Terminally Ill Page 24

  “I’m really fine,” I said, down the eight floors in elevator. “So, so fine,” I continued, while buckling my seat in the cab hovering by the front door, vaguely aware of Tucker giving the driver directions. “I’m a real asset to the team. Mega-excellent.”

  Chapter 26

  Of course I woke up in front of my apartment because the cab driver, who smelled like curry, was poking my shoulder and saying, “Lady. Lady!” I was seriously skeeved to get pushed to the sidelines, but common sense won, so I passed out in my own bed and let Tucker take over.

  I woke up for good at 7:20 a.m., with funky teeth and a growling stomach. Over a bowl of cereal, I confirmed that I had a sweet note from Ryan, no messages from Tucker, palliative care in the morning, and my family medicine clinic that afternoon. I’d forgotten to quiz Elvis about his allergies, but I knew he might be in the middle of rounds, and I had to hustle, myself, so I just texted Archer about it before brushing my teeth.

  The morning passed relatively quickly, with two consults in the emergency room. I didn’t see the pharmaceutical guy’s mother, but Dr. Huot assured me that Mary Kincaid was already ensconced very comfortably upstairs in room 5656. Then a shadow crossed her smiley face, and she lowered her voice, leaning forward on the nursing station counter so that no one else would overhear. “I also spoke to the pathologist, but I was unable to obtain permission for you to attend the autopsy, since it was a criminal matter.” She recovered her twinkle. “However, next Wednesday, we will have pathology rounds based on another case, and everyone will benefit from that.”

  “Wonderful,” I said, trying not to yawn. I’d gotten over eight hours of sleep. What was wrong with me? As if to punctuate the point, my ER chair suddenly lost its pneumatic pressure and lost and sank down three inches of height, so I was now looking up at Dr. Huot like she was my mommy. I stifled a curse.

  Dr. Huot continued to beam. “Mrs. Bérubé was hoping to speak to you. Perhaps you could call her before you go to lunch?”

  “Of course,” I said, and took the number from her, since Mr. and Mrs. B were no longer in residence. I ducked into the emerg resident’s sleep room to call Mrs. Bérubé, but it just rang and rang until I was forced to leave a message. I checked my cell phone and pager, and even popped into the library to log on to my e-mail, but Tucker still hadn’t contacted me. Jerk.

  After a quick rowing work-out and a lunch of reheated spaghetti, I hurried to the FMC. At least today I had Dr. Levine instead of Dr. Callendar, and that alone was worth a few bonus points. Dr. Levine was a heavy, curly-haired, soft-spoken doctor who mostly worked at a CLSC (centre local de services communautaires, or public health care clinic) downtown, but did Friday afternoons with us twice a month. My mood improved when my first two relatively pleasant patients just needed their ten thousand medications renewed. One more patient, and I’d sprint to UC Hospital and check on Elvis.

  I knocked twice on the thin, oak door and stepped into the cramped, square examining room. Then I spotted the give-me-pills-or-give-me-death thirteen-year-old, Kameron, pouting by the broken window blind on the far side of the room.

  I sucked in my breath and double-checked my appointment sheet to make sure I hadn’t misread it. No Kameron. I was scheduled to see Kaitlyn Rosenberg. Was she changing her name now?

  “Relax, it’s for my sister,” said Kameron. She raised her hand and pointed beyond the desk, behind the door that I was still holding ajar.

  “Yikes,” I said, jerking back involuntarily, which is not exactly professional, but who expects a patient to lurk behind the door, where she might get smacked by a sheet of solid wood?

  The girl stepped out from behind the still-open door. She crossed her arms over her chest and lowered her eyes. She had the same round mouth and little nose like Kameron. She was wearing similar clothes, too—for Kaitlyn, it was an oversized, grey shirt and loose skinny jeans. The main difference was that Kaitlyn seemed a third of Kameron’s size, the kind of skinny that makes you want to put your arm around her and say “It’s okay” while force-feeding her a chocolate bar.

  I said, “Kaitlyn?”

  She nodded, still staring at her immaculate, sparkly white sneakers, while I took stock of the dark circles under her eyes—les yeux cernés, as French parents often point out in their sick children. The air in the room felt heavy and humid. The silence in my room was magnified when Stan started joking with his patient next door and we could hear them laughing through the cardboard walls.

