Chapter 58: Back to Work
June 6
One consideration Amelia and Owen had failed to recognize when they planned Amelia's return to work was that returning in June meant returning during summer break. Suddenly, all the hours of supervision covered by the school were times when someone needed to keep track of Nolan, Ryder, and Olivia. At 4, Olivia could still go to the hospital daycare. Although the boys could also go there in a pinch, neither wanted to hang out in a baby or preschool room with a bunch of little kids.
After pulling out the multi-colored grid, Amelia decided to return to the hospital for just 20 hours/week during the summer. That allowed Lynne to stay at 40 hours a week and limited the amount of time that any one adult was alone with all 5 kids. Owen insisted that they try the routine for a few weeks, knowing that they could reassess and reconfigure if needed. Between the hours he, Lynne and Amelia would end up alone with all five kids, he was skeptical that the plan was do-able from the perspective of any adult maintaining his or her own sanity.
The revised schedule still included 7-hour shifts for both Owen and Amelia on Mondays and Tuesdays. Owen's hope was that there would be ample opportunity to meet up in on call rooms. Amelia's hope was that she could easily pop up to daycare to see the girls on those days. To one another's face, both shared the hope that they could share lunch those days.
As Amelia thoughtfully put her med coat on in the Attendings' Lounge, she couldn't help but feel as if she were some sort of imposter impersonating a doctor. Her days of rushing critical patients through the halls and into ORs seemed so far in the past. She wondered if she'd accidentally wipe off a colleague's face or begin speaking in baby talk spontaneously. This life – this doctor role – nearly seemed foreign.
As she stepped into the hallway and made her way to find Derek, everyone she encountered stopped and welcomed her back. The more adult conversations she had; the more Amelia relished in the opportunity to return to the hospital. As she strolled down the hall, her pager sounded, and she jumped in surprise. She reached for it and saw that Derek was calling her down to the ER. She ran toward the elevator and headed to the pit. It was time to shift into 5th gear.
"Karev, take bed 2 – 5-year-old with possible broken ankle. Edwards – basic neuro exam on beds 3, 4, and 7. Torres – you're needed in Trauma 2, Avery – what's the status in Exam 3?" Owen hollered out as he saw Amelia and nodded to recognize her presence. She smiled widely. Owen didn't have time to smile. He headed back out to the ambulance bay to meet the next ambulance. Deflated, Amelia's heart sunk. She'd been living in a world of caring conversations and not rushing. She would need to recalibrate to the fast-paced realities of the ER, where results mattered far more than relationships.
Amelia stood still for a split second, attempting to recall what to do in a time of chaos. Derek ran by her and yelled, "Amy, get over to Trauma 2 and review the head CT. Then I need you in Exam 3 – rule out TIA. We're backed up. Hustle." Amelia thought to herself, Welcome back, sis, so great to see you. Boy am I glad to be working with you again. She walked over to the Nurses' Station and grabbed the chart for Trauma 2, then proceeded to enter the room.
The floor of Trauma 2 was nearly flooded with blood as the patient's leg hung loosely together and a complex compound fracture presented itself for all to see. Amelia bracketed out the scene as she met Edwards at the patient's head, "What have we got, Edwards?" Amelia asked.
"Portable CT over by the x-rays of the leg. Pupils reactive and equal," Stephanie reported.
Amelia walked over to the scans and immediately spotted multiple large bleeds. "Torres, how soon are you ready to transport to the OR?" Amelia asked.
"Yesterday. Waiting on you," Callie snapped.
"Then let's move. Edwards – call up for an OR and tell them we're on our way," Amelia ordered as she grabbed the scans so they would be available in the OR.
In the hallway as the team rushed to the elevators, Derek spotted Amelia with the patient. "Amy, what are you doing?"
"We've got multiple bleeds and a limited time to address them," she explained.
"I've got it," Derek insisted. "Stay down here and check out Exam 3 then manage any other neuro consults. No surgeries today unless you're assisting." Derek offered his last sentence with a pointing finger as the doors to the elevator closed. Owen, nearby, overheard and agreed with Derek's instructions but could see that Amelia was livid.
She took in a slow, deep breath and mumbled to herself, what am I, a 2nd year resident? I can't operate on my own? This is ridiculous. Welcome back, Junior Doc.
