TITLE: Unbearable Brightness (ch.3)
AUTHOR: Naomi Pardue
GENRE: SL
RATING: PG
TIMELINE: Mid-S11 (my own version thereof)
DISCLAIMERS: They own it, I don't.
(Quick note here: When I'd started writing this, TPTB hadn't yet seen
fit to give Dubenko a first name. I created one for him. After the
show decided on "Lucien, *I* decided to not change the name I'd
selected. Deal with it.)
----------------------------
What do you have for me, Jerry?" Susan asked, approaching the desk.
"Not much, Dr. Lewis. An ear ache, 3 cases of the flu, menstrual
cramps."
"Let me guess. Weaver told you to go easy on me."
Jerry gave an embarrassed smile. "Not in so many words ... but
yeah."
"Well, you can take off the kid gloves. I'm really ok. I can handle
real medical cases. Real sick people even."
"If we had any I'd give them to you. But therejust isn't much
this morning. Night shift cleared out all the urgent cases. You're
left with the dregs."
Susan sighed and took the first chart in the rack. The dregs indeed.
Cough, fever, body aches. The flu.
She pushed open the door to exam 2. "Good morning, Mrs. Franklin.
I'm Dr. Lewis. I'm understand you're not feeling well today."
xxxxxxxxxxxxxxxxxxxxxxxxxx
"Rest, drink plenty of clear fluids, and take Tylenol for pain and
fever, Mr. Woo. Come back if you aren't feeling better in a week or
if the cough gets significantly worse."
Susan made her way back to the desk. "If I could discover a cure for
the flu I'd be a rich woman, Jerry. Six patients in the past two
hours ... five of them healthy adults with influenza."
Jerry smiled and handed her a chart. "Yosh just sent this one back
from triage. A real sick person. Fever and abdominal pain. I think Yosh
is thinking appy."
"Thanks, Jerry." Susan took the chart and glanced over it. Appies
weren't especially exciting, but at least they were something she -
or the hospital anyway - could actually treat. Telling patients to go
home and take Tylenol was not why she'd gone into medicine.
Heading into the exam room she found a 13 year old girl lying on the
bed, while her anxious looking mother paced the room.
"Hello Angela. I'm Dr. Lewis. I hear you have a belly ache."
"Yeah."
Lydia looked up from taking Angela's vitals. "Temp 101, pulse 120,
resps 15, bp 100 over 70."
"When did the pain start, Angela?"
"This morning. The first day of Christmas vacation." Angela pouted
a little.
"It always seems to work out that way, doesn't it?" said Susan
with a smile.
"Can you give her something for the pain?" asked the mom.
"Not just yet. I need to examine her first, and we'll probably want
to have a surgeon check her over as well."
"If you can just give her something to make her feel better we can
leave."
"What's the hurry?"
"We have tickets to Aspen. We're supposed to leave for the airport
in 2 hours!"
"You may want to call the airline and change those tickets." Susan
returned her attention to her patient, sitting her up to listen to her
heart and breathing. "Any nausea or vomiting?"
"Yeah. I threw up right after breakfast," Angela said.
"Your periods been ok?"
"Uh huh."
Susan motioned for Angela to lie down again, then pressed gently on her
stomach, searching for tender spots. "Tell me if I hurt you," she
started to say, but a cry of pain from Angela made the instructions
redundant. "Ok, Angela, you just take it easy for a few minutes.
Lydia, lets get a CBC and call upstairs for a surgical consult."
"I need an operation?" Angela whispered.
"I don't know. We'll have to see what the surgeon says." Susan
made a few notes on the chart. "I'll be back in a few minutes.
Lydia, page me when surgery shows."
"I hope it's soon," grumbled the mother, looking at her watch.
Ten minutes later Susan was sitting at the desk charting when the
elevator doors opened and Dr. Dubenko stepped out. "You paged me, Dr.
Lewis?"
"Yeah, exam 1. Thirteen year old girl with a probable hot appy."
