Kyra was more than a little bit concerned when Joel didn’t answer the intercom. She knew that if Joel wasn’t able to buzz her upstairs, he likely wouldn’t be able to answer the door either. She needed a way to get inside.
“You have a key to the apartment, don’t you?” Kyra asked the doorman.
“I can’t give that to you, ma’am,” the doorman said.
Kyra dug in her purse and pulled out her wallet. She flashed her hospital ID at him. “Listen to me,” she said, “I’m a surgeon and Dr. Dergan called me to tell me that he was feeling very ill. I don’t care if you have to get a super to let me in or what, but I need to get into that apartment. Now.”
Everyone always did as Kyra said and less than a minute later, Kyra was riding up in the elevator accompanied by the superintendent. She noticed the way he was staring at her, but she kept her eyes on the elevator doors.
Kyra didn’t bother to knock on Joel’s door. “Open it up,” she told the super.
“Don’t you want to ring the doorbell first?” he asked, wide eyed.
“Open the fucking door,” Kyra said. He didn’t argue with her again.
The second Kyra walked into the apartment, she knew what she was going to find. She went straight to Joel’s bedroom and bound through the door. She saw the phone lying on the floor, beeping loudly, and she yelled to the super, “Call 911! Now!”
Joel was lying in his bed, his face very damp and flushed. Even his hair was wet. She could hear him breathing, but it was shallow. She sat down on the bed and rubbed his sternum with increasing pressure. “Joel? Joel, wake up!”
He groaned and didn’t open his eyes.
She checked his pulse. It was rapid and thready. There was no doubt in her mind that he was getting septic and possibly about to go into shock. He needed IV antibiotics and he needed a central line. There wasn’t much she could do for him here in his apartment. She cursed herself for not having called for an ambulance sooner, but she hadn’t wanted to overreact.
Since Joel was a quadriplegic, she could take a guess at the source of his infection. It was either from his urine or from a decubitus ulcer on his lower extremities or buttocks. She pulled the blanket off the lower half of his body and saw the catheter tube snaking out from under his boxers. She followed the tubing to the side of the bed, where the bag of his urine hung. The urine was very dark and tinged with red. Bingo.
Kyra knew that the catheter was infected and it would be best to get it out of him. She bit her lip, knowing Joel probably wouldn’t like her doing this for him, but she had to, for his own good. She pulled down his boxers and saw the catheter coming out of his circumcised penis. She gasped slightly when she saw his lower body—the bulging abdomen and the stick-like legs. She had seen patients with bodies like that, but she had a hard time connecting it with Joel. He always seemed so healthy and fit to her, even in the wheelchair.
She guessed that the catheter was likely held in place with a tiny balloon that inflated inside his bladder and she’d need to deflate the balloon before she pulled it. She hurried into the bathroom and looked around for an unused syringe. She opened the bathroom closet and saw more hospital supplies than the clean utility room at the hospital. She grabbed a box of syringes and pulled out the first one. She ran back to Joel’s side as she yanked off the wrapping from the syringe.
She used the syringe to deflate the balloon. She hadn’t pulled a catheter in years, that was the nurse’s job, but she thought she was probably doing it right. She gently gripped Joel’s penis as she pulled out the infected catheter. As it came free, some urine dripped out of his penis onto the dark sheets.
Kyra looked down at her hands and saw that they were trembling. Funny… she had performed thousands of complicated surgeries in her life, yet she was shaking like a medical student over the simple task of removing a urinary catheter.
“Joel,” she leaned over him. He wasn’t registering her at all anymore. “Joel, please hang on. Please…” She laced her hand into his, wincing at the dampness of his palm. “I’m so sorry, Joel. I’m so, so sorry…”
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Kyra rode in the ambulance with Joel, holding his hand. He became mildly arousable during the ride, but she could see that he was still very out of it. The paramedics started a line in both of his arms and started pumping in IV fluids when they saw that his blood pressure was dropping. Kyra had to use all her self-restraint to keep from barking orders at the paramedics.
