Author's Note: ER has been doing strange things with time this season: one
episode ("NICU") covered a whole month, 34 days passed between "Impulse
Control" and the next episode, and Ella had a freakish growth spurt. That
makes it hard to keep my story perfectly in synch. So, let's say this
chapter takes place about 3 weeks after the last chapter, a little while
before the episode "Forgive and Forget". The next chapter will coincide
with "Forgive and Forget". In my world, Ella is still going-on-three years
old. I haven't decided whether Susan is pregnant or not.
*****
Saturday morning . . .
'Why exactly did I want to work with this guy?' Karl De Raad thought, smiling wryly.
He was sitting in his den with Robert Romano, during their second therapy session together. The first session had been taken up by Robert's diatribe against psychiatry in general. Karl mostly let him rant, figuring this was something his colleague needed to get out of the way before he could move on. Also, the "discussion" gave De Raad the opportunity to explain the difference between psychoanalysis, which was the target of much of Robert's disdain, and the mostly cognitive approach he had planned.
For the second session, Karl steered the conversation toward what Robert wanted to change in his own life. Still, Robert kept his comments impersonal, bitching about the "mouth-breathing idiots" who staff and frequent the ER. He was relentlessly angry, dissatisfied with everything.
Karl understood that extreme negativity was to be expected from somebody in Robert's psychological state. But such was one of the pitfalls of counseling friends and coworkers: the social connection makes it hard to slip completely into the therapist role. One has to fight the tendency to regard the patient as one would regard him socially, and the concomitant urge to simply tell him to knock it off when he's being difficult. Of course, with this particular patient, the personal connection had an up- side: Karl was quite sure that Robert would not be here without it.
When Robert paused for a moment, Karl said, seemingly out of the blue, "Some people have difficulty expressing anger. For them, doing so in a therapeutic setting can be productive."
Robert looked puzzled, "And your point is . . ?"
"Do you, by any stretch of the imagination, think you have this problem?"
"Hah!" Robert snorted. Then he looked surprised and bemused, "Uh, are you telling me to shut up?"
Karl smiled, "No. If you want to vent a bit, that's fine. Maybe it'll save your poor employees a little stress. But protracted complaining about how everything sucks is probably not the best use of our time."
"Don't give me that 'think-happy-thoughts' crapola . . .," Romano sneered.
"Robert, you were maimed and you lost your life's work. You're supposed to feel bad about that. But a common maladaptive thought process in depression is to perceive only negative occurrences while discounting anything positive that happens."
"I'm not depressed," Robert put in sullenly.
Unwilling to argue the point, De Raad said, "I want you to tell me one good experience you had in the last day or so. Can you do that?"
*****
The previous day: Friday -- 8:07 am . . .
Robert picked up a newspaper and a pack of M&Ms at the newsstand near the El stop closest to his house. Eyeing the weirdly washed out color of the candy package, he grumbled to himself, "Stupid colorless M&Ms promotion – what bonehead thought THAT was a good idea?"
Since the El stop was about a mile from home, Robert usually just drove in to work. But, lately, he was trying to avoid driving in city traffic. Both the Jeep and the Jag had manual transmissions, which were a hassle, especially with the Utah arm still "in the shop". His prostheticist had given him a loaner – a body-powered prosthesis – that he could use to brace the wheel while shifting. But, as Elizabeth had remarked, "That's not even remotely safe."
Thinking of Elizabeth's amusingly appalled tone made him smile. As he handed his money to the girl behind the counter, he added a wink to the smile. The cashier was twenty-something, a little heavy but reasonably pretty, with a tight sweater that showed off her assets admirably. Robert wasn't flirting with her in any serious way; she was too young, and not really up to his pulchritude standards. He just liked the ego-boost when women responded positively to his advances. And when, instead, they got offended – well, that was fun too.
Sweater-girl did neither. Momentarily, fear and revulsion crossed her face as her eyes flicked down toward the counter. She recovered quickly, giving him a weak smile and a "Have a nice day."
Robert took his change, dropped it and the M&Ms into his pocket, then tucked the newspaper under his hook and left without a word.
*****
10:31 am
After sitting through morning lecture and having a quick caffeine/study session with Neela and Lester, Abby Lockhart started her shift in the ER. It was a quiet morning, so far. Abby walked by the exam rooms to see where she could be useful. As she approached Exam 2, she heard a woman's voice raised in an angry tone.