As they started towards the exam room together Dubenko said, "I was
surprised to get a page from you. I didn't expect you back at work so
soon."
Susan sighed. She'd been asked that question a dozen times today.
Though, beyond that, no-one had had much of anything to say to her.
"Maybe I need to pin a sign to my coat. 'I'm fine. Really.'
Because I am. I'd much rather be back at work than moping around at
home. Oh, I'll return your handkerchief to you later in the week. I
need to wash it first."
"I'm glad you found it useful, but you can keep it. I have a whole
box full at home."
What a strange man, Susan couldn't help thinking. Did anyone actually
use cloth handkerchiefs in the 21st century? God had invented tissues
for a reason.
He pushed open the door to the exam room. "Do we have labs yet?"
"No, but it's a classic presentation; fever, nausea, lower right
quadrant pain with rebound tenderness.
Dubenko smiled at Angela. "Hi, I'm Dr. Dubenko. Let's check out
that belly of yours."
"Are you a surgeon?"
Dubenko lowered his voice to a conspiratorial whisper. "Don't tell
anyone, but actually I'm the janitor. They just let me operate when
the real surgeons are on vacation."
Angela giggled - a giggle that turned into another yelp of pain as he
pressed on her stomach. "Do you have to keep doing that? It hurts!"
"Sorry. It's the fastest and easiest way to tell if your appendix
is inflamed. But the good news is that I only have to do it once."
"So ... is it?"
"Very much so. Which is the bad news."
"So I need an operation? I'll be spending Christmas in the
hospital?"
"I think we'll have you home before Christmas."
Angela's mother piped up again. "I don't suppose it could
wait?"
"An hour or two, certainly," Dubenko said. "I'd like to wait
for her labs to come back before I operate. If the blood test is
uncertain, we may want to do a CT to confirm it."
"I was thinking more like a week. If you could just give her
something for the pain and nausea, we could come back next week."
Dubenko sighed. "Appendicitis is an emergency, Mrs. Grey. If we
don't operate within afew hours, the appendix will rupture, and your
daughter will be very, very sick. If we operate today, she'll be
feeling a lot better in a couple of days, and, as I told her, will
probably be home for Christmas."
"There goes our vacation," Mrs. Grey grumbled.
"She'll only be in the hospital for a few days," Dubenko started
to explain again, but Susan interrupted.
"They have tickets to Aspen this afternoon."
"Well, I suggest you reschedule. I hear late January is a good time
to go." He made some notes on the chart and handed it to Mrs. Grey.
"I'll need you to sign this consent form, Mrs. Grey. Dr. Lewis,
I'll go hold an OR. Call me when her labs come back. Do we have an
ETA?"
"The lab's not busy," Lydia said. "They said it would be about
half an hour ... and that was 15 minutes ago."
"Good." Mrs. Grey had signed the consent with an angry scrawl, and
he took the chart back.
"Will you be operating on me?" asked Angela.
"Absolutely. Only the best for you."
Angela smiled a little through her pain and Susan and Dubenko went back
out into the hall. Before the door had closed behind them Mrs. Grey's
angry voice erupted.
"You picked a hell of a time to get sick! Those tickets aren't
refundable. We saved all year for this trip!"
Susan shook her head. "Charming woman."
"You want to go back in and talk some sense into her?"
"No, Lydia will handle it. She's good at putting idiots in their
places." She smiled. "You were really good with that little
girl."
"Better than her mother, anyway."
"The Wicked Witch of the West would be better than her mother. Thanks
for coming down."
"My pleasure ... not to mention my job."
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Angela was sent up to the OR, and the morning continued to crawl by as
Susan struggled to stay busy with the slow trickle of boring cases.
Several times Kerry encouraged her to go home. "It's really slow
Susan. We can manage with just one attending for the rest of the day.
There's no need for you to push yourself."
"You can go, Kerry. I'm sure you've been working a lot of shifts
lately. Take the afternoon off yourself. Go do your Christmas
shopping."