“He’s not sat’ing too well, we may need to intubate him,” one of the paramedics told Kyra, as he held an oxygen mask over Joel’s face. “Would he want that if his oxygen drops?”
The question made Kyra furious. “He’s only 34 years old. Why wouldn’t he want that?”
“Some people with severe disabilities—”
“Listen to me,” Kyra snapped. “This man is a doctor. You better do everything possible to save his life or you will never work in the medical field again.”
The paramedic stared at her, shocked by her words. He looked like he was going to respond, but then thought better of it.
Kyra was dismayed when the ambulance took them to the hospital where Joel worked. She wished she had specified to take him to another hospital, even though this one was the closest. She guessed that Joel wasn’t going to like getting his medical care at the same hospital where he worked.
As soon as they reached the hospital, Joel was immediately whisked away to an ICU bed and Kyra was told she couldn’t come with him. “Are you his wife?” a nurse asked her.
“No… I’m not,” she admitted.
The nurse shook her head. “You’ll have to stay in the waiting room.”
Kyra went out to the waiting room and plopped down in a chair, exhausted. She had called her secretary from the ambulance and had her own surgeries canceled for the day. She wanted to be here with Joel, in case something happened.
The waiting area for the ICU was a somber environment. The people were grouped into family units, usually with one or two members teary-eyed and being comforted by someone else. Kyra was the only one who was here alone. I’m 34 and I have nobody, she realized. And neither does Joel.
After about an hour or two, Kyra was approached by a young man in a white coat that covered blue scrubs. He looked like he was a medical resident. “Mrs. Dergan?” he asked.
“Actually, I’m Dr. Manning,” she said. “I’m a friend of Dr. Dergan.”
“I see,” the resident said. He look like he was debating how much to say. “He seems to have stabilized for the time being.”
“Did you have to intubate him?” Kyra asked.
The resident nodded.
Kyra bit her lip, “You have a central line going?”
“We put in a subclavian line,” the resident told her. “We’re giving him some pressure support and we’ve got him on broad spectrum IV antibiotics. His urinalysis was very dirty so we’re thinking that’s the source of the infection. We’re doing all we can.”
“I see,” Kyra said, narrowing her eyes.
The resident hesitated, “I… uh, I worked with Dr. Dergan before. He’s a really amazing doctor. I’m sure he’ll be okay.”
“He’d better be,” Kyra said. She knew how serious septic shock was and she wasn’t going to put too much stock in the words of this young resident. “Young man, I’d like to speak with an attending. Right now.”
“Uh… we’re kind of busy with—”
“What’s your name?” Kyra interrupted him.
The resident stared at her with wide eyes. He didn’t know what he was in for. “I’m Dr. Parker.”
“Well, Dr. Parker,” Kyra said, “when you’re addressing an associate director of surgery, the words ‘too busy’ should not be in your vocabulary. I want to have a talk with the attending this instant. You got me?”
The resident didn’t know what to say. He mumbled the words “I’ll be right back” then hurried into the ICU. Kyra knew she was being harsh, but sometimes these kids needed to know who was boss. Medicine residents really got coddled in her opinion.
A few minutes later, Kyra was face to face with a tall, silver-haired man with an easy smile and a long white coat. Even in Kyra’s heels, the man had a good six inches on her. “Hello, I’m Dr. Petrovich,” he said, holding his hand out to her.
“Dr. Manning,” she replied, taking his hand. “How is Joel?”
“He’d be much better if he hadn’t waited so long before seeking medical care,” Petrovich said. He shook his head. “I would have thought Joel would know better than that.”
“The resident told me he’s stable…”
“He’s stable but we have him on quite a bit of pressure support,” Petrovich said. “Obviously, we’re doing everything we can for him. He’s one of our finest physicians and someone I respect very much. I hate to see him like this.”
Kyra had more questions, but a lump rose up in her throat and she suddenly no longer trusted herself to speak. “Can… can I go inside?” Kyra asked.
