AT TEN IN THE morning, Gwen Howard was lucky enough to find a parking spot just four blocks from City Hospital. Walking toward the main entrance, she thought about Kevin Bartholomew, how engaging and appealing he had been on the phone yesterday. Had they been flirting?
Stop it, Gwen ordered herself. He’s got to be at least four years younger than me.
Since her divorce, she had dated enough to learn the hard way that men could handle being with a woman who was two, maybe three years older. Any more was inevitably a deal-breaker. Gwen concentrated on the building she was entering.
Though she had already been inside several times to check on sick clinic patients, the place still unnerved her. This modern version of City Hospital with its closed wards and individual rooms was nothing like the brick towers that stood here when she was an intern. The house staff and nurses seemed to work in isolation. It was too white, too bright, too silent for her. Nothing like the old hospital’s raucous open wards where she had become adept at sticking intravenous catheters, spinal needles, and bone marrow trephines into desperately ill people. The constant, colorful chatter, even the patients’ complaints, had been public reassurance that she was doing her best, all that anyone in her position could be expected to accomplish.
But will my best meet the bar here? Poor Larry Winton was a case in point. Being purely objective, she had to conclude he was in the ICU with respiratory failure because a few weeks earlier, when she saw a tinge of blue in his nail beds and considered calling an ambulance, she had also imagined an emergency room physician complaining about yet another patient unnecessarily sent over by an idiot clinic doc who didn’t know what real cyanosis looks like.
“Christ,” she said aloud in the empty elevator. “I should have just bit the bullet and called 911. The sub-specialists here would have had plenty of time to figure it out by now.”
Gwen hadn’t gone into the new ICU on her previous visits. Her self-confidence sunk lower as she looked at the modern equipment. It was all foreign, from intravenous pumps to wall-mounted oxygen valves and chest tube drainage systems. The ventilators had dials to control parameters she had never heard of. It made her re-think applying. How long would it take her to come up to speed? The patients she cared for rarely had anything worse than a bad cold or a sexually transmitted disease. And if she was accepted into the residency, it would mean being here triple the hours she now worked, so much time away from Eva.
Yet Eva did seem to need her less. She was thriving in fourth grade and happy to play in an after-school program until six on the days Gwen worked. And Gwen knew she could find a college girl with a car to cover the nights and weekends on call. It wouldn’t be that expensive. Parenting certainly wouldn’t get easier once Eva started adolescence. In any case, Gwen’s days at the Haight-Ashbury clinic were numbered if she didn’t acquire a specialty credential. Health department doctors like her would soon be required to be boarded, and eligibility for a board exam required completing two additional years of hospital training after internship. The clincher was Proctor, the private school Eva attended. Its tuition was eroding her savings, and her ex-husband Daniel refused to help. He believed private schools were politically incorrect.
A middle-aged nurse, a good ten years older than Gwen, asked, “Can I help you?”
“I’m Dr. Howard from Health Center 3.”
The nurse gave her a disinterested, faintly disapproving look.
Is it my appearance, Gwen wondered. Hair too long, dress too short for thirty-five? She was proud of her trim, tennis-toned body. A pretty face, too, she’d always been told.
“A patient of mine is here. Larry Winton.”
The nurse pointed to a red-haired man in a white jacket seated on a stool. He was watching a heart monitor.
“Winton is his.”
Gwen studied Kevin. What gorgeous green eyes, she thought. He could be cute if he lost twenty pounds. She halted further fantasy. He indeed was too young for her. But this reminded her of another plus in doing of a residency—so many opportunities to meet men.
As Gwen approached Kevin, she saw he was exhausted.
“Hi, I’m Gwen Howard. We talked about Larry Winton yesterday?”
Kevin immediately brightened. He stood up and offered his hand.
“It’s great you came by. He hasn’t had any visitors.”
“That doesn’t surprise me. He’s kind of a loner.”
Kevin looked at his wristwatch.
“He’s going to be bronched soon. You want to see him now?”
“Sure,” she said, her pluck fading again.
Kevin led her to Larry’s room. She slipped past him, rolled a stool to the head of the bed, and sat down.
Larry had a vacant expression. With each inhalation, the hollows of his neck retracted and he lifted his shoulders. To the uninitiated, he might be meditating or practicing yoga. The sad irony, Gwen knew, was that no one, not even the world’s greatest marathon runner, could sustain this level of breathing work for more than a day or two.
“Hi, doc,” he said, his words echoing inside the oxygen mask. “What’re you doing here?”
“He called me,” she said with a nod toward Kevin.
“What do you think? Is it TB?”
“Maybe,” she said, trying to sound hopeful.
Larry looked skeptically at her, then at Kevin.
“I don’t know what it is,” Gwen confessed. “I am so, so sorry this happened.”
“Not your fault, doc. I fucked up. Blew off your advice. Shoulda got my ass here sooner. Don’t worry. They’re doing all they can.”
“I know they are,” she fervently agreed.
Larry’s smile was fractured by the curved, translucent shell covering his mouth. Gwen bit her lips and turned away. In the doorway, she saw two people in white gowns and masks. They hovered there like wraiths. Behind them stood a middle-aged Asian-American man wearing a sport jacket and tie. He was frowning.
Herb apologized for being late. Kevin handed him the most recent arterial blood gas results. Herb glanced at the numbers, checked the oxygen flow valve by Larry’s bed, and gave a barely perceptible shake of his head.
“Time to go,” said Kevin.
Larry recoiled.
“They do this every day here,” Gwen murmured. “You’ll be OK.”
While Larry was being moved to a gurney, Kevin introduced Gwen to Herb.
“What do you think?” she asked, struggling to tamp down her anxiety.
“Not TB,” Herb answered. “Though I’ve been wrong about that before. Hypersensitivity pneumonitis, cocci, sarcoid? It could be anything. Let’s hope the bronch washings tell us something, at least a clue as to whether steroids might help.”
Gwen liked the self-deprecation, but he sounded pessimistic. Laying crepe was what they called it when she was an intern.