"Naw. As soon as I leave we'll probably get a six car pile-up."
Kerry picked up another chart and headed down the hall.
Susan had just dispo'd her ninth flu patient of the day when the
ambulance bay doors flew open. "Can I get a hand here!"
"Got it!" Susan yelled, and ran to the moving gurney. The paramedic
rattled off the bullet.
"Meet Ralph Ison, age 43. Probable MI. Sudden onset of chest pain
while shoveling the driveway. BP 180 over 120, tachy at 130, resps 20,
no LOC. Pain initially 9 out of 10, down to 7 out of 10 after two nitro
sprays."
"Ok," Susan said. "Trauma 2. Lets get a 12 lead, CBC, coag and
cardiac enzymes, portable chest. Mr. Ison, do you have any history of
heart trouble?"
"No. I'm real healthy. I work out three days a week."
"High blood pressure?"
"No. But it hurts like hell, doc!"
"We'll get you something for it as soon as we can."
"And please ... call my wife. She's at work. Sandberg Junior High
up in Rogers Park."
"I thought school was out for vacation."
"Not for the teachers. She teaches music."
The door opened as they were transferring Mr. Ison from the gurney.
Kerry again. "Susan, why I don't I take this one. There's a
sprained ankle in curtain 3."
"I've got this one, Kerry." She looked Kerry steadily in the eyes
for a long moment, and Kerry finally turned and disappeared down the
hall.
"What was all that about?" asked Ralph.
"I've been off for a couple of weeks. But don't worry, Mr. Ison,
I haven't forgotten everything I know."
"Vacation? Must be nice."
"It was." The EKG machine began spitting out its strip, and Susan
picked it up to look at it, to avoid looking at Haleh's surprised
face. What the hell was she *supposed* to have said? 'No, not a
vacation. I just spent a month watching the love of my life die a slow
and horrible death.'
The pattern on the strip was unmistakable. He was having an MI. "Ok,
let's get Mr. Ison an asprin."
"Aspirin? I think this pain needs more than an aspirin."
Susan had to laugh. "The aspirin is for your heart, Mr. Ison. For the
pain we'll titrate 5 of morphine."
"So, it's a heart attack?"
"I'm afraid so, but you're in luck, because County has one of the
best cardiac units in the city. Haleh, please call the cath lab, tell
them we'll be sending up a client shortly. And somebody please call
Mr. Ison's wife."
"The number's in my ..." Mr. Ison's voice suddenly fell silent,
just as the steady beeping from the monitor was drowned out by the
angry buzzing of an alarm.
"V-fib!" said Haleh, already opening the crash cart and getting the
paddles ready. She handed them to Susan.
"Charge to 200," said Susan. "Clear." Nothing. "300! Come on
Ralph, you are NOT going to die!"
"Should I get Dr. Weaver?" asked Haleh.
"No!" No way was she going to work with Kerry today. "But find a
resident. We need more hands in here." Conni ran out, returning a
moment later with Ray. "Ray, tube him. Conni, start another line. And
somebody call his wife!"
...........................................................
"Ok ... another amp of epi ... Damn it Ralph, do your part here ...
you have a wife who needs you! 360 again."
She heard the door open but didn't look up. Kerry's voice. "Need
a hand here?"
"No, I've got it under control. Again, 360."
"How long has he been down?" asked Kerry quietly.
"Only about 5 minutes."
"It's been almost 35 minutes, Dr. Weaver," said Haleh. Startled,
Susan looked up at the clock. Had it really been that long?
"Ok, Susan. You're done."
Susan shook her head. "360, Haleh. And more dopamine. Kerry, we got
him back once ... there's still a chance. If we can just keep him
going long enough to get him to the cath lab ...."
"Look at the monitor, Susan. He's in asystole. He's not coming
back." Kerry's voice was gentle but firm.
