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.”
“But that won’t happen to Mrs. Mac?” Blake asked, biting at his bottom lip.
“My assessment is that she seems to have plenty of power in the family. Of course, I might be wrong there.”
The cogs were whirring in Blake’s head. Welcome to the world of general medicine, sweetheart; there’s no easy surgical answers here.
Blake nodded, and he still looked worried.
“All any of us can do is be aware,” I said. “You just learned something that I doubt the rest of your intake have figured out yet.” I smiled at him and then opened my desk drawer, taking out a bag of candy and offering it to him. “Gummi bear?”
He took one and shook his head in disbelief. “You keep sweets in your desk?”
I pointed at the box of Kleenex on the desk. “Standard teaching aides. Gummi bears and tissues will fix most things.”
My pager was whirring away on my hip as Blake left. I propped my feet on my desk, switched my monitor on, and logged into the mail server to retrieve the pages. Post-it notes festooned the monitor; I added two more to the collection as I listened to my messages. Med school questions about assessment. A message from my ex about our son.
Messages from the outpatient clinic. Two drug company reps who could safely be ignored. Why did nobody ever leave a message asking me if I wanted to have sex? I’d settle for a date; it didn’t even have to be sex.
By the time the particularly uninspiring young man with the hair falling in his eyes had finished, I was working hard at looking supportive and encouraging when I really just wanted to gouge my eyes out with the PDA that the shy Asian girl was fiddling with. Fuck, if she was playing Snake on it, I’d give her extra marks if she handed it over to me. It had to be more interesting than this tutorial.
When it was her turn, she put the PDA down, took out her index cards, and began to drone on. Why me? Why did the med school insist on sending their neophytes to me for house training? I must have done something dreadful in a previous life to deserve this.
Thankfully, she was the last. I nodded, smiled at her, and said, “Mr. Blake, will you hand me over your cards?”
Blake looked anxiously down at the stack of cards on the table in front of him, then passed them to me.
They were just about unreadable, but I could make out the scrawled headings. I redid his presentation for him; cut the social history back to four words, spent a couple of hundred on her CT results, another hundred on her Us and Es, and brought the whole lot home in 90 seconds.
There was a stunned silence around the table as I handed Blake back his cards and said, “For a ten minute presentation, I want some substantial content. Some real meat. I want to hear about treatment options, conservative and interventionist. I want to hear what the real world cost of the treatment is, and how much of the department resources it’s going to consume. I want some discussion of patient compliance, too. No point in using home monitoring if they haven’t got two neurons to rub together. The goal for the hospital has to be to shift management back to the family doctor where possible.”
The students looked horrified, so I rescued my empty coffee mug, scooped up my files, and left them. No doubt they’d have bitter things to say as soon as I was out of hearing, but I was comfortable with that.
Blake was waiting outside my office at the end of the following day, and I regretted letting him find out where it was so easily. I preferred the students to find it by themselves; it was a good test of initiative to make them locate it through the central hospital directory. Not to mention courage when it came to getting past the guard dog, who was smiling fondly at Blake from behind her tacky magazine. He must have charmed her somehow. I was impressed.
I opened the door, flopped into my chair, and looked expectantly up at him. He sat down and shuffled his index cards nervously.
“Yes?” I said.
“I want to redo my presentation.”
“I’m not going to change your mark.”
“That’s not… I just want to get it right,” he explained.
“Okay, I’m listening, but I reserve the right to stop you if it’s crap,” I said. “I’m not being paid enough to sit through presentation reruns.”
I didn’t have to stop him. He did it cold, no notes, and it was solid and concise. Still unspeakably dull, but renal insufficiency was like that. I stood up and held out my hand to him.
He looked confused as he stood and took my hand. I shook it. “Congratulations. You’re not a moron. Keep going like that and you’ll restore my faith in humanity.”
He coloured a little and blinked, his eyelashes tiny fans against his skin, then smiled at me. This must have been what he had done to get past The Secretary From Hell. Fuck, but he was gorgeous, and I let go of his hand before it all became far too embarrassing.
“Get out of here,” I said, but my voice wasn’t the least bit grouchy.
Chapter Three
Lin, the Asian girl, said, “There’s Dr. Maynard in the queue,” grabbing my arm and pulling me behind her up to the junk food counter. All right, so I wasn’t the only student to have noticed he was cute. I followed her, even though I was carrying my own food in my backpack. I could always scrape together the coins to buy a can of soft drink.
He smiled at both of us in greeting, then leaned across the counter and said, “I’ll have the cardiology special,” to the bored-looking teenager behind it.
“Righty ho,” she said and took his money.
“What’s the cardiology special?” Lin asked. “Is it really healthy or something?”
Dr. Maynard shook his head. “No way. It’s a burger with cheese and fried egg, with fries and a thick shake. The cook changed the name when he noticed that the cardiology team all ordered it. I think they made one of their residents measure the saturated fat in it once.”
“How much was in it?” I asked. “Just out of morbid curiosity.”
Lin ordered a salad and Dr. Maynard took the bright yellow shake the girl handed him.
“Thirty-five grams I think.” He quirked an eyebrow at us.
“Okay, what’s the recommended maximum daily intake of saturated fat?”
I looked blankly at him, and Lin promptly said, “Twenty grams, no more than half of the total daily fat intake of forty grams.”
I ordered a Diet Coke, and Dr. Maynard said, “You haven’t read the latest papers on Aspartame, have you?”