The door opened, as the woman continued, almost yelling, ". . . don't talk to me about 'quality of life'! What do you think we've been doing the last twelve years? We've been making her life as good as possible! And you doctors come in here and tell us . . ."
Dr. Romano, exiting the room, cut her off with, "Someone will be in to discuss your options with you shortly." Then he closed the door behind him. Spying Abby, he shrugged and gave her a "whatever" look. She raised her eyebrows as her lips pursed into a half-smile, and said nothing. After a beat, he barked, "Are you Doctor Abby or Nurse Abby now?"
"I'm a med student until four. Hopefully I won't have to pull any nursing shifts until the weekend."
"Hey, maybe we can get you little buttons that say "D.A." and "N.A." . . .," he teased.
"And how about 'A.A.' – 'Abby Abby' – for the times when I'm not supposed to be working, but you won't let me leave. That way we could cover all the major twelve-step programs," she shot back sarcastically.
Romano laughed, "Ooooh . . . I like it."
"I'm kidding!" Abby put in, realizing that she should know better than to give him ideas. "Or, you know, you could just read the schedule."
Romano dismissed that idea with a wave of his hand, as charged off toward the Admit area.
Abby observed that Dr. Romano seemed to be in a good mood, for now. In the past weeks he'd been vacillating between mocking the staff in an almost friendly way and being nastily critical of everything they did. Though the unpredictability was unsettling, the ER had lived through out-of-control- enraged-Romano and almost-catatonically-withdrawn-Romano. In comparison, moody-cranky-Romano wasn't too bad.
Abby smiled as she caught herself thinking of her evil boss in somewhat affectionate terms. She mused, 'When did I stop despising him?'
She supposed it had been a gradual process and that Susan's tolerant attitude had rubbed off on her a bit. But the turning point had been just after Carter returned from Africa. There John was, with his beautiful new girlfriend and baby-to-be. Everyone was so happy to see him. Susan had offered to hate him for a while, as a best friend should, but Abby told her it was OK, she didn't have to do that. No, Abby was going to suck it up and be mature. When the other staff members saw that she was taking the high road, they followed suit, putting everybody at ease to enjoy the new developments in Carter's life. It was all very adult, very civil.
But there was one glorious exception to all this maturity. Twice, during the short time between Carter's return and the start of Abby's NICU rotation, when speaking to Carter in Abby's presence, Romano had incorporated some particularly cheesy words and turns of phrase from Carter's break-up letter into his speech. His delivery was completely deadpan, the words perfectly integrated into the flow of conversation – so much so that at first Abby wasn't 100% sure it was intentional.
But then Romano had shot her a sideways glance, as if checking to make sure that she knew he was mocking Carter, not her. Carter appeared thoroughly perplexed and uncomfortable. Abby managed to get out of the room before cracking the hell up. It was simultaneously the sweetest and the strangest thing anybody had done for her in a long time. After that, despite Romano's abhorrent treatment of her in the past and continuing rudeness, Abby just couldn't hate him.
From down the hall came a familiar bellow, "Hey, it's 'Doctor Abby', not 'Doorstop Abby' – Let's get a move on!"
'Doesn't mean I can't want to slap him upside his little bald head . . ,' she thought, hurrying to catch up.
Abby and Romano approached the Admit Desk, where Susan Lewis was sorting through charts, passing them off to various residents. Holding out the chart of the patient in the room he'd just left, Romano said, "Got another one for ya."
"Scared kid?" Susan asked gently. Not infrequently, young children got wigged out by Romano's prosthesis, especially when he wasn't wearing a cosmetic hand. Romano was unfailingly decent when that happened – he passed those patients off to other doctors without complaint.
"Uh, no. Pissed off Grandma."
Susan's sympathetic expression hardened into annoyance. "What did you do?"
"She, uh, might have overheard me mention that her darling grandchild has the mental capacity of a cabbage." Romano's expression was slightly sheepish, but Abby got the impression that he wasn't really sorry for the indiscretion.
"Brilliant," Susan scoffed. "Fine, I'll take her. But I'm giving you one of my cases that I hate. Let's see, we've got explosive diarrhea, oozing pustules, homeless guy with . . ."
"I'm not taking any of those," Romano said, his mouth set in an unyielding line.
Susan gave him a dirty look, then her expression brightened, "OK, here's 6- year old twins, skin rash, no fever."
"What's the catch?" Romano inquired, suspicious.