Susan looked at the monitor, just for a second, then back at her
patient. She wouldn't look at Kerry. "Dopamine! And don't bag so
fast, Ray."
"Call it, Susan."
"He's my patient. I'll decide when we're done!" Susan looked
at Kerry and regretted it. She could read Kerry's thoughts much too
clearly in her eyes, on her face. **Poor Susan. She can't face up to
her loss. She can't accept that Luka's gone, that he's not coming
back. So she's going to flog this poor man for an hour, unable to
accept that she can't bring him back either. Poor Susan. Poor, poor
Susan.**
She quickly looked away again. Kerry was wrong. This wasn't the first
time she had tried extra hard for a patient. They had all done it,
trying long past the time when there could be a miracle. She had done
it often enough. So had Kerry. And so had Luka. And, once or twice,
there had been a miracle. There could be one today.
"One more time, Haleh. 360." Another shock, and she looked at the
monitor again. Asystole. No doubt about it. Very slowly she set the
paddles down on the cart. "Ok, that's it. Time of death ... 1325.
Is his wife here yet?"
"Not last I checked," said Conni. "Roads are pretty bad."
"Find me when she gets here."
"I can tell her, Susan," Kerry said.
"He's my patient," Susan snapped again. I can do it. I'll be in
the lounge." And for the second time that day she pushed past Kerry
and out into the hall.
In the lounge she poured herself some coffee and sat on the couch. Was
Kerry right? Had she lost her perspective? Was she really not ready to
come back? Not ready to deal with critically ill patients? No, she WAS
fine. She had done all that for her patient, and for his wife, not for
herself. She felt no pain, no grief. She felt nothing at all. Which was
just as it should be, just as it had to be.As long as she could go on
feeling nothing, as long as she could keep a smiling mask on for the
benefit of the patients, she'd do fine. She could do her job; get
through the days, one at a time. Getting through the nights would be
another matter.
xxxxxxxxxxxxxxxxxxxxxxx
It had been an incredibly long day, but Susan WASN'T glad it was over.
The end of the work day meant going home to her empty apartment again.
Eating her supper alone. Lying in her bed alone, trying to sleep,
counting the minutes until morning.
She was on her way back to the lounge for her coat when she almost
bumped into Dubenko coming around the corner.
"You're through for the day?" he asked her.
"Yeah. I just need to get my coat and I'm out of here. How'd
surgery go on the appy girl?"
"Like clock-work. In and out in about 20 minutes. I just checked on
her. She's sleeping, her mom's on the phone with the travel
agent."
Susan smiled and was about to say, 'Well, I'll see you tomorrow,'
but Dubenko continued. "I guess you had a pretty rough day."
"It's always hard getting back into the swing after being off for a
few weeks. I'm ok."
"I heard about your MI. I'm sorry. It must have been hard."
"It's always hard losing a patient."
"You look tired."
"I just worked for 12 hours." Susan looked towards the lounge. How
long was he going to keep her here talking?
"Are you sleeping ok?"
"Eight hours every night." Susan looked pointedly at her watch, but
he still didn't take the hint.
"Is that eight hours sleeping, or eight hours lying in bed? I know
that it can be hard to adjust to sleeping alone ...."
Susan shook her head, baffled. "Dr. Dubenko, if you are
propositioning me, it's in amazingly bad taste."
"No ... I didn't mean that," Dubenko said quickly. " And
please, call me Chris. May I call you Susan? Good. There was a
fascinating article in the "Journal of Clinical Psychiatry" a few
months ago. July, I think. It was about grieving and adjustment in
young widows. The authors found that sleep issues were common, a large
percentage of subjects in the study reported difficulties in adjusting
to sleeping alone. If you'd like to see a copy of the article ..."
"I don't think so," Susan said briskly. "And I'm not a widow,
so it doesn't apply to me anyway. I'm sleeping just fine. I need to
get going, Chris. I'll see you tomorrow." Before he could say
anything more, she turned and hurried into the lounge.
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