Petrovich squinted at her. He must have known that Joel wasn’t married. “You’re his… girlfriend?”
“I’m a friend,” she corrected him. “We’ve known each other for many years.”
Petrovich hesitated another moment, then nodded and led her to the room. The ICU rooms were lining the circular corridor, one bed to a room. The walls were made of glass so that the nurses could keep an eye on the patients. Joel’s room was right next to an obese old man who looked like he had put up permanent residence in the ICU.
Joel was lying in bed, his face still damp and flushed. He was intubated and Kyra could hear the rhythmic noises of the ventilator as he pushed air into his lungs. He had IV’s in both arms and a line sewn in place near his neck. She looked down at his legs and saw the sequential compression devices working to keep blood moving in his lower extremities.
That was when Kyra lost it.
She began crying almost hysterically, burying her face in her palms. Her shoulders shook in big, wracking sobs. She hadn’t cried in such a long time. The last time she could remember was the day that Joel broke up with her six years ago. Even though she had seen it coming, it still hurt like hell. She had wanted to spend her life with this man.
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Ann was just as surprised as the rest of her team when the attending who showed up for rounds in the morning was a tall man with graying hair and a full beard. “Hello, I’m Dr. McKenna,” he said. “I’ll be covering for Dr. Dergan for a while.”
“Where’s Dr. Dergan?” Ann asked.
“Dr. Dergan was taken to the ICU by ambulance this morning,” Raj told the team.
Ann could see the shock registering on Cody and Sheldon’s faces. She felt her own stomach sink. What had happened to Joel? How could he be in the ICU? He hadn’t looked that good the day before, but she didn’t think he was physically ill.
“What happened?” Cody spoke up. Ann noticed there were tears in her eyes. Cody adored Joel.
“He went into septic shock,” Raj said. “He’s intubated up in the ICU.”
“Can we visit him?” Cody asked.
Raj shook his head. “Better you don’t. They don’t want his room to get too crowded with visitors, and from what I’ve heard, he’s completely out of it anyway.”
Dr. McKenna was pleasant enough. He listened to the presentations, nodded his head, and made occasional suggestions. He didn’t grill anyone with questions or make any effort to teach them. There was less tension than there was when Joel was leading rounds, but less energy too. Dr. McKenna seemed especially uninterested in teaching medical students—he didn’t even ask Ann her name.
When rounds were over in a record time of one hour, Dr. McKenna nodded at the team, “Good job, folks. I’ll see you tomorrow.”
“That’s it?” Ann whispered to Cody.
“Not every attending cares about teaching as much as Dr. Dergan,” Cody sighed. “I’m not a big fan of Dr. McKenna, but what are you gonna do?” She bit her lip. “Hey, do you want to try to see Dr. Dergan?”
Ann raised her eyebrows. She wanted to see him more than anything right now. “Raj said we couldn’t…”
“Screw him,” Cody said. “We have white coats… nobody will stop us.”
Ann had never been to the medical ICU of the hospital. It seemed cleaner than the rest of the hospital—more sterile. There were more nurses and more machines. Every room was filled with equipment and beeping noises. Ann wanted to grab onto Cody’s arm for support.
“Act like you know where you’re going,” Cody whispered to Ann.
They strode forward purposefully as Cody checked each room. Finally, near the end of the hall, she grabbed Ann’s arm: “This is it!”
Now that she was here, Ann didn’t want to go inside anymore, but she followed Cody rather reluctantly. The first thing she noticed was the tube coming out of the side of Joel’s dry lips. She heard a rhythmic blowing sound and with each puff, his chest would rise. His eyes were slightly open and she could see the small crescents of his light brown irises but he didn’t seem to be aware of his surroundings.
“Dr. Dergan?” Cody rubbed his shoulder. He didn’t respond.
Ann was in shock. Just yesterday he seemed completely fine. Now he seemed like he might never wake up. “Is… is he going to be okay?” she asked dumbly.
