“What’s his name again?”
“Edward Roger Rickover.”
“Jeez. Ricky is much better. Have you guys been close for a long time?”
“No. But since I got here, yes. I have made a big deal of his initials being ERR.”
“What do you guys talk about?”
A mischievous face flashed. “Women, the other residents in our program, you, football, pizza, cars. All of the finer things in life.”
“Me?”
“What did you expect? Ancient Roman history?”
“Oh yeah, Einstein’s theory.”
Josh sent the question back, “What do you and Natalie talk about?”
“Clothes, men, people around us. Not pizza. Not you. Not cars.”
“We need to stop talking about pizza. You’re making me hungry.”
“I need to get to work. I’ll see you later.”
He watched her walk away. “You need to take your eyes off her,” a voice behind him said. “She’s jailbait.”
“Shut up Ricky,” Josh quipped. “I look at hummingbirds and it doesn’t mean I want one.”
“That,” Ricky said, “has nothing to do with this situation. You want her and you want her bad. The drooling is sometimes annoying.”
“Like with you and Haley? We all see that too.”
“There is one big difference, Josh. Haley’s not married.”
“Yeah. I don’t know how to handle that part. My attraction to her is not fading, and yet she’s forbidden fruit.”
Ricky chuckled. “Be careful. Going to bed with someone else’s wife can get you lead poisoning.”
“Oh, you mean hot, high-velocity lead?”
“That kind.”
“Yeah. I guess I just have to look at her like I look at hummingbirds and New Mexico sunsets.”
“Good idea. Avoid lead poisoning.”
Chapter 7
Brian Yankton was the attending of the day, and stood with the troop of trainees for morning rounds. To his surprise, a stranger appeared, who quickly got the attention of the group.
“Good morning. I’m Margarita Valdez, a retired obstetrician from Crystal Springs, which is about 150 miles east of here in the middle of nowhere. The main products of Crystal Springs are cactus and sagebrush. Not really, it’s oil and agriculture. I delivered babies out there for almost forty years, and many of you have talked to me on the phone when I needed to send patients here for specialized care. Your director, Emily Beacham, asked me to fill in here as attending and supervisor for a few months until a permanent faculty member is recruited. Please help me learn your routines, your names, and the location of your bathrooms.”
A smiling face said, “My name is Ann McCauley, and I’m the second-year fellow in high-risk obstetrics. I’ve talked to you several times on the phone and I’m glad to finally meet you.”
Brian Yankton stood silent.
“Yes, Ann. I remember you. You should call me Peggy.”
“The last patient you sent us was a lady who was on dialysis for kidney failure. I can’t believe the number of complicated patients you had in that little town.”
“There were amazingly twisted issues out there. It’s what kept me going for so long.”
“I’m Josh Menkowicz, Dr Valdez. I’m a first-year resident. Glad to meet you.”
“Thanks, Josh,” Peggy said. “You guys should all call me Peggy.”
“I’m Faith Pernitelli,” a tall, dark-haired woman with bright eyes said. “I have a lot to learn. I ask lots of questions which seem to unsettle some people. Please don’t be unsettled.”
“Questions don’t bother me. I will do my best to answer. If I can’t answer today, I’ll answer tomorrow.”
“I’m Edward Rickover, but people call me Ricky. This is Haley Denton. I’m a second-year resident, and she’s a third-year resident. She has a serious birth defect — freckles.”
“Shut up Ricky.” There was some snickering.
Faith started the presentation of cases. “Today, we’ll have a repeat cesarean section and a post-partum tubal ligation. The cesarean patient has had two previous cesarean sections, and the baby is large, over nine pounds, but she doesn’t have diabetes. We also have someone in labor who will deliver in the next few hours.”
“Why did you think it was important to tell me the patient didn’t have diabetes?” Peggy asked.
“Because patients with really large babies often have diabetes, and having diabetes would change how you manage the patient after her operation.”
“Good job, Faith,” Peggy said. “What else do we have?”
Ann said, “The only ante-partum patient we have — that’s what we call pregnant patients in the hospital for reasons other than delivery — is Beatrice Castro who has an asthma attack at twenty-two weeks. She didn’t respond to breathing treatments in the emergency room, so we brought her here for more medicines and support. I discovered that her problem is that she has not been able to afford a steroid inhaler.”
“Can she get to Juarez?” Peggy asked, referring to the Mexican city located just across the Rio Grande from El Paso, a four-hour drive from Albuquerque.
Ann said, “I didn’t ask her. What are you thinking?”
“Steroid inhalers are cheaper in Juarez,” he said.
“Is that something I should suggest?”
“I would think so.”
“Did you do that routinely in your practice? We don’t need ICE picking up our patients trying to cross the border.”
“I did suggest that to my patients, because asthma medicines, insulin, and oral contraceptives are way cheaper. At least from Crystal Springs, patients could always buy goods and visit relatives without interference from Border Patrol.”
“I’ll ask her about that,” Ann said.
“And theophylline,” Peggy said. “An old, safe, cheap medicine she can take orally twice a day.”
“I don’t know that one,” Faith said. “What is it?”
“It is a caffeine-like drug we used to use all the time. Older folks get heart complications from it, and it makes toxicity in children if not used carefully, so it has fallen out of favor. But pregnant patients, with their huge increase in kidney function, don’t get toxic and are young enough not to get heart events.”
“I’ll use that,” Ann said. “How much do you give her?”
“Maybe 300 milligrams twice a day. Adjust to effect. You can get blood levels if you want to, but usually I don’t.”
Heads and faces indicated that rounds had been good. Faith said, “Afternoon rounds are here at four, Peggy.”
On that note, the group divided up the work and scattered to their duties. Departing, Ann said to Peggy, “We’ll have a good time with you. You already put a dimension on care we hadn’t thought about or discussed for a long time. It’s that kind of input we need.”
“That’s easy. I feel like my brain is bursting with gems I need to give someone. It will be fun to dump them on you guys.”
“We’re ready.”
“I’m supposed to have a desk in the ‘fellows’ closet,’” Peggy said. “Would you mind telling me where that is?”
“I have to go there now anyway, so we can go together. I wondered why they crammed another desk in there earlier this week. I have to warn you, I didn’t think there was room for a fourth.”
They headed down the hall into an older part of the building. An aging, carved, wooden door with a frosted glass window labeled “Private” creaked open into a small, bare room. Four metal desks with ancient wooden rolling chairs shared the space, in one of which sat Brian Yankton.
“Peggy Valdez,” Peggy said extending a hand.
“Brian Yankton.”
“Are you the third-year fellow?”
Brian made clear he was insulted. “No. I’m an attending. I thought they would give you a real office.” He looked at Ann. “Did you know she was coming?”