"Shepherd-Hunt," Owen called out.
"Yeah?" Amelia responded as she shook herself back into the present space and moment.
Owen guided her over to a corner where nobody else would hear him, "Be as pissed as you like, but keep your commentary to yourself. Bitching and moaning in the hallways is out of line and doesn't do anything positive for morale. Hit Exam 3 then meet me at Bed 3. We're stacked up and running behind."
Although she was ready to slap him, Amelia nodded at the Head of Trauma who, for the moment, was her boss and not her husband. As she walked to Exam 3, she heard Owen call out, "Edwards, what's the status on 7? I need an update. Kepner, how's the board? Wilson, let's head over to the bay." Amelia did not want to admit it, but she was ready to sit down and take stock. The frenzy was overwhelming her, and Owen's insensitivity hurt her. Her feelings, not the usual experiences of Dr. Amelia Shepherd-Hunt, Neurosurgeon, only served to frustrate her and caused her to wonder who she'd become.
Entering Exam 3, Amelia found an older gentleman in his mid-80s gazing at the wall, grinning peacefully, and appearing lost in his thoughts. A nurse's assistant was obtaining vitals as the patient happily cooperated. After quickly reviewing the chart, Amelia began, "Mr. Strauss, I'm Dr. Shepherd-Hunt. Looks like you had some dizziness and double vision earlier?" She proceeded to flash her pen light in his eyes and to examine the patient as she spoke to him.
"Yes, then I fell down but that nice lady doctor with black hair said nothing is broken," Mr. Strauss responded.
"That was probably Dr. Torres. When you fell down, was there a loss of consciousness?" Amelia questioned as she peered at the assistant's notes to review SATS.
"Well, ma'am… I don't remember falling or hitting the floor. I was walking down the hall to work on the puzzle in the library and to meet my Elsie. Next thing I knew, I was looking up as my friends and the paramedics looked down at me."
"Have you eaten much today, Mr. Strauss? Any feelings of nausea? Numbness? Confusion? Pain?" Amelia rattled off too many questions at once.
"I've eaten fine. No more confusion than any other day for an old guy still chasing the ladies," Mr. Strauss joked with a grin.
"Good to note," Amelia smiled. "How about pain? Or numbness?"
"No. Neither of those. Stomach was a little upset since I woke up. Uncomfortable but not painful," Mr. Strauss explained.
Amelia looked at the assistant and ordered, "Let's get an EKG and EEG underway and find a resident to assist me, please."
The assistant responded, "Yes, Doctor," and left the room.
"So, what kind of doctor are you, Ma'am, besides a smart one? I can tell you're smart," smiled Mr. Strauss gently.
"I am a neurosurgeon. I'm going to take a look at the electrical activity in your brain and order a CT to see inside your head. The cardiologist will be in shortly to review your heart activity," Amelia explained as Wilson entered.
"You needed a resident, Dr. Shepherd?" Jo confirmed.
"Yes. Wilson, let's get both an EEG and an EKG going on Mr. Strauss. Page cardio once the EKG is underway. Let's also draw some labs – Chem 7, CBC, standard tests to review neuropathy. Obtain a full history - maybe you have an intern who can assist with that? Page me with blood and EEG results – whichever comes in first," Amelia ordered. Jo nodded and introduced herself to Mr. Strauss. Amelia assured Mr. Strauss she'd be back to check on him soon.
Stepping out of the room, Amelia saw Owen heading toward her. He looked perturbed and impatient. "I've been waiting for you at Bed 3," he growled.
"I was just heading over. How can I help?" Amelia asked nicely as she ignored Owen's tension.
"Where the hell have you been?" Owen snapped.
Amelia looked Owen in the eyes and retorted, "I've been examining Mr. Strauss and assessing the possibility of stroke."
"You took so long in there that I paged Nelson. He was able to answer his page, examine my patient, weigh in, and take the patient to surgery in the time it took you to shake someone's hand and ask a few questions," Owen held his gaze toward Amelia with a look of frustration.
"Owen, I don't have…" Amelia began as Owen shook his head, held up his hand and ran to another Trauma room.
