Disclaimer: I don't own Twilight, and am not making any money off this.
Author's note: Like Dr. Carlisle, I work in emergency medicine (and love it). Unlike Dr. Carlisle, I work in a prehospital environment, so I might have made an error or two when it comes to how emergency rooms work. Some of the patients are based on patients I've had over the years, but everything is HIPAA-compliant. I'm going to put a quick "glossary of terms" at the beginning of each chapter for the non-medical amongst you. If you have any questions leave them in the reviews and I'll answer them at the beginning of the next chapter. Also, don't tell my coworkers I wrote Twilight fanfiction because I'll never hear the end of it.
Glossary:
Thrush: refers to an oral candida overgrowth, basically a yeast infection in your mouth. Can happen as a result of antibiotics disturbing your internal microbes.
Obecalp, nacl: "Placebo" spelled backwards and NaCl (sodium chloride, saline solution) respectively.
Otoscope: The pointy scope with the light that the doc uses to check your ears, nose, and throat.
"Mrs. Beckins, I understand your concern, and I sympathize with your son's condition, but I can assure you that antibiotics will not help with a viral cold," I said to the frowning woman clutching her son on the bed in front of me. "The cold will run its course in a week or so, and he'll have a cough for up to four weeks, and then he'll be right as rain."
Mrs. Beckins's frown deepened. "Are you sure he has a cold?" she demanded. "You didn't even test for strep!"
"Your son doesn't have a sore throat," I explained. "Strep always presents with a sore throat. I can assure you, it's a cold." Plus, if he'd had strep, or any other bacterial malady, I would have smelled it the moment Jeremy Bekins started coughing on me.
"I still think he needs antibiotics," Mrs. Beckins insisted. "When I had a cold last year, I took some of my husband's leftover antibiotics and it was gone in a week. I don't want my Jeremy to be coughing up a lung for a month."
I had seen people cough up lungs. Or bits of them, anyway. Tuberculosis will do that to you. Jeremy wasn't coughing up anything except respiratory droplets teeming with more viruses, ones that I, fortunately, was immune to. I was not, however, immune to being annoyed that Shari Beckins had brought her child to the emergency room for a cold.
I tried a different tactic. "Mrs. Beckins, antibiotics are fairly serious drugs. You don't want your son to develop thrush or gastrointestinal problems just to get rid of a cold faster, do you?"
"Ha! They do get rid of a cold faster. I knew it!" Mrs. Beckins crowed. "The ones I took started with a V. It was something like victorsmicin. I want a script for that."
She probably meant vancomycin, one of the stronger antibiotics used for serious infections, which made it all the more worrisome that Mr. Beckins hadn't finished his prescription.
"I don't think that that would be helpful for a cold," I said.
"Well then what would?" she demanded.
"Rest, fluids, tylenol if the fever comes back. Most children's cough syrups and decongestants don't work, though some people have success with honey in children older than one."
"No, he needs antibiotics," she insisted.
A man of lesser morals would have longed for the days when it was more acceptable for physicians to prescribe "obecalp," or give shots of "nacl," and tell the patient that they would get better soon. It was unethical and a breach of trust, but I knew for a fact that it had made certain patient encounters a lot shorter than they otherwise would be.
"Well?" Mrs. Beckins pressed. "Are you going to write the script or not?"
"I'm afraid not," I said. "Your son's cold will go away on its own. Follow the instructions in the discharge paperwork, and you can follow up with your primary care provider if you still have concerns." I gave her my most charming smile.
She deepened her frown until I thought she might sprain a facial muscle. The charm doesn't work on everyone, apparently.
"Do I get a sticker?" Jeremy asked.
"I'll have the nurse bring you one when she gives your mom the paperwork," I told him. He deserved two, for putting up with that nightmare of a mother.
I quickly stepped into the hallway, Mrs. Beckins's squawks of "needs antibiotics" and "medical malpractice" fading behind me. I brought up my patient's chart on the computer and began rapidly, but not too rapidly, typing a note for the encounter.
"Shari in with one of her kids again?" Katie, one of the nurses, asked, clucking sympathetically.
I nodded. "The oldest, Jeremy. She wanted antibiotics for him, and I'm afraid I wasn't able to explain the situation to her liking."
"Don't feel bad," said Katie. "I don't think anything is ever to her liking. If you'd given her the antibiotics she'd have complained that they were fake antibiotics that didn't work or something. Did I tell you what she said when I tried to sell her on vaccines for the kids?"
I shook my head.
