My favorite part of rural medicine is getting to see and do so much. In a lot of clinics stitches and other small procedures would get passed onto PAs or interns, births would be handled by OB/GYNs and children's well checks by pediatricians. Here in La Push I get to do it all. The reservation has a small population and we get a few patients from neighboring towns and reservations, even with the low numbers, we keep busy.
The next patient in the waiting room is a 26 year old Quileute man with a laceration on his right shoulder. My heart skips a beat when I see his name on my screen, Jacob Black. It's been 10 years since he left me at the movies and stopped returning my calls. His father said he had mono but I never heard from him again. He wasn't the reason I chose a residency in La Push, but the thought that our paths might cross didn't deter me from taking it either.
Our one and only medical assistant already has him in the room and is preparing him for stitches. I can hear her taking a brief medical history while the blood pressure machine takes it's reading. Steadying myself with deep breath and I knock on the open door.
"Hi Jacob, my name is Dr. Swan, I'm going to be taking a look at your shoulder and then stitching you up if that's okay." I say, avoiding his eyes.
"Bella?" Jacob asks, trying to place me in his mind.
I stand behind him and start my exam. When I am thoroughly pleased with the exam and cleaning of his wound I begin stitching his wound closed. I try my best to focus on the task at hand and not his toned body and smooth dark skin beneath my hands.
"How did this happen?" I ask, it is important for me that I get a full and honest history, no matter the patient I want to be able to rule out domestic abuse and illegal activities.
"I was helping my sister roof her house, a blade fell and cut my shoulder. It was an accident. No foul play or dangerous activity. I promise" he says.
"Bella, I'm sorry I left the way I did. I never should have listened to my dad and ignored your calls. I got so wrapped up in things with the tribe I guess I lost our friendship. I'm truly sorry"
"That was a long time ago Jacob. It won't affect the treatment you get" I say as I tie off the last stitch. "I'd like to see you back in a week to remove the stiches. Sue will be back into to discharge you, take care" I say, walking quickly from the room without making eye contact.
I'm barely out of the room before I start to break down, my breathing is rapid and I am on the verge of tears. Thankful that he is my last patient of the day, I grab my things and head for the break room to make myself some dinner and a cup of tea. Seeing Jacob stirred up more feelings than I would like to admit.
The way that my residency is set up I spend Monday night through Thursday on the reservation and Thursday night through Monday in Port Angeles. I will spend the next two nights in the female on-call room on the second floor. As the only female doctor the reservation has ever had I have the on-call room to myself and I have for the most part made it my home. The clinic is open from 0700-1700 Monday through Friday, but someone is here 24/7 all one needs to do is ring the doorbell and the doctor on-call will get a page.
After eating a quick dinner I have settled into bed, in my pjs with the charting I have been putting off all day. On the nights when I am not here, Dr. Freedmen is on-call. He typically eats dinner with some of his friends on the res and doesn't come back to the clinic until late. He has built a life and made friends here, I hope to do the same, but I haven't yet. Dr. Freedmen tells me as long as I have my pager and stay on the res it's fine to leave the clinic. Even with his permission, I don't like to leave for too long.
By 9:30 I am ready to call it a night. I have another early day tomorrow. My light has been out for barely 10 minutes when my pager goes off. It's rare to have someone calling at this hour. In my four years I have only had a handful of overnight pages. I stumble out of bed, turn on the light and pull on a fresh pair of scrubs. I flip on all the clinic lights as I make my way to the front door. I am shocked when I see who is standing on the other side of the door.
Jacob is holding a small baby in his arms. The baby has dark hair and Jacobs eyes. I recognize him instantly as Zeke, a 5 month old baby who I helped to deliver. His mother Rebecca was one of first pregnancies I followed solo. One thing I know for sure is that Jacob is not Zeke's father. I open the door and usher them into the lobby.
"My nephew Zeke isn't breathing right!" Jacob excalimes, pressing Zeke into my arms.
He is right, Zeke's breathing is ragged and labord, but I wouldn't label it as agonal. He is definitely still receiving oxygen. I hurry both of them to our only trauma room. I lay Zeke on the table and take a listen to his lungs. He is working hard to breathe but his lungs aren't crackly, it's not pneumonia. I hook him up to a pulse ox and see that his O2 stats are lower than I would like. I put Zeke back into Jacob's arms and grab a baby nasal aspirator. Quickly suctioning the mucus out of the little one's nose. I fix a low flow O2 mask over his face, while Jacob attempts to soothe him. His stats are already coming back up.
"I'm sorry I rushed him in, I just didn't know what else to do."
"Don't apologize, that's what I'm here for" I say.
Zeke isn't calming down. His face is bright red and he's having trouble catching his breath. Nothing that Jake has tried has worked to sooth the inconsolable infant.
"Jake, does Rebecca still nurse Zeke?" I ask
"Yeah I think so, she left me prepared bottles."
"Do you mind if I look through the diaper bag?
"Not at all, especially if you think it will calm him down." he replies with tension in his voice.
After a moment of searching through the diaper bag I find what I am looking for. A bottle full of milk and a nursing cover. I place the nursing blanket over my shoulder and turn back to the bed.
"Do you mind if I try something?" I ask Jake
"Be my guest."
I scoop Zeke from Jakes arms and cradle him against me. Within moments he has calmed down enough to take the bottle. I rock back and forth gently, while feeding him. The nursing cover still carries his mothers sent, which is why he calmed so quickly. Little Zeke was just missing his mom.
For the first time since being reunited I look up at Jake and our eyes meet. I stare into the handsome chocolate brown eyes I have been missing for the last 10 years. Looking into his eyes, the rest of the world disappears, I can only see him and he can only seem me. Something in the air shifts.
When he breaks our eye contact I am overcome with emotion. Needing some air I quickly place Zeke back into Jacobs arms. Our skin brushes and sends electric currents through my body. Instantly I notice that his skin is hot, maybe even feverish.
"Jacob you're burning up. Do you feel okay?" I ask, forgetting that a moment earlier I wanted to run.
"I'm fine. It's nothing." he says in a short tone.
"I'm serious, let me take your temperature. I also need to check your shoulder, it could be infected" I say already moving in the direction of my tools.
"Look at my shoulder if you must, but a thermometer is really unnecessary."
He lifts his shirt over his head, exposing his shoulder and his toned chest and abdomen. I had forgotten how handsome he was. I begin examining his laceration. The stitches I placed earlier are still there and I see no obvious signs of infection. Yet I can't wrap my head around how fast his injury seemed to heal. The wound appears as if it is 5 days old, not five hours.
So as not to alarm him to my findings, I simply suggest that both he and Zeke come back for follow ups tomorrow. Zeke's oxygen is normal on room air, the dose of decongestant should help his breathe and sleep well tonight. With this, I feel comfortable discharging both of them.
"Promise me you'll both come back for follow ups tomorrow?" I ask, catching Jake's eye again.
"Of course"
When I close the clinic door behind them an unfamiliar feeling creeps into my mind. It feels as though a piece of me is missing. Even in my agitated state I am able to fall asleep, I dream of Jake. We are riding the motorcycles we built together, my body is pressed against his back and heat is radiating off of him. Just as it was tonight. When I wake, the same unwhole feeling is back, my only solace is knowing I will see Jacob today.