Amelia began to walk toward the Nurses' Station when Owen popped his head out of Trauma 1 and called, "Shepherd, we need your hands in here."
Amelia ran in and gowned up, sticking out her hands for the nurse to glove her. The patient was seizing, and Amelia ordered, "Bullets?!"
The nurse answered, "Patient arrived unconscious so we don't have an identity or history. Approximately 40-year-old female, possible internal bleeding after an MVA. Normal heart rate and temp. BP 138/90."
"Push Topamax. Has the patient been seizing or is this new?" Amelia asked.
The resident responded, "First we've seen regarding seizures. Patient was clammy upon arrival."
"Clammy?! That's the kind of information I need, people." Amelia snapped. "Crap. Hold the Topamax and push Diamox." Amelia snapped the chart out of a nurse's hand and perused it quickly.
"Add Zonegran," Amelia ordered as she flashed a light in the patient's eyes.
"Don't you mean Zarontin?" Owen barked with exasperation.
Amelia shook her head, "Yes, thank you, Dr. Hunt. Zarontin." In reality, Amelia did mean Zonegran, but Zarontin would suffice. Correcting herself in the moment was easier than entering into a debate in the middle of a trauma.
"What have we got?" Derek asked as he walked in.
Amelia began to share bullets, but Owen spoke over her, saying, "Your doc seems to have some confusion about best initial meds."
Amelia narrowed her eyes as she glared at Owen. She stepped away from the patient and threw her gown down, "Obviously, Drs. Shepherd and Hunt have this covered. All yours gentlemen."
Derek, who had truly stepped in for the bullets and not to take over, approached the patient. He confirmed Amelia's med choices and told the nurse, "It looks like the seizing is dramatically calming down. If it amps up or recurs before I return, add Zonegran. I'll be right back." Owen continued to palpate the patient's abdomen and note the obvious bruising and swelling.
Derek stepped out of the room to find Amelia, who was nowhere to be seen. "Kepner, have you seen the other Dr. Shepherd?"
"I'm pretty sure she just entered Exam 5, which is currently empty," Kepner offered with slight confusion.
Derek burst through the door to find Amelia leaning against the wall crying. He yelled, "Do not ever step out of an active trauma and assume I've got your back. I needed bullets. I was assessing neuro's overall case load. I had no intention of taking over."
Amelia wiped her eyes and pursed her lips as she stood up, "I apologize."
"Don't apologize. Just get your ass back in there and follow through with your patient. This isn't a game where we have do-overs, Amelia. Step in and do your job. I can't have you in the ER if you can't handle criticism from a non-neuro doc about your medication choices," Derek barked.
"I understand," Amelia responded. "On my way."
Amelia stepped around her brother as he ended with, "You're back in the big leagues. Be the surgeon we're used to seeing, not some overwhelmed neophyte." His harsh words struck her to the core as she forced herself to keep walking toward the trauma room.
Amelia burst through the doors. "What's the latest?" she asked as she entered the room and threw on a fresh gown.
"Seizing stopped after an initial dose of Zarontin," the resident informed her.
Owen, feeling like a jerk for his earlier words, stated, "I need to get in for an ex-lap and see what else we're dealing with."
"It'll have to wait. I need a head CT STAT and vitals every 5 minutes. As long as the patient is stable, we have some time," Amelia ordered. "I'll meet you up in the OR," Amelia told the resident.
The resident and two nurses wheeled the patient toward the elevator. Amelia ripped off her gown and threw it to the ground. Owen walked over to Amelia slowly, "Hey…"
"Stay the hell away from me, Owen," Amelia barked. "If we end up performing simultaneous surgeries, so be it. Otherwise, I have nothing to say to you right now."
"Amelia," Owen said loudly as she turned away from him. Calmly, he requested, "Please turn around and talk to me."
"I'll see you in the OR, Dr. Hunt," Amelia snapped as she stepped out of the Trauma Room. Her body was shaking just under the surface and her breasts were hard and swollen with milk. She wanted to find a quiet and peaceful corner where she could simply fall apart or hold her babies.
Derek was running toward the elevators alongside a patient when he saw Amelia leave Trauma 1 and asked, "What's your status?"