“I’m sure he will,” Cody said. “I mean, he’s young…”
Cody was looking at the ventilator settings when a redheaded nurse burst into the room. “Dr. Hwa! What are you doing in here?” she demanded.
“Oh, hi Sandy…” Cody smiled guiltily. “We’re uh… consulting?”
The nurse shook her head and took Cody by the arm. “Nice try… no visitors right now. Dr. Dergan is very sick and he can’t have the whole hospital coming into his room!”
Cody obediently left the room and Ann followed. She almost wished she hadn’t come along. It was painful seeing Joel like this and she didn’t think she’d forget it for as long as she lived.
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The morning after Joel was admitted to the ICU, Kyra went back to her apartment just to shower and change clothes before going back to her hospital vigil. She noticed that her hands were shaking as she turned her key in the lock. Yesterday had been a difficult day and Joel was still unstable. He was still on the ventilator and still running a temperature. She wanted to get back to the hospital in case anything happened and he needed her.
Kyra tried to ignore the blinking light on her answering machine as she searched in her dresser drawer for a clean shirt, but she finally gave in to temptation. She heard Dr. Timothy Potter’s voice blaring out at her: “Kyra? It’s Tim Potter. I know you called in sick yesterday, but I need to talk to you rather urgently. I’ll be in my office all morning today.”
“Shit,” Kyra said aloud. She could tell by the tone in Potter’s voice that this wasn’t good news.
Kyra took a five minute shower and threw on a blouse and jeans, without bothering to blow dry her blond hair. She knew she looked unprofessional, but she didn’t care anymore. Nothing seemed to matter right now.
Kyra had learned from Joel’s mistakes and had chosen an apartment only minutes away from the hospital. Considering most of her life was spent there, it made sense to live nearby. From her parking space in the garage, it took her about two minutes to sprint to Tim Potter’s office. She arrived at his door with her thin face flushed, her shirt untucked, her damp hair disheveled.
“My god, Kyra, are you okay?” were Potter’s first words when he saw her.
“Fine,” she gasped, trying to catch her breath. Damn cigarettes were destroying her stamina. She wanted to get this over with and get back to the hospital. “I’m fine. What’s this about, Tim?”
“Have a seat, Kyra,” Potter said.
Kyra took a big gulp of air. “No, I think I’ll stand, if that’s okay with you.”
“I got a call yesterday about a cholecystectomy patient named Brewster,” Potter began.
It took a few seconds for the name to register, but as soon as it did, Kyra felt her heart sink. Fuck! That was Joel’s patient, the one she left the towel in. This was bad, really bad. She had known she’d be hearing about that patient sooner or later, but now was the worst possible time. She couldn’t deal with this right now.
“This is a big deal, Kyra,” Potter said.
“I know,” she said. She lowered her eyes.
“And… considering your recent history…”
She braced herself.
“I think it would be best if you went on unpaid leave while we sort through all this,” he said.
She nodded. It could have been worse, she supposed. He could have fired her on the spot. It wouldn’t have been unwarranted.
“And in the meantime, I would suggest you seek counseling,” he added. “I understand if you don’t feel comfortable discussing your problems with me, but it’s clear that you’re dealing with a lot right now. I have some names of therapists in the area if you’d like…”
Kyra gritted her teeth as she accepted the list of psychologists that Potter handed her. She knew in her heart that her unpaid leave would be end up being permanent and she would not be coming back to work at this hospital.
Yet she was surprised by the lack of emotions she felt. She remembered her ex-husband’s Paul’s words to her during a particularly brutal argument: Nothing will ever be more important to you than your career. But he was wrong. Her career was unraveling before her eyes, but the only thing she could think of was Joel lying in that ICU bed. Seeing him again after all these years made her realize how much she had lost when he had fallen asleep behind the wheel and crashed his car.
And she knew that if she lost him again, it would destroy her. She couldn’t let that happen.