Susan put her penlight back in her pocket and slung her stethoscope across her neck. “Great. You’re a normal almost-teenager, except you don’t sass your mother enough. If you’re going to develop into a proper teen, you have to practice your sarcasm, eye rolling, and door slamming.”
Susan thought she saw a ghost of a smile cross Monterey’s face, but the girl did not speak.
Susan waved a dismissive hand. “Ah, don’t worry. You’ll get it. We all do.” With that, she exited the room and headed to visit the second patient on her list.
She found Dallas Moore sitting in the common room with several other boys, watching a video on the enclosed screen. She recognized him at once, the only African-American in the group. He had close-cropped hair and pudgy cheeks. He looked younger than his ten years, notably short for his age, and as round as a basketball. Legs like tree trunks jutted from his shorts, the skin ashy dry and in need of lotion. He breathed loudly, almost snoring, though clearly wide-awake.
“Dallas Moore?” Susan asked.
The deep brown eyes darted toward her. “Call me Diesel.”
“Diesel, okay.” Susan remembered seeing the nickname on the sheet Stony Lipschitz had given her. “I’m Susan Calvin, your new doctor.”
The boy nodded, clearly more interested in the television screen than in her. “Hopefully, I’ll be out of here before you are.”
Susan smiled. “That is precisely my plan. You mind if I examine you?”
“Here?”
Susan chuckled. “In your room. I can wait until after the movie, if you prefer.”
“Thanks.” Diesel’s gaze went back to the screen.
Susan left him there and started looking for her other charges. She expected to find Sharicka first. The only preschooler in the mix, she ought to stand out jarringly. Instead, Susan found a girl standing in clear confusion, as if she had just awakened in an unfamiliar body in a strange location. She shuffled a few steps, stopped, and looked around with her brow furrowed. She went to take another step, staggered, and fell.
A nurse ran toward her, but Susan arrived first. “Here, let me help you.” She took the girl’s hands and gently helped her to her feet. “Are you all right?”
“I think so.” The girl clung to Susan’s arm, her fingers like ice cubes. “I get dizzy sometimes. And confused. But I’m all right now.”
The description sounded familiar. “Would you happen to be Starling Woodruff?”
“Yep, that’s me.” The girl sounded shaken. “Would you mind helping me to my room?”
“Not at all,” Susan said. “Which way?”
Starling pointed down the back corridor. Knowing the doors had patient names on the jambs, Susan headed in the indicated direction, reading as she went. She found Diesel’s room, then, two doors down, Starling’s.
“I’m Dr. Susan Calvin, Starling. I’m your new resident physician.”
“Of course,” Starling said. “First of the month.” Her eyes narrowed.
“Which month?”
“July.” Susan helped Starling to her bed. “And it’s the third. The first was a Sunday, and I got here too late to bother you yesterday.” As Starling let go, the frigidness of her touch remained, engrained on Susan’s flesh. “Your hands are really cold.”
“They always are.” Starling leaned her back against the wall. “Feet, too. I suppose you want to examine me?”
Susan closed the door. “If you don’t mind.”
Starling made a gesture to indicate she did not.
Susan performed a slightly more thorough exam on Starling, including a check of all four lower extremity pulses. She had just finished confirming Starling’s cold feet when someone knocked on the door. Susan made sure Starling’s body was appropriately covered before answering. “Yes?”
Kendall Stevens pushed the door open a crack. “Time for rounds, Calvin.”
“Excuse me,” Susan said to Starling. “Will you be all right now?”
“I’m fine.” Starling rose carefully, walked to her shelf, and pulled down a Nancy Drew book. “I’ll just sit here and read for a bit.”
Susan headed out the door. “Do you want it open or closed?”
Starling nestled back on the bed, book in hand. “Open, please.”
Susan left the door open, then trotted to the staffing room, where she could just see Kendall’s back disappearing. As she rounded the corner, she noticed all of the R-1s sitting in chairs along with Clayton, the R-2. Stony perched on the edge of a desk, and Dr. Bainbridge sat on another, looking around the clustered group. The nurses hovered on the fringes, working and listening simultaneously.
Dr. Bainbridge addressed Stony. “Are they all here?”
“Yes, sir.”
Bainbridge nodded briskly. “Let’s start with . . .” His gaze wandered over the group and landed back on the R-3. “Which one took call last night?”
Susan’s heart rate quickened.
“Susan Calvin.” Stony gestured at her.
“All right, let’s get to work.” Susan suspected she was about to meet the side of Bainbridge that Stony had warned them about, the one that asked difficult questions and expected quick and well-considered answers. “Susan Calvin, present your first patient.”
Chapter 4
Susan began with one of the patients she had actually examined. “Starling Woodruff is a thirteen-year-old white female with a history of odd behavior who has been on the Pediatric Inpatient Psychiatry Unit for almost two years.”
“Odd behavior,” Bainbridge interrupted. “Is that her diagnosis, Dr. Calvin? Odd Behavioral Disorder? Isn’t that akin to diagnosing a child with a specific chromosomal deletion as having Funny-Looking Kid Syndrome?”
Irritation seized Susan, but she held her tongue. “Starling’s official diagnosis is dementia, status post A-V fistula repair.” She did not add she did not agree with the diagnosis. It would sound arrogant and ridiculous to contradict the numerous physicians who had treated her over the last two years. “Her symptoms consist mostly of memory lapses, particularly short-term, aimless wandering, lack of concentration, and confusion.”
Nods suffused the group, residents and nurses included.
Susan continued, wanting to get out the entire history before letting the other shoe drop. Going first made things so much more difficult. She had to guess how much information Bainbridge wanted, enough so he fully understood the situation but not so much it made her look incapable of sifting out the pertinent from the history. The residents’ reports at rounds might be the only knowledge Bainbridge would have of their patients.
“Starling underwent repair of a cerebral arteriovenous fistula in September of 2033. In the nearly two years since, she has developed worsening psychiatric problems, treated with various cholinesterase inhibitors. She is currently taking rivastigmine, which seems to help with memory and confusion, as well as sertraline for agitation and depressive symptoms. In addition to her psychiatric symptoms, she fatigues easily and has grown poorly for age, currently in the tenth percentile. She had previously been growing along the seventy-fifth percentile curve. On physical examination, she was pale, with remarkably cold extremities. Her pulse was thready. I could feel the liver edge, implying possible hepatomegaly, and I could hear a soft S4 gallop.”
Susan looked at the nurses, several of whom had creased foreheads. Apparently, they had never noticed the extra heart sound, which did not surprise her. It was subtle, not something expected in psychiatry, and, even under normal circumstances, required significant training to hear.
Stony pursed his lips, head bobbing. “Nice catch.”
Bainbridge looked from Stony to Susan. “Are you sure?”
“After rounds, I’ll double-check it,” Stony promised.