“How’s the pain, Mrs. Mac?” Dr. Maynard asked loudly, bending forward over the old woman.
“Can’t complain, doctor,” she said, and Jane rolled her eyes expressively. The old girl obviously did complain. I reached forward and took the folder out of the rack at the foot of the bed.
“You can’t do that,” Nevins whispered, but I ignored him, opened the folder, and scanned the obs chart and the meds sheet quickly.
I jumped when Dr. Maynard said, “Perhaps Mr. Blake could tell us the pertinent information about Mrs. McDonald’s pain management regime?”
Jesus Christ. There was a trick here. I looked through the oxycodone entries. The old dear was PRNing to the max.
Every three hours…
There it was.
“Um,” I said. “Her analgesics’ frequency drops off during visiting hours. She’s going five hours at least between doses in the afternoon.”
Dr. Maynard nodded approvingly and I knew what a pet dog felt like when he dropped a soggy stick at someone’s feet.
“And?” he said.
And? What else was there? Oh, impact on management, of course.
I flicked through the file to her nursing admission. Mrs.
McDonald lived alone, with her family dropping in every couple of days to check on her.
“The patient might have a better quality of life in a less isolated environment. Living with other people in a hostel, perhaps.”
“I’m not going to no fucking old age home,” Mrs. McDonald said. “You can all just fuck off.”
There was a snigger from my fellow students, and Dr.
Maynard’s eyes were twinkling at me when I looked up at him. I closed my mouth quickly, kicking myself for having walked into that trap.
He patted Mrs. McDonald’s hand. “We’re not going to put you in a home, Mrs. Mac,” he said. “I was thinking of you going to live with one of your daughters.”
“They’re monsters,” Mrs. McDonald said. “They won’t let me have my ciggies.”
“Seems to me that you can’t have had many cigarettes stuck in a hospital bed,” Dr. Maynard said. “And you don’t seem to be suffering too badly. How about I talk to your family and we see what we can work out?”
Mrs. McDonald harrumped and tucked her bedding around herself more securely with hands wizened by arthritis. I looked at the medication chart again. Yep, the old bat was on nicotine patches, that was why she wasn’t having cravings.
Dr. Maynard nodded at Jane. “Page me when the Mac clan comes in to visit, and we’ll do a family conference.”
I put the folder back where it came from and we moved en masse into the next cubicle, all the students scribbling notes frantically. DAP. Data, assessment, plan. My scrawl was illegible.
The rest of the round was all like that. We took turns being idiots, though Nevins was the biggest idiot, making a patient cry by pumping the blood pressure cuff up too far.
In the staff room afterward we sat around, trying to look insignificant, while Dr. Maynard explained to us exactly how we had stuffed up and handed out follow-up work.
“I want a ten-minute presentation on these patients. I want to know what’s wrong with them, and how we can get them back on their feet.” He allocated us a patient each and I kind of expected to be given Mrs. McDonald, but he gave me the teenage girl with renal insufficiency instead. I was relieved; I had some hope of charming the girl into talking to me.
We all dreamed of making some kind of earth-shattering breakthrough in a case, like Amy Tsien had last year. She’d found a neurological deficit from aminoglycoside ototoxicity that all of the medical specialities team had missed. It had earned her an A for her major case study, something that was supposed to be impossible.
I wasn’t the only one thinking along these lines, because Nevins said, “Is this assessable?”
Dr. Maynard stared at Nevins for a moment as if he was something nasty that had been spilt on the floor. “It is now,”
he said. “And for asking that question, I can tell you the best mark you can hope to get is a C. Now all of you, get out of here, and let me do some real work.”
There was a coffee and loo break before we were due in anesthetics and we stood eagerly as Dr. Maynard collected together his papers and files.
As we left, Dr. Maynard said, “Mr. Blake? A moment, please?”
I looked wistfully across the ward as my fellow med students in their short white jackets and shiny new stethoscopes bolted for the dodgy lifts. “Yes, sir.”
“I want you in on the Mac family conference. Have you got a cell phone?”
I nodded and scrawled my number on the notepad he pushed toward me. He looked less tired now, and really rather attractive with his strong jaw and faded blond hair, and I wished for a moment that I was giving him my number in a bar somewhere.
“Thanks,” Dr. Maynard said, and I nodded and practically ran for the stairs. No way was I going to risk the lifts when there were exactly seven minutes for me to get a coffee in.
Chapter Two
The Mac clan was as argumentative as Mrs. Mac herself, and the family conference was loud and boisterous, but I didn’t sense any underlying hostility. It seemed this was just the way the whole family related to the world.
It had ended satisfactorily, with Mrs. Mac eventually pointing one gaunt hand at the short fat daughter and announcing she was going to live with Our Sheryl and they could all shut up.
Matthew Blake leaned against the wall of the elevator, looking frazzled, like most students did, and I smiled at him.
“You okay?”
He smiled weakly back. “Yeah, though I think my head hurts now. Are all family conferences like that?”
I shook my head. “That was a good one. I never doubted that the kids would do the right thing. It was just up to Mrs.
Mac to decide who could look after her best.”
“What’s a bad one like?” Blake asked, and he went up a little in my estimation. Most med students would have been too overwhelmed from the family conference to try and extract additional information from it.
“Sometimes families refuse to look after an aged parent.
Sometimes bad things happen.” The elevator door opened and Blake got out, too, following me to the cupboard that the hospital deigned to call my office. Another point for the kid.
He could have just stayed in the elevator.
“Bad things?” he asked as I nodded to the permed ogre, who was technically the general medical secretary, and unlocked my office door.
He followed me in and I collapsed down into my squeaky chair and ignored the blinking light on my phone. If someone really wanted to talk to me, they’d use my pager. “Yeah, bad things.” Blake sat down on the plastic garden chair that was the only other thing to sit on apart from my desk, which was covered in textbooks and coffee cups and Xeroxes.
“We had a patient a couple of years ago. I can’t remember what his exact complaint was; basically he was confused and failing to thrive. He was underweight, so we asked his family to sit with him for meal times, just to encourage him to eat.”
I must have looked grim because Blake said, “What happened?”
“The nurses noticed something. Every meal, whoever was supposed to be feeding him was eating his meal for him.”
“Elder abuse?” Blake said, frowning. “How could they do that?”
The concern on Blake’s face touched me, made me really look at him for the first time. He was lovely: clear-skinned, dark curls, long elegant hands. God, it was usually only the female med students I looked at like that.
“Sometimes love and hate and power all look the same,” I said. “Kinship betrayals are the worst kind. He went to an old age home, where at least he’d get something to eat. There wasn’t much else we could do for him.”