  “How can I help you?” I asked. I closed the door and sat down at the desk so I was now located between Kaitlyn and her sister. I opened up the brand new FMC file and uncapped my pen, swiveling my torso toward Kaitlyn, trying to establish rapport with the patient of the day.

  Kameron walked over to her sister and hooked her arm through hers, so my body language was now facing both of them.

  Kaitlyn didn’t move. Her arm hung limply.

  Kameron hugged the arm to her own side and said, “This is my sister. Kaitlyn should be on the pill, too.”

  Oh, no. We just did that movie. I tried to channel Dr. Callendar and channel joy that a young girl was acting responsibly. I set my pen down. “Kaitlyn? Hi.” I held out my hand.

  Kaitlyn glanced at me and at my hand like she’d never seen one before. Kameron squeezed her right arm, so Kaitlyn touched my fingers quickly with her left, not clasping my hand, and muttered, “Hi.”

  Comparing the two sisters standing side by side, the silent beanpole and the angry hot air balloon, I noted that Kaitlyn was a few inches taller. I checked the chart just to be sure. She was fourteen-and-a-half, the older sister, but she seemed younger and less confident. “I only have one chair, but do you want to sit down?” I asked Kaitlyn.

  She glanced at Kameron for permission. Kameron shrugged, and Kaitlyn hesitated before she pointed at the black examining bed pushed against the opposite wall.

  I nodded and turned my chair around to face her. She climbed up on the bed, making the paper crinkle, while Kameron dropped into the single chair by the desk, near the window, with a sigh and said, “Can we get this over with? We’re supposed to be at school.”

  “Your mother can write you two a note.” Kameron snorted a little, and I said, “Your mother knows you’re here, right?” I swung around to ask Kaitlyn, who’d crossed her jean-clad legs like she was sitting at a desk instead of having her feet dangle in the air. She’d also folded her hands neatly. But her pale blue eyes were wide and frightened. If she were a video game, she’d be flashing the ABORT, ABORT sign.

  Kameron jumped out of the chair to stand between us. “Of course she can write a note. God! What’s with the third degree? We just need some more pills.”

  I kept my eyes on Kaitlyn. If anyone was going to crack, the older, frailer sister would. “If I called your mom, would she come to the next appointment with you two?”

  “No. She’s working,” said Kameron. “We know how to take the bus. She writes us a note to get us off school. What is your problem?”

  “What kind of work does she do?” I asked Kaitlyn.

  Her cheeks flared red. She swung her legs in the air.

  “Hello. What does this have to do with birth control?” Kameron snapped her fingers in front of my face. “We need some toute suite.”

  “You need some manners tout de suite,” I said, under my breath.

  Kaitlyn smiled faintly. So she was alive in there, and had a sense of humor, even if she didn’t show it much.

  “Maybe I should talk to Kaitlyn alone,” I said.

  “No! We’re a team!” said Kameron, and Kaitlyn jerked up her head, alarmed enough to make eye contact with me and shake her head.

  “Then you need to be the quiet member of the team,” I said.

  “Fine. God!” Kameron pulled out her phone and pushed some buttons. “I wanted to play Angry Birds anyway!”

  “Quietly,” I repeated.

  Kaitlyn smiled slightly again. Then she answered my medical questions in a whisper. She�
��d had her period for the past two years. She turned red and mumbled that yes, she was sexually active. No contraindications to the pill. But she’d never had any STI testing, either.

  “You’ll have to come back for that,” I said.

  Kaitlyn shook her head. Her hands dug into the padded edge of the examining table. “I can’t miss any more school.”

  I tried to infuse gentleness into my voice. “I don’t have time to do a pelvic exam unless you make an hour-long appointment, so I can’t do one today. I explained this to your sister before.”

  “I can’t!” Her fingers jerked on the examining table, crunching the paper cover under her palms. She glanced at Kameron, who said, “Look. You can do all the weird exams you want on me. I don’t care. But she doesn’t want one. Too scary.”

  “Nobody likes them,” I assured Kaitlyn, “but they sound worse than they are. Really, it’s just using a big Q-tip to take cultures from the cervix, which is the bottom end of the uterus, and the vaginal wall.”