"Oh, nothing. They're just annoying. They've got this creepy 'Village of the Damned' thing going."
Accepting the charts, Romano shrugged, "I can do annoying." Susan and Abby shared a smirk as he turned to head toward the exam rooms.
After stopping off at Romano's locker, where he put the plastic hand covering over his hook, Romano and Abby entered the exam room. Inside was a mother with four children: six year old twin boys and two girls, about 4 and 2 years old. The twins were identical, but really, all four children strongly resembled each other – pale skin, white-blond hair, blue eyes. The boys wore matching clothing, and the girls' clothes were similarly styled and hued.
Reading the charts, Abby presented, "Travis and Trevor spent the weekend with a family friend and came home with a rash – itching, but no vomiting or other signs of illness. Their sisters, Taylor and Tyler, are asymptomatic so far." She had to raise her voice toward the end, as the older of the girls started crying and the younger one banged her shoes on the bottom of her chair.
"The twins can't go back to school until this is taken care of, and my HMO couldn't give me an appointment until next Tuesday," the harried mother explained. She ineffectually hushed the boys, who had begun bickering and trying to step on each other's toes, and added, "I brought Taylor and Tyler too, in case it's contagious." Taylor, the four-year-old, took this as her cue to scream louder, and Mom withdrew with her to a corner of the room, soothing, "The doctors aren't going to give you a shot, honey, it's OK . . ." The two-year-old stayed where she was, contentedly kicking her chair and watching her brothers with owlish eyes.
"Alright," Romano began brusquely, "Which of you is Travis, and which is Trevor?"
"I'm Travis." "No I am." "He's Trevor." *hee hee hee*
"Let's try again: Travis. Trevor." Romano ordered in a stern don't-mess- with-me tone.
More giggling: "I'm Trevor." "So am I." "No you're not."
Abby sighed. Mom was busy consoling Taylor (or was it Tyler?), so she wouldn't be much help. Abby supposed they could just go ahead with the exam and sort the names out later, though she didn't like letting the bratty behavior win out.
Romano addressed the boys, "Fine. Arnold, you sit there. Arthur, show me your rash."
The boys looked confused. One said, "My name isn't Arthur . . ."
Romano repeated his instructions, this time pointing to each of them in turn, "Brandon, sit. Bradley, let me see your rash."
Now they were catching on. 'Bradley' laughed and complained, "I wanna be Brandon."
"Too late, Cornelius," Romano replied, keeping a straight face.
"Who am I?" the other boy pestered.
"Conrad," Romano said flatly, as he examined him. 'Conrad' giggled.
A few minutes later, Romano and Abby had ascertained that 'Milton' and 'Mitchell' had poison ivy. Romano wrote a prescription and told their mother that a nurse would be in if she had any questions about applying the topical treatment. As he left, he nodded at each of the boys, "Trevor. Travis."
Outside the room, walking back toward the Admit area, it hit Abby and she laughed, "You knew who was who all along?"
"Yeah," he grinned, "I was just messing with them. I watched where the baby sister looked when I said their names."
Abby shook her head, smiling. Distracted by another case coming in, Romano tossed out, "Don't trust anybody over thirty . . . months." Then he darted off, leaving Abby once again in his dust.
Abby wondered aloud, "Am I the only one who's not even a little bit surprised that he gets along well with hyperactive children?"
*****
2:31 pm
Susan Lewis studied her patient's lab results as Dr. Romano ran through the woman's surgical needs with Neela and Lester. The patient, an assault victim, had multiple stab wounds, including deep punctures to the abdomen. Since she was an obvious surgical candidate, Susan had paged surgery. They sent down a new-ish resident, Dr. Lotz, whom Romano completely ignored. Flustered, Lotz left in a huff, saying that she would be back in a minute. Susan would have felt more sympathy for her, had Lotz not been a size two with perfect hair. 'OK, I'm shallow. Sue me.'
"Mr. Lester, what do you want to ascertain next?" Romano queried.
"Check for sub-cu air," Lester answered, checking. "Negative," he reported.
"Alright, Miss Rasgotra, how are you going to control the bleeding?"
"Clamp the main artery, and can we put in temporary sutures to . . ."
As Neela spoke, the doors swung open and Dr. Dorsett entered, followed by Dr. Lotz. "You could do that, little lady, but I've got a better idea," Dorsett said cheerfully. Unaware of, or unconcerned by, the hostile glare Romano was shooting his way, Dorsett addressed Lotz, "Let me show you something. Here, give me your hand."