"Awaiting a CT. Guessing I'm in for a long surgery to repair bleeds. Want me to keep you posted?" Amelia responded.
"No. I'll take that. You take this one. Aneurysm clip. Better and shorter surgery for your first day back," Derek instructed as Amelia sighed internally. "I'll ask Nelson to join you."
At 11:20 am, after being supervised by an inferior doctor and completing the simple aneurysm repair, Amelia headed to the cafeteria to grab something to eat. Originally, she and Owen had planned to eat together around noon. Now, she planned to grab something to go and head up to the nursery to nurse the girls.
Meanwhile, Derek and Owen worked quietly as they operated on the MVA patient. Owen eventually asked, "Did she ask to be tagged out?"
"No. I gave her an aneurysm clip and took this from her. She doesn't need this complexity on her first day back," Derek explained without looking up at Owen. He asked for suction as he analyzed a spot on the patient's brain. "I'm not so sure here. What's your status, Hunt?"
"Going well. Bleeding and repairs were minimal. Just about to close. What's your concern?" Owen asked.
"I'm having a challenging time reaching this last bleed. I need to flip the patient," Derek shared.
"There's quite a bit of risk to that, don't you think?" Owen pondered aloud.
Derek grimaced, "Yes, but so is attempting to fix this bleed without flipping. Page the other Dr. Shepherd – I'd like her to weigh in with her thoughts."
The nurse paged Amelia who had just begun nursing. "Dammit," Amelia grumbled as the page arrived. She called down to the OR as she awkwardly balanced her phone on her shoulder while feeding the babies, "How can I help you, Derek?"
"Amy, I'd like you to scrub in and take a look at my quandary. The patient you worked up in Trauma 1 has a bleed directly above C-1. I addressed the other bleeds while the patient underwent an ex-lap, which is now completed. I'm considering flipping the patient to access the bleed more easily. Vitals are stable," Derek explained.
Not wanting to state she was busy playing Mommy, Amelia attempted to brainstorm over the phone, "What if you used an ultrasound assist? Or changed the patient's angle by, say, 15 degrees? I wouldn't flip unless I absolutely had no other choice."
"Great initial insights, but I'd like to have you review the scans and the patient in person. Can you join me down here?" Derek asked.
"Sure…" Amelia responded flatly, knowing she would finish the feeding before heading to the OR. Owen looked up at the clock as he completed his final stiches. He guessed Amelia was breastfeeding, but didn't want to speak on her behalf.
After the call concluded, Owen suggested, "My hands are free. Can I assist somehow?"
"You've got an ER to run. Amy can join me," Derek confirmed as he tinkered.
"You know, in the Army, we would have wedged the patient upward with some towels or blankets and accessed the bleed that way," Owen suggested. "Let's give that a try." Owen looked Derek in the eye and held the exchange, hoping Derek might clue in. He did.
"Sounds good," Derek nodded. "Let's get some towels under the left shoulder and back. When we're ready, we're going to slowly move the patient's head to the right very, very carefully. Can someone please call off the other Dr. Shepherd? I won't be needing her input after all."
After Owen and Derek successfully fixed the last bleed, they scrubbed out and headed to the cafeteria. Owen scanned the room looking for Amelia, but did not see her. He sent a text to her phone, Still joining me for lunch? Would love to have you beside me.
Owen purchased his food and carried his tray over to a nearby table. Amelia decided not to text him right away, and Owen's phone remained silent. Derek sat down across from Owen and immediately shared his observation, "She's not ready to be back, Owen."
"It's only her first day. She'll get back in the routine in no time," Owen attempted to persuade.
Derek shook his head, "She's too unsure of herself and too slow. I feel like I have a new resident, not one of my stellar attendings."
"Give her this week, Derek. Just a couple more days," Owen urged as his phone vibrated. "Excuse me," he said as he read Amelia's text, Already ate. See you later at home.
Owen responded, ? We drove in together.
She wrote back, I know. Will see you at home. Can you take the babies with you?
I guess,Owen texted. Then he sent another text, I'm confused. Where are you going to be?
She didn't respond until 3pm, when she confirmed See you at home. Will be there by 5.
Owen stared at his text conversation and sighed. Working together after having babies was not going to be at all the same as working together before children.