  “I can’t. Please! He’ll—” She bit off the rest of the sentence.

  The last syllable hung in the air.

  Kameron shot her a killing look.

  Kaitlyn looked mortified. She clamped her hands over her mouth and squeezed her eyes shut.

  “He’ll what?” I asked, as calmly as possible. There was no man in the room.

  Kaitlyn shook her head, still in a mute, “speak no evil” position

  “Are you talking about your boyfriend?”

  “No!” Kaitlyn said, disgusted, and Kameron snorted.

  What other “he” would she be worried about? I said, “Would you and your partner like to come in for testing together? You could have a Pap test and you could both have HIV and Hepatitis testing before I vaccinate you two against Hepatitis B.”

  Kaitlyn covered her whole face with her hands this time and started rocking back and forth. The paper crackled with every move

  Kameron gave a short, sharp laugh. “That’ll never happen.”

  “Who is your partner? Or partners,” I asked, remembering to use the politically correct word this time.

  Kaitlyn’s shoulders jerked, but she rocked without answering.

  Kameron cleared her throat. “I told you. We don’t want the human lie detector machine. Why are you asking all this stuff? We just want the pill.” But her voice rang hollow.

  I didn’t like any of this.

  I said, as calmly as possible, “Actually, it is my job to ask these questions. Now the age of consent is sixteen in Canada, and neither of you is sixteen yet.” I’d looked it up after my last clinic.

  Something flashed in Kameron’s face, a hard kind of triumph. I stared at her, but the microexpression vanished, and she just shrugged and said, “You’re a real barrel of laughs.”

  Kaitlyn kept rocking. She was the one who was sexually active. She was the one I had to reach, so I focused on her. I pulled my chair closer to her, so that if she opened her eyelids and raised her head a fraction, she could make eye contact with me. I made my voice as gentle as possible. “Is there something you want to tell me?”

  Kameron butted in. “Yeah, she doesn’t want a Pap test. Can’t you just do what you did for me? Give her a few boxes of pills and bring her back later?”

  Kaitlyn’s body stilled. She waited for me to answer.

  “I can,” I said slowly, “but she still needs a Pap test. And—”

  Kameron cut in again. “Well, she can’t have one. But she needs the pill, like, pronto. God! I knew I should have just waited for the CLSC.”

  I considered throwing Kameron out of the room, but Kaitlyn said suddenly, “Can you knock me out?”

  I blinked at her.

  She lowered her hands away from her mouth and kept her eyes pinned to the floor, but she mumbled, “You know. While you do…that. So I don’t feel anything.”

  “That’s a great idea,” said Kameron. “I bet you’ve got nice drugs. Okay. Hey, maybe I’ll take some, too.”

  “You mean, you want me to put you to sleep while you have your Pap tests?” I asked, a few steps behind them.

  “Yeah. Exactly! Can you do that?” said Kameron.

  “I can’t,” I said. “We do conscious sedation in the emergency room—that’s where we put an intravenous in your arm and give you drugs to put you to sleep, but you’re still breathing—”

  “Yeah, yeah, yeah!” said Kameron.

  Kaitlyn nodded vigorously at the ratty floor carpet and bit her lower lip.

  “—but I’ve never heard of that for a Pap test. And we wouldn’t do that in the family medicine centre.” Hell, we barely checked blood glucose levels at the FMC. For conscious sedation, we’d call the respiratory therapist, get the patient on a cardiac monitor, follow their oxygen saturation and blood pressure (“Take a deep breath, Mr. Lalonde. Big, big breath! Big! That’s better.”), and have everything ready to intubate in case they lose their airway completely and we have to breathe for them. A big deal for a pelvic exam. Not impossible, but you’d have to have a good reason.

  Kameron threw her arms in the air. “So useless. You’re, like, not even a real doctor, are you?”

  I ignored her. I talked to Kaitlyn. “Is there some reason you’re scared of a Pap test?”

  Tears sprang into her pale blue eyes. She blinked.

  Kameron put her hand on the examining table, crunching the paper cover while she stared at Kaitlyn.

  But Kaitlyn was making eye contact with me.

  The moment was so delicate. I knew it could blow any second, especially with Kameron the tank in the room.

