Disgust coated Brian’s face. “Can’t I just hunker down, take care of patients every day, and go home at the end of the day?”
“No. You have to be aware of your surroundings. It might mean collecting data to see what works for your patients, and then sharing that with others, which is called research. Or, imagine inventing some kind of instrument to find out the amount of oxygen in a fetus’s blood. We would do a fraction of the cesarean sections for fetal distress because we could tell which fetus needed intervention and which did not.”
“It’s exhausting.”
“That’s what I meant when we talked about a deeper issue. It sounds like you are out of energy.”
“Sometimes I think that.”
“Is that new?”
“I don’t know. Maybe. Medical school was invigorating, Faith was exciting, residency less so, and fellowship was a drag. And here I am and all I want to do is go home.”
“Did you hear what you just said?”
“What did I say?”
“You have depression, and it is getting worse.”
“I didn’t say that.”
“How would you sum up the gradual decline you just described?”
Brian was silent for a time.
“Are you having trouble concentrating?”
“Stop! I need you to stop,” Brian’s voice declined with his posture. Energy spilled on the floor and headed for a drain, making whirlpools and sucking sounds on the way. “I have to think about this.”
Brian slowly got up, shook Peggy’s hand, and left the room. The frosted glass in the door rattled.
Chapter 10
“Dr Valdez, this is Faith,” came over the phone.
“What’s up?”
“I’ve got Betsy Melendez, she’s thirty years old and asthmatic, at twelve weeks with influenza B. We got a chest x-ray which shows pneumonia in the lower lobe of her right lung. The fetus is alive.” Faith felt a new lively confidence in her evaluation, her interpretation of the patient’s situation, and her newfound ability to concisely deliver the pertinent information. She also always enjoyed the interactions with Peggy.
“Do you want to keep her in the hospital?”
“I would, yes. She will need good isolation and monitoring of blood oxygen.”
By the time arrangements, phone calls, and territorial arguments had been settled, a good hour had passed before Ms Melendez’s arrival in medical ICU was confirmed. By that time Ann had joined them at the Labor and Delivery charting station. The three headed that direction. Intimidating sentry double doors with stern warnings bowed to a swipe of Peggy’s ID badge. A busy hallway with thirty beds, mostly occupied, held several bays with glass doors guarded by tall carts containing masks, gowns, and gloves, known as personal protective equipment, or PPE. The three dressed up and entered Betsy’s room.
“Betsy, this is Dr Valdez and Dr McCauley.”
“Thanks, Dr Faith. Am I bad sick?”
“Not yet, and we hope you don’t get that way, but we don’t want to wait until you are in distress to move you here. If you don’t develop a severe case, we’ll get you out of here.”
“Have you ever been in a hospital for asthma before, Betsy?” Ann asked.
“When I was a child, maybe four. The only thing I remember is the nasal oxygen and the steam tent.”
“Have you been using your steroid inhaler?”
“Yes. I’ve been a little wheezier for about a week, but not bad enough to need my other inhaler. I used my other one twice yesterday and four times today. I always have a little more trouble with my asthma in the winter.”
“Did you get a flu shot?”
“No.”
Faith said, “We’re going to check in on you in an hour or two. By morning we’ll know what’s going to happen. Do you have family?”
“Yes. They are in Farmington. I told them not to come until I found out what was going to happen. Knowing my mother, though, they’re on their way. It’s more than a three-hour drive.”
“Jeez,” Faith gasped, “did you drive all the way down here?”
“No, my sister-in-law brought me down.”
“You’ll get better,” Faith assured her. “We’ll take good care of you.”
“Is there anything else we can do for her?” Ann asked.
“We could give her theophylline,” Peggy said.
“You talked about that at rounds,” Faith said, stepping to a computer to enter orders. She leaned toward Ann. “Can you help me with this?”
“Sure,” Ann said.
Faith finished up with the computer and the three headed back to Labor and Delivery. On the way, Faith asked, “How do you know about theophylline, how it decreases the need for inhaled steroids, and all the stuff you guys seem to know?”
“You listen to patients,” Ann said. “And remember what happens to them. If you can’t remember what medicine you gave her, look it up so it sticks in your brain.”
“Read, read, read,” Peggy said. “Ann, she may need to take her theophylline for the rest of the pregnancy.”
Ann said. “I want to try it in a few of my office patients.”
“You will have to test it out for yourself. New drugs, or old drugs with new uses, will come along and you will have to decide whether to use them. Get real information from reliable sources, not from salespeople, figure out in your brain how they fit in your personal algorithms, and decide if and for whom you like them. Some you will kick out forever, some will transform the way you approach certain diseases.”
“How would I know theophylline is cheap?” Faith asked.
“Easy,” Ann replied. “Look it up in Facts and Comparisons or in UpToDate. Also, if it’s cheap, it’s on Walmart’s four-dollar generic list. walmart.com.” Ann giggled.
“Boy, I have a long way to go,” Faith said. “How did you get there? Peggy, how did you get all that you know in your brain?”
“I worked hard, read everything, looked up everything. Nowadays, you can find things so quickly on the internet. You must be careful where you find them, but if you stick to the subscription services, you’ll get reliable information. The University provides you with subscriptions to UpToDate, Facts and Comparisons, and the American Congress of Obstetrics and Gynecology videos and reading material.”
Ann said, “I’m five years ahead of you. You’ll catch up.”
“I’m more than forty years ahead of you.”
Ann patted Faith on the back. “You’ll get there. And I know that because you want to.”
Josh was sitting at the charting station when the three arrived. Ann and Peggy both soon departed.
Faith said, “I enjoyed Betsy, our influenza patient. She told me all about Farmington and a place called Shiprock. The tall mesas and rock formations sound beautiful. It would be fun to see them some day. She also talked about not having running water, and how a service comes by with a truck and puts water in a tank at their house. It is amazing that Americans still live that way.”
“It is amazing,” Josh said. “Did she say if they had electricity or a phone?”
“No, I didn’t ask her. That’s a good question. I can imagine that it’s hard to take good care of yourself like that. How do you take a shower or a bath? How do you care for a new baby?”
“How far does she have to drive to get medicine, even?” Josh asked.
“After she has her baby, are we sending her home in a day or two to a place that doesn’t have running water? I didn’t ask her because I didn’t think of it, but your point is a good one. Is she out there without electricity or a phone with a baby that’s two days old? I wonder if she even has a car.”
“Hard to grasp.”
“I really like working here,” Faith said. “We see patients from all walks of life. And our attendings let us manage the patients how we want, we just have to understand what we are doing and why. We can manage patients in ways that fit their lives, and not that fit the textbooks.”