Chapter 13
THIRTEEN
LUKE
I rarely look forward to Tuesdays because I don’t get to operate, but I’ve been anticipating this one. It’s the date of Claire Thompson’s follow-up appointment, and since her dad lives in Toronto, it’ll probably be Melissa who brings her.
But before I can go to the clinic and see Melissa, I have to make it through a Surgical Bed Capacity Committee meeting.
As the newest member of the General Surgery Division, I got suckered into being the physician representative.
As far as I can tell, the committee consists of a bunch of middle managers who sit around a conference table and lament the fact that the hospital has a bed shortage.
The managers claim they want a surgeon’s input, but I’m convinced that what they really want is a surgeon to tell them they’re brilliant.
Brilliant, and doing such a good job that there’s no way they could do better.
I inherited this role from Ethan, whose advice was to keep my mouth shut and bring snacks.
But since I forgot to stop at a bakery this morning, I had to grab an overpriced bag of mini brownies from the cafeteria.
I set the brownies on the table and take a seat.
As usual, I’m the only man at the table.
Everyone else is a woman between the ages of thirty and fifty-five, dressed in the standard hospital management uniform of a button-down shirt and black or khaki pants.
The majority are wearing the oversized plastic-framed glasses that are currently in style.
I wonder what would happen if I brought pot brownies.
I’m the only person who isn’t staring at a laptop, so I search the pocket of my jacket and find a folded piece of paper. It’s a receipt from the last time I went to the dentist, but the back is blank, so I unfold it carefully and take out a ballpoint pen. I’m ready to take notes.
I should have bought coffee as well as brownies because I’m fighting to keep my eyes open.
The woman sitting next to me pushes the bag of brownies towards me and I take one, hoping the sugar will help me stay awake.
It’s stale and bland, as expected, and I regret having taken it.
I try not to eat crap unless it tastes good, but nothing wears down willpower like a Bed Capacity Meeting.
We hear that the surgical ward is at 111% capacity, but I’m not really sure what they expect me to do about this. All the surgeons can do is discharge patients more quickly, but if we do, they’ll likely come back with complications.
Everyone else is typing industriously, so I write the date on the back of my dentist’s receipt, then add a title: Bed Capacity Committee. My mind drifts to an image of Melissa sprawled out on a bed, with her hair fanned out on the pillow behind her.
“Dr. Carlton?” It’s Tara, one of the managers. She’s about my age, and she clearly takes her job very seriously.
“Yes, Tara?”
“Do you have any insights into the question?”
I don’t even know what the question is. I’m tempted to suggest that bunk beds would help the bed shortage issue, but I’m not sure the idea would go over well.
“Well, it’s clearly a complex situation, with a lot of moving parts,” I say seriously. “The solution will likely require collaboration with multiple stakeholders. We could consider starting with a needs assessment.”
Heads nod around the table, and I breathe a small sigh of relief.
“Thank you, Dr. Carlton,” Tara says with a big smile. “Having a surgeon’s perspective is really valuable in this situation.”
No doubt.
The meeting finally ends, and I hustle across the hospital to the clinic. The clinic started an hour ago, and Nick’s been in charge while I was at the meeting.
I find Nick in the office, finishing up a chart.
“Any issues?” I ask him.
He shrugs. “The patient in room five refused to see a resident. She’s waiting for you.”
“Okay,” I reply with an inward groan. Patients who refuse to see residents are usually difficult, so this is unlikely to be a fun encounter.
My gaze drops to a cookie tin on the counter, beside Nick’s elbow. The tin is powder blue with white polka dots, and there’s a blue card taped to the lid with my name on it.
I open the envelope and pull out the card, which bears the following message:
Dear Dr. Carlton,
Thank you for taking such good care of me.
Yours truly,
Claire Thompson
“They’re peanut butter pretzel,” Nick informs me, gesturing to the cookies. “Kind of a weird combination, but they’re good.”
“What room is she in?” I ask him abruptly.
Nick’s brow furrows. “Who?”
“Claire Thompson,” I say impatiently. “The girl who brought the cookies.”
“Oh, she’s gone already,” he says casually. “She’s doing really well, so I discharged her from the clinic.”
“What?”
Nick looks taken aback by my tone. “I didn’t know you wanted to see her,” he says defensively. “I examined her myself, she was fine.”
“Okay.” I force myself to smile at Nick. It’s not his fault; as a senior resident, he has the authority to send patients home if he thinks I don’t need to see them. He had no way of knowing I’ve been waiting all week to see Melissa.
To soothe my disappointment, I take a cookie from the tin and take a bite. There’s nothing weird about the combination of peanut butter and pretzel. It’s inspired.
“Okay,” Nick says warily. “Uh, room five? They’ve been waiting for a while.”
“Right.” In my opinion, patients who refuse to see residents deserve to wait. On the other hand, the longer they wait, the more miserable the encounter is likely to be. I scarf down the cookie and pull up the chart on the computer.
As it turns out, Mrs. Meecham in room five is a sweetheart, a shy seventy-two-year-old who was diagnosed with colon cancer last week. It’s her daughter who’s the problem.