  “Just give us the fuckin’ pills,” Kameron said, on cue, but I ignored her and fixed on Kaitlyn.

  Tell me, tell me, tell me, I silently commanded her.

  Kaitlyn shook her head, eyes filling with tears.

  “Great, now you made her cry. Is that what they teach you in med school?” Kameron said.

  “Kameron, could you step outside for a minute?” I asked, still holding Kaitlyn’s eyes with mine, but the older sister’s mouth opened in a silent O and she shook her head from side to side before grabbing Kameron’s hand, so I said, “Never mind.”

  Kameron patted Kaitlyn’s hand in a few short, hard strokes, the way you might pet a cat you didn’t really care about.

  Kaitlyn gulped and sniffed. Her mouth opened and closed, her thyroid cartilage (Adam’s apple) bobbed up and down, and then her eyes just kind of blanked out. Like she was a mannequin.

  “Kaitlyn?” I said. It was so abrupt, I almost thought I was imagining it. We all zone out, but this was on another order of magnitude.

  Kameron swore and stood up, hugging her sister, but also blocking her from my view. “She’s fine. She’s just, like, catatonic because you’re taking so long.”

  I tried to make eye contact with Kaitlyn, behind Kameron’s bulk, but the glimpse of her eyes were the same no-go-zone.

  “Huh,” I said. “Does she do that often?”

  “What? No,” said Kameron. She let go of her sister with one arm so she could snap her fingers in my face. “Pills. Pills, s’il vous plaît. What, do I have to get them myself?”

  She was trying to rile me up, and damned if it wasn’t working a bit, but in my gut, I knew there was something really wrong.

  “Just a second,” I said, and slipped out of the room, letting her think that I was obeying her commands. Instead, I hurried back to the conference room to talk to Dr. Levine.

  Even as I closed the examining room door firmly behind me, my ears pricked with the sound of a male voice singing a somewhat familiar song. He was a bit loud for an iPod, and as I stalked toward the conference room, the singing grew louder.

  I stepped into the room, where Dr. Levine was standing, his back to the blackboard, facing the table, his profile to me in the doorway. His eyes were closed and his head was thrown back as he sang in a high, thin voice.

  His hands conducted an invisible orchestra, swishing through the air. His voice broke slight
ly, but he held the last note, giving it his everything, before his hands dropped to his side and his eyes opened.

  Wow. Dr. Levine knew how to let loose on a Friday afternoon.

  Stan started a slow clap from the other side of the conference room, so I joined in, still shell-shocked from my encounter with the Rosenberg sisters.

  Stan said, “Way to go, man.” When I glanced at him, one of his eyelids dropped in a barely perceptible wink, but all Stan said aloud was, “Did you know Dr. Levine used to be a tenor in the Montreal Jazz Choir?”

  “Ran out of time,” said Dr. Levine, breathing a bit hard, “but once in a while, I still perform.”

  I glanced at Stan the Mouth, who smirked and said, “I always enjoy a little ‘Con Te Partiro’ on a Friday afternoon.”

  For a second, I almost wished for the despicable Dr. Callendar. At least I could count on bilious insults instead of Canada’s Got Talent. I said, “Uh, I have a patient to review. It’s kind of a strange one.”

  “Of course, of course!” Dr. Levine pulled out a chair for me near the door.

  I closed the door and sat. “Well, it’s hard to explain. I had a thirteen-year-old sister come in for the birth control pill last week, even though she hasn’t even had menarche yet. She’s planning to be sexually active, though, so at Dr. Callendar’s request, I gave her two months’ worth and booked her another appointment for her Pap. Only today, it’s her fourteen-year-old sister who showed up. This one, Kaitlyn, is actually sexually active and has regular periods, with no contraindications, but...”

  “But what?” asked Dr. Levine.

  “I don’t know,” I said. “She’s terrified of a Pap test. Started to cry and then just kind of...blanked out. Her sister swore at me.”

  “Hm,” said Dr. Levine. “Well, lots of young girls don’t like Pap tests. Has she ever had one before?”

  I shook my head.

  “If they feel very uncomfortable, I refer them to a gynecologist.”

  “Okay,” I said slowly, “but I’m concerned about this. She actually asked for conscious sedation for a Pap.”