in Oregon and still trying to get info about Willow.
His ongoing campaign was to send her five or six text messages a day at random hours, hoping to catch her off guard.
Tristan: Whatcha doing?
Tristan: Is it dinner time? Hanging out with your roommates?
Tristan: How’s my sister today? Roan stopped by lately?
Tristan: Are you taller or shorter than your roommates?
Tristan: Which of your roommates is most likely to shoplift?
Another unfair event out of her control—obnoxious brothers.
She closed the text messages rather than send him a scathing response. It would only encourage him.
Like her witchy chiefs, staying silent and carrying on was her best choice.
Because there was nothing else.