Dorsett guided Lotz's hand to a place inside the patient's abdomen where she could control the bleeding manually. She gazed at him adoringly, enthralled.
Romano, obviously less enchanted by the display, interrupted, "News flash, Don Juan: It's a patient, not a prop to help you pick up chicks."
Ignoring Romano, Dorsett continued, "We'll just be on our way, then."
"The hell you will," Romano said firmly, "Not like that you won't."
"Look, you called for a consult. I'm here. I have the situation under control," Dorsett snapped, "Why don't you just let me do my job and get back to yours?"
"Because you're doing a half-assed job of it, that's why," Romano retorted, sneering. "Transporting the patient like that increases the risk of infection. Plus, your little groupie's never done this maneuver before, so I'm not convinced she'll have full control of the bleeding."
"Doing it this way saves time," Dorsett shot back, "time that we're now wasting discussing the matter."
Carter poked his head in the door and asked, "Is there a problem?"
Nobody answered him. Susan shook her head almost imperceptibly, indicating that he should hold off and not get involved. John seemed to think that Romano-damage-control was his duty. But in this situation, at least, Susan felt his input would be counterproductive: 'We don't need four attendings fighting over one patient.'
Keeping her tone light, Susan interrupted the combatants "OK, enough with the macho pissing contest. How much time are we talking about?" She looked to Romano for a reply, as did Lester and Neela. Carter and Lotz looked to Dorsett. They responded simultaneously,
Romano: "Ten minutes."
Dorsett: "Twenty minutes."
Romano smirked, "If it takes you that long, 'Fast Eddie' is a misnomer."
Susan rolled her eyes. Then she addressed Dorsett, "That's not much time, and the patient is stable. How about we do it the old-fashioned way and get on with our lives?"
Dorsett replied, "It's not your call, any more than it is his," looking over at Romano dismissively.
"Yeah, it is," Romano corrected angrily. "I may not have any say in what procedures you perform later, but it's my business how the patient is prepped for transport before she leaves the unit. If I deem the transport isn't safe – 'cuz, for instance, Barbie Doll's got her hand stuck inside the patient's belly – I'm not releasing her to you."
Addressing Susan, Dorsett appealed, "Is he serious?"
Susan nodded, adding, "And incredibly stubborn." Barely suppressing a smirk, she continued, "If you can't work this out with Dr. Romano, we can always ask your boss, Dr. Corday, to settle it."
As Susan suspected, Dorsett was not keen on that idea. He reluctantly agreed to clamp off the bleeders before transport. Gesturing toward Neela and Lester, he grumbled at Romano, "Dr. Lotz gets to do it, not the med students. That's why I came down here in the first place – you won't let my resident do anything."
Romano smiled with mock-innocence, "I thought you liked medical students, seeing as how you're married to one."
The look on Dorsett's face, and Lotz's, was priceless.
*****
6:22 pm
"Dammit," Robert swore softly, as he dropped a stitch while suturing a long laceration on an elderly woman's arm. His progress was painfully slow. Even with his myoelectric prosthesis, this task would be difficult. Without it, it was next to impossible. But he couldn't bring himself to give up.
A fire in a long term care facility had flooded the ER with casualties, many of the injuries due not to the fire itself, but rather to inept evacuation procedures. After caring for the few critical cases, they were left with numerous patients with mild smoke inhalation, plus lacerations and contusions from their rapid exit. Romano's current charge was among those with minor injuries. Since she was in a persistent vegetative state, she wasn't bothered by how long the procedure was taking. But the delay in closing the wound wasn't good for her, and Romano was acutely aware that they needed to free up the bed for another patient.
Any minute now, he knew, some staff member would creep in here and awkwardly point out the obvious: that Romano should let somebody else finish up. He could save face by handing off the job to someone more capable before that happened. Knowing this did not motivate him to do so. He felt intensely frustrated by his physical limitations as well as by his inability to give in and do the dignified thing for a change.
Additionally, at the moment, he was in quite a bit of pain. Normally, during the day, the phantom pain manifested itself as a dull ache or occasional cramping sensations in his missing limb – annoying, but something he could ignore if he kept himself busy. In the last couple of weeks, however, it had intensified to a moderate ache with intermittent intervals of bone-deep agony. After researching the subject, he had concluded that the worsened symptoms were most likely due to the fact that he did not have the prosthesis to which he'd become habituated. Hopefully the problem would abate when he got his Utah arm back.