"She said that they were full of chemicals, and something about a conspiracy to give children autism. Like, what do you think's in antibiotics? And I thought we'd established by now that Wakefield is a quack and autism is genetic."
I smiled in amusement, and nodded. "Some people are reluctant to accept what's right in front of them, I suppose."
"You can say that again," Katie said, and headed for the coffee machine.
The only other patient waiting was a six-year-old male with a chief complaint of foreign object in nose. Dr. Snow, bless him, had been assigned the other two patients in the ER that night, a man with sudden-onset testicular swelling and a woman whose gangrenous foot ulcer I could smell from across the ER. I wished him luck, and headed for room five, with my hand resting on the small hot pack I kept in my coat pocket.
Inside, my patient was sitting on the bed, playing with a toy train and rubbing occasionally rubbing at his nose, no apparent distress. Looking tired and careworn, his mom sat in the chair next to him, absently stroking his back.
"I'm Dr. Cullen," I said, extending my freshly warmed hand. The boy's mother shook it and gave a weary smile, and I noticed no ring on her hand.
"Betsy Kemp. Nice to meet you." I inhaled slightly and caught a whiff of cheap makeup, store-brand laundry detergent, kids' snack food, instant coffee, and printer ink. Office worker, probably the lower end of the totem pole, trying to meet the equally brutal demands of work and motherhood, and doing it all alone. I felt for her, though I'd met people in far worse situations.
"And you must be Oscar," I said, turning to the boy.
He put down his train. "Yup. I put a tire up my nose."
"From his train," Betsy explained, gesturing at the toy. I looked down and noticed that one of the rubber washers around the wheels was missing.
"Well, let's see what we can do about that. I just have to ask your mother some questions." After confirming all the information in the chart, I put on gloves, more for Oscar Kemp's protection than my own. There were very few infections that preyed on my kind. "Why don't you lie down, Oscar. I'm going to shine a light up your nose."
"Okay," Oscar said. "Am I going to have to have an operation?"
"For this? No," I assured him, as he lay down and tilted his nose up. I took an otoscope off the wall and aimed the light up his left nostril. I could just barely see the edge of the rubber washer at the very back of the nasal cavity.
Katie had left me some hemostats in varying sizes on an instrument tray. I selected the smallest ones. "Oscar, I'm going to need you to stay very still for this part. It's not going to be very comfortable. I'm going to have to stick these tweezers—" I showed him the hemostats, "—up your nose to get the tire out. Can you hold still for that?"
"Uh-huh," Oscar said. Betsy leaned forward and gave his hand a reassuring squeeze.
I leaned over and, otoscope light still in my left hand, I slid the tweezers up Oscar's nose and snagged the rubber washer. Oscar whimpered as I pulled it out, but honored his promise to hold still. With a small smile, I held up the mucus-covered washer for him and Betsy to see.
"Wow!" Oscar declared. Before I could stop him, he grabbed the washer from between the hemostats, wiped it off on his shirt, and stuck it back on his toy train.
"Oscar, no, that's…" His mom abandoned the rebuke. She turned to me. "It's good for kids to be around some germs, right? For their immune systems?"
"That's a current theory, yes."
"We good to go?" She suddenly looked exhausted.
"I'm going to have a nurse print out your discharge paperwork, and then yes, you're good to go."
"Thank you," Betsy said, relief written all over her face. Then she winced. "Jesus. How much is this going to cost?"
Even after three hundred years, I still shuddered internally at what my father would have done to some who'd taken the Lord's name in vain like that.
I shook it off and said, "Don't worry about it. You've got insurance, and if the claim is denied the hospital has a very generous budget for forgiving medical debt. Most people only end up owing the copay." I didn't tell her that the budget came from a nonprofit I'd set up years ago, when I'd gotten tired of seeing people bankrupted by car accidents and cancer and childbirth complications. It was only proper. Even as far back as the Code of Hammurabi, it was understood that the rich should pay the doctor more because he cannot charge the poor.
"That's a relief. Thanks, for everything." Betsy put her arm around her son, who was happily spinning the wheels on his toy train. I threw away my gloves and went to see about the discharge paperwork.
My shift was almost over. Dr. Caldwell would be relieving me in about ten minutes. I hadn't saved any lives that night, but medicine, even in the age of science and evidence-based treatment, was rarely about saving lives. Every so often we could snatch someone from the waiting claws of the Grim Reaper, but mostly we were a refuge for the sick and the desperate.
And also for children with tires up their noses.
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