“Can you guarantee there won’t be any complications?” her daughter asks, after I spend ten minutes explaining the surgery and the potential complications. Clearly I was wasting my breath.
I bite back the urge to retort that any doctor who guarantees there won’t be complications from a procedure is either a liar, an idiot, or both. It’s just not how medicine works. “I’m afraid every surgery has some risk of complications,” I say instead.
The daughter frowns and uses her middle finger to push her glasses higher on her nose. I’m not sure if she’s trying to make a point or if she’s just oblivious. “Well, we’ll need some time to think about it,” she says.
“Of course. You can call my secretary when you’ve reached a decision,” I say pleasantly. “The doctor who did the colonoscopy was concerned the bowel could obstruct, so if you want to go ahead with surgery, it would be good to do it as soon as possible.”
The daughter’s frown deepens. “I’ve joined a Facebook group for cancer patients, and a lot of people have been getting good results from naturopathic treatments. We’re considering going that route instead. What do you think?”
Her expression dares me to argue. She’s hoping I’ll make a disparaging comment about naturopathy so she can write me off as an asshole.
And it’s extremely tempting. You’re absolutely right, ma’am. The cancer could be cured by an infusion of herbs, but I’m recommending a risky surgery because I need to make money. How about it?
But I bite my tongue.
“Natural remedies aren’t my area of expertise,” I say instead. I turn my head to address Mrs. Meecham instead of her daughter. “In my opinion, surgery is your best chance for a cure, but it’s your decision.”
“Thank you, doctor,” Mrs. Meecham says with a quiet nod.
“And you’d like some time to think about it?”
“Yes, doctor.”
I get the sense Mrs. Meecham wants the surgery, which is really her best chance of survival.
I consider asking the daughter to leave the room so I can speak to Mrs. Meecham directly, but I suspect it would make things worse.
The daughter would get angry and dig in her heels, and Mrs. Meecham would get upset.
And at the end of the day, Mrs. Meecham will probably do what her daughter wants.
“All right. Give my secretary a call if you have more questions or if you’d like to book the operation. It was a pleasure to meet you,” I say as I leave the room.
The clinic is running behind, which means patients are already grumpy when I enter the room.
Nick gets pissy with one of the nurses when she forgets to take someone’s vital signs, so I send him off for a lunch break to defuse the situation.
I keep slogging through patients myself, and by mid-afternoon, I decide I’ve earned another peanut butter pretzel cookie.
But when I look for the tin, it’s disappeared.
“What happened to the cookies?” I ask Nick, who’s back at a computer reading a chart.
“I took them to the nurses’ break room.”
And again, I have to fight the urge to snap at Nick. He hasn’t done anything wrong; patients often bring food to the clinic, and we always share it with the nursing staff. It helps boost morale, and if I ate all the junk myself I’d be diabetic by the end of the year.
But these were Melissa’s cookies, and I’d planned to take them home with me. There’s no chance of that now; the break room is shared by nurses from three different clinics, so the cookies will be long gone.
The rest of the day is no better. A patient leaves in a huff when I tell him I can’t book his gallbladder surgery for six months, since it’s not urgent and we’re short operating room time.
The situation is beyond my control; I love to operate, and I’d take his gallbladder out today if admin gave me the OR time.
But the patient doesn’t blame admin, he blames me.
After the last patient leaves and the staff go home, I spend an hour finishing my charting, then another half hour reviewing the charts of the patients Nick saw. Claire’s chart is near the top of the list.
Nick didn’t write much, just that she’s eating and drinking normally, her bowels are moving, and her abdominal exam was unremarkable.
In fairness, I might not have written much more, but I’m still disappointed that the chart doesn’t answer my questions.
Is she having any pain? Has she heard about an appointment with the allergist?
And how is her mother doing? Nick’s notes don’t even mention Melissa, even though she must have come with Claire this morning.
And since I’m supervising Nick, I convince myself it’s my responsibility to make sure nothing was missed.
I pick up the phone to call Melissa, but before I hit the button to dial, I realize I won’t be able to properly assess Claire over the phone.
My eyes wander to the home address in the top left corner of Claire’s chart.
Eighty-nine Poplar Drive. I recognize the street name; it’s not far from my condo.
But Melissa has my phone number, and she could have called me if Claire had any problems. Paying her a house call would be crossing the line. A clear boundary violation.
I drive home and change out of my work clothes. I consider hitting the gym downstairs, but I’m sick of the treadmill. It’s a glorious fall evening, and the leaves have just started to change color. I’ll take a walk around the block to clear my head.
Except I don’t walk around the block. Instead, I walk in the direction of Poplar Drive.
It’s in one of Somerset’s older neighborhoods, where the houses are a mix of century homes and new builds.
A family neighborhood, with kids playing in front yards and minivans in the driveways. A comfortable neighborhood.
God. When did I become a sap?
I turn onto Poplar Drive and stop in front of number eighty-nine. It’s a small two-story redbrick with a big maple in the front yard.
And before I can talk myself out of it, I walk up to the front door and ring the bell.