Which didn't help much for right now. Right now, he just wanted to go home. And drink. A lot. 'God, I'm not even halfway done with her . . .'
Idly, Robert wondered which staff member would be coerced by the others into doing the dirty deed of prompting him to pass off his patient. He hoped it would be Pratt. He really felt like laying into somebody, and Pratt was always his favorite victim. 'Ah, hell, with my luck it'll probably be Carter.' The young attending would be polite and reasonable, with just a hint of condescending smugness. Robert much preferred Pratt's in-your-face antagonism.
A quiet knock, and the door slowly opened to reveal . . . Neela. Robert groaned inwardly. It wasn't like he never yelled at the girl, but she was his last choice as a rage-target.
Neela made eye contact briefly, her nervous expression changing to concern as she read the distress in her supervisor's eyes. Then she looked down, paused a moment, and smiled shyly as she put a glove on her left hand only. She gazed up at Robert again, walked across the room, and slipped in front of him on his left side. Without discussion, she started using her left hand to do the jobs that his left hand would do: stabilizing the wound, moving the thread when needed, sometimes picking up stitches.
Robert broke into a surprised grin at the unexpected pleasure of being able to sew quickly and freely once again. He looked down at Neela with uncharacteristic warmth. She didn't see his expression. Her eyes were focused on what she was doing, features screwed in concentration. Working in tandem with someone like this was tricky; it would be impractical for complex tasks. Robert noted, amusedly, that it would be tough for him to do it with almost anybody but Neela, who was small enough that he could comfortably see over her shoulder. As his hand flew through the remaining stitches, he could almost hear his favorite British surgeon sarcastically suggesting a stepstool.
*****
Saturday morning – back in De Raad's den . . .
After a short pause, Robert responded to Karl's challenge with a smirk, "I got to bust Dorsett's balls yesterday. That was kind of fun."
De Raad frowned, trying to place the vaguely familiar name, "Dorsett . . ?"
Robert explained, "He's a surgeon. And an ass. Been at county a year or so now."
De Raad sighed, his lips quirking into a smile, "I thought we were trying to get away from spite as a motivator."
"This was more malice than spite," Robert clarified, grinning. As his colleague shook his head in mock-exasperation, he added, "Come to think of it, annoying you is kind of fun too."
"Remember how I said, before, that I wasn't telling you to shut up . . ?"
*****
Saturday morning . . .
'Why exactly did I want to work with this guy?' Karl De Raad thought, smiling wryly.
He was sitting in his den with Robert Romano, during their second therapy session together. The first session had been taken up by Robert's diatribe against psychiatry in general. Karl mostly let him rant, figuring this was something his colleague needed to get out of the way before he could move on. Also, the "discussion" gave De Raad the opportunity to explain the difference between psychoanalysis, which was the target of much of Robert's disdain, and the mostly cognitive approach he had planned.
For the second session, Karl steered the conversation toward what Robert wanted to change in his own life. Still, Robert kept his comments impersonal, bitching about the "mouth-breathing idiots" who staff and frequent the ER. He was relentlessly angry, dissatisfied with everything.
Karl understood that extreme negativity was to be expected from somebody in Robert's psychological state. But such was one of the pitfalls of counseling friends and coworkers: the social connection makes it hard to slip completely into the therapist role. One has to fight the tendency to regard the patient as one would regard him socially, and the concomitant urge to simply tell him to knock it off when he's being difficult. Of course, with this particular patient, the personal connection had an up- side: Karl was quite sure that Robert would not be here without it.
When Robert paused for a moment, Karl said, seemingly out of the blue, "Some people have difficulty expressing anger. For them, doing so in a therapeutic setting can be productive."
Robert looked puzzled, "And your point is . . ?"
"Do you, by any stretch of the imagination, think you have this problem?"
"Hah!" Robert snorted. Then he looked surprised and bemused, "Uh, are you telling me to shut up?"
Karl smiled, "No. If you want to vent a bit, that's fine. Maybe it'll save your poor employees a little stress. But protracted complaining about how everything sucks is probably not the best use of our time."
"Don't give me that 'think-happy-thoughts' crapola . . .," Romano sneered.
"Robert, you were maimed and you lost your life's work. You're supposed to feel bad about that. But a common maladaptive thought process in depression is to