Wednesday, November 16, 2011


As Sylvia swept through the door into the waiting room, the receptionist called out from behind the counter.

Dr. Kris, Dr. Kris, Mrs. Beckwith is on the phone. She's having back pain again!

Sylvia paused, the bag carrying her laptop propelled forward and then snapped back on the shoulder straps. Her laboratory jacket was folded neatly across one arm and the adjacent hand held a cell phone. She was about to call the Nanny. She pushed the power button on the phone and glanced at the display.

Technically, it's after four. Give it to Dr. Short, he's on call!

The secretary opened her mouth to explain that the covering physician wasn't familiar with Mrs. Beckwith, but then thought better of it.

It wouldn't have mattered anyway, the front door of the office had already slammed shut.

Sylvia was gone.


The choice of practices was perfect. Sylvia could work a full schedule and still have time to cart the kids back and forth to their various activities. Hospitalists had taken over the inpatient responsibilities. Call duties were light and spread among a large group of physicians. The clinic closed at four.

Sylvia congratulated herself on finding the perfect post residency job. The work-life balance was exactly what she and her classmates were looking for. At first, she had been worried about being able to handle the more difficult patients. But she quickley realized that there were always specialists to refer to, and she could send the sick ones to the ER. And when the clock struck four, they were someone elses problem.

As Sylvia bent down to place her bag into the passenger seat, she felt a faint twinge of pain radiate down her stomach and into her pelvis.

I wonder what that was?

She quickly walked around the side of the car and got into the driver seat. Her son would be finishing soccer practice soon, and she didn't want to be late.


Upon awakening, it took a moment for Sylvia to realize that she was about to vomit. As she jumped out of bed, she felt a sharp stabbing pain emanate from her epigastrium and spread into her chest. At first her mouth watered, and then she heaved violently. Her body spasmed over and over again until she had completely emptied the contents of her intestines.

She crawled back to bed and fumbled with the phone.

Hello...hello...I need to talk to Dr. Phillips immediately.

She silently prayed that her personal physician could give her some guidance. She felt alone in the large bed left absent by her traveling husband.

Dr. Stone is on call for Dr. Phillips. Please call back If you don't hear from him within the next half an hour.

Each minute seemed like an eternity. As Sylvia watched the clock desperately, she wondered if the phone would ever ring. When she walked into the bathroom to rinse her mouth, she was taken aback by her own reflection. The whites of her eyes had turned yellow.


Sylvia watched the nurses bustle back and forth in the emergency room. The dose of dilaudid had calmed her abdominal pain, but not her anxiety. She was all alone. Her husband was thousands of miles away. Her parents were sleeping in her guest room next to the children.

She reached over to the table to check her cell phone. Maybe Dr. Phillips had returned her call. Maybe he would walk through the exam room doors like Marcus Welby, and grasp her hand and tell her that everything would be okay.

Unfortunately, the only one who came was the Surgical PA. He explained in an emotionless tone that the ultrasound showed choleycystitis. In a matter of moments the antibiotic would finish running and then it was time for surgery.

Dr. Carson is on the way. The anesthesiologist will explain everything and then we'll put you under.

Sylvia grasped for words as she felt a sense of terror rise from her belly.

But don't I at least get to meet my surgeon.

The PA's back was turned and he was moving quickly toward the door.

Sure. After the procedure.


As the anesthesiologist placed the mask on Sylvia's face, her mind raced. First she thought of her husband and children. She wished that they were by her side.

Then she thought of her parents and how they used to comfort her as a child.

But as the intense feeling of fatigue washed over her body and she started to lose consciousness, she conjured up the face of poor Mrs. Beckwith. She imagined her sitting alone in a cold room with her arm retro flexed and her hand grasping her painful flank.

She recognized the fleeting sensation of empathy.

It was something she hadn't felt recently.

Not since the early days of medical school.

1 comment:

Skeptical Scalpel said...

Interesting post, but I don't know of too many places where the surgeon would not meet/examine the patient before the surgery.

While many PAs are excellent clinicians, I would not operate on a patient based solely on a PA's evaluation.

There is the issue of informed consent, not to mention the preop "time out." The OR staff and anesthesiologist would not allow the patient to be put to sleep without the surgeon being present.

Most surgeons I know would consider operating on a patient without examining her to be unethical.