Extraits

I recognized the tension in Gramp's voice. I'd heard it before. Normally, he was a pretty easygoing person, but when things started to fall apart, that all went away and he got quiet and serious.

It was hard getting the words out, but I wanted to insult them. Angry men made mistakes. If I could get them upset enough, I might be able to move.

There was rarely certainty in medicine. That was part of the appeal, though most of the appeal came from my interest in using my mind, trying t solve problems and to help others.

Chapter 1

Screams echoed along the hall, the kind of piercing screams that seemed determined to penetrate beyond my eardrums and straight into the back of my skull, lodging there and leaving me with a pounding headache. Some were tolerable, but when they rose in intensity, becoming shrill the way this one did, there was nothing tolerable about having a child screaming in your face.

It was just another day in the ER.

Times like this, I thought it might almost be better to fight demons. At least when I’d fought the demons, I could shut them up, even if it meant cutting through them.

My shift was nearly over, and I was tired. Today had been an avalanche of abdominal pain. Medicine was strange like that, with spurts of certain diagnoses. Yesterday had brought the run of COPD exacerbations, and I think I filled the pulmonary ICU myself. Two ended up on vents, taking far more time than I liked, and the rest were just old smokers, too tough or stubborn to know that it was nearly the end of the line.

Days like today reminded me why I hated seeing abdominal pain, especially when they all came at once. Two cases of appendicitis were made all the worse by the fact that Dr. Tewal took the calls. It would have been better had I been able to punt them to the surgical residents—at least they answered when I paged and made it down to the ER—but Dr. Tewal was a private practice surgeon and somehow both of these cases had wanted her. And I was happy to let them have her if only she’d answer her damned pager.

“I’ve tried reaching Dr. Tewal several times, but she’s unavailable,” I said. It felt as if I’d been repeating myself, and maybe I had been. I couldn’t remember what I’d already told this woman. Her irritation was understandable—it was her sweet little boy who shrieked in my ears—but there was a limit to what I could tolerate.

“Isn’t there anyone in her office you can call to try and get a hold of her?” the mother asked. She had to be mid-twenties, and her blond hair was frazzled and her makeup streaked below her eyes.

I’d done my best to reassure her that this was only a simple appendicitis, not a rupture, so we had time, but she had refused. Worse, Dr. Tewal preferred her patients not be medicated before she had a chance to examine them. That was fine when she came in a timely fashion, not so fine when it meant a little boy would suffer for another hour.

“I’ve paged her directly twice,” I said. I’d been lucky that she’d answered within a reasonable time when the last appy had come in, but this time she’d gone MIA. Were it not Dr. Tewal, I would have suggested having the surgical residents assume care, but Tewal would learn. I’d seen her question attendings when she hadn’t been called on a case she later decided she could have managed, grilling the attendings about why they’d chose a specialist over her. I never understood why she cared, especially as she seemed to hate coming in for simple things like this. “I can try again, or I can have one of the surgery residents—”

“There’s no need.”