The Queen of Hearts(81)

“Right. Here you go, Mom. Let’s have you hold him on your lap. Yep, good. Can you hold his arms too? Great,” barked Dr. Tamara. I stood at the ready, armed with the nasal speculum, curious to see the extraction technique. As lowly a procedure as this was, it was still something I wanted to do competently, and I’d been baffled by how to accomplish it. That sucker was way up there.

“Okay, Zadie, wave your equipment around in the air. No, bigger,” instructed Dr. Tamara. Baffled, I did as instructed and began pinwheeling my arms, dragging the forceps through the air like a demented little airplane.

Dr. Tamara eyed me with what looked suspiciously like amusement. “Great. Now maybe add in some zoomy noises,” she said.

“Whoosh,” I said, feeling ridiculous.

Nose Bean stared at me, so captivated he forgot to yell. Quick as a wink, Dr. Tamara leaned in and kissed him hard on the mouth. The bean shot out of his left nostril and hit the floor with a tiny clack. Dr. Tamara picked it up and handed it with a flourish to the mom, who immediately let it drop back to the floor.

“Wha— How did you do that?” I asked as soon as we’d left the room.

“You forcefully exhale into their mouth while occluding the other nostril,” said Dr. Tamara. “Normally you have the mom do it, but did you see the size of the canker sore on that ho’s lip? Kid was better off with me. I’m celibate.”

Well, any reply to this statement would be fraught with potential missteps, no? Agreeing a herpes-infested crack ho wasn’t fit for kissing seemed easy enough, but wasn’t it kind of judgmental to assume Nose Bean’s mom was actually that degenerate? And there was no good way to touch the celibacy declaration. Maybe honesty was the best policy.

“I really cannot think of what to say here,” I confessed.

“Yeah, sometimes I overshare,” said Dr. Tamara. “Anyway. Moving on. We’ve got a call from radiology.” She gestured with a thumb toward the radiology outpost in the center of the ER work area. “They’ve got something for us,” she said.

Inside the dark little cave, there was an ambient glow from the ghostly reading screens. This gave the radiology guys a slightly vampirish appearance, like they might shriek and fall over clutching their chests if exposed to the harsh brilliance of the ER proper or, even worse, the outdoors. Our summoner stood up from his chair when we entered, continuing to murmur into a black dictation device as he motioned us over to the gleaming wall. It was covered in rectangular black films, each of them subdivided into smaller images of blacks and whites and grays. This must be the scan of the gentleman who’d been coughing blood.

“George Chang,” said the radiology resident, setting down his microphone and extending his hand to me. He was a trim Asian guy in a button-down, with little owl-eye glasses perched neatly on his nose. “And who might you be?”

“I’m Zadie,” I answered. “I’m a third-year student. This is my ER rotation.”

“And they turned Dr. Tamara loose on you? How are you holding up?” he inquired, his gaze mischievous.

“Well, I—”

“Georgie, you perv, stop hitting on my med student.”

“You can’t blame a man for trying.” He smiled, shrugging. “Seriously, Zadie. Are you free for dinner?”

Dr. Tamara was firm. “I mean it, George. We are busy saving lives here. Move on.”

George lost the smile, turning toward the films on the board. “It’s really bad for this patient, Alanna.”

I looked at the incomprehensible films while Dr. Chang was talking. “. . . soft tissue attenuation, with these scattered well-circumscribed lesions in the lung periphery. And you can see, there are extensive liver mets too. Guy is all eaten up.” He pushed his glasses back up absentmindedly.

“Shit,” said Dr. Tamara. “This sucks.”

“Yes. And, actually, the primary could be colorectal. He’ll need a workup, of course, but that’s my guess.”

“How the hell did we miss this on the plain film?”

“Oh, we didn’t,” said Dr. Chang, sounding surprised. “That’s his X-ray hanging next to the CT. You can plainly see the outline of these larger nodules. Don’t you ever look at my reports, Sensei?”

“I thought I’d rely on the third-year med student’s reading, Georgie. You hedge too much.”

“Oh no,” I said, feeling my face betray me with a hot blush. “Oh, I am so sorry. I don’t know what I did. I must’ve looked at the wrong X-ray.”

“You wouldn’t be the first to do that,” said Dr. Chang kindly. “It’s a good lesson to learn early. Always double-check the names. You don’t want to send this guy home with an ‘all clear’ and tell the guy in the next room he’s got metastatic cancer and a few months to live.”

“No, I don’t,” I agreed fervently. “But, oh my God. Does he have months to live? He’s forty.”

“Well, let’s not jump the gun here, George,” Dr. Tamara interjected. “We’ll get him admitted and biopsied and let the onc guys get started with all their toxic potions and shit. Zadie, we need to talk with him.”

“What are we going to— I mean, how do you tell him something like that?”

“I’m going to let you tell him.” Dr. Tamara studied the films as she spoke. “But I’m a strong believer in just coming out with it. Don’t use a lot of euphemisms or half the people you’re talking to will be clueless from the get-go. Same thing for telling folks someone croaked. You really need to say ‘died.’ No one will hear a thing you say after that either, so if you have other information to give, you gotta get that in first.” She rocked up and down on her heels. “Okay, I’m done with the pearls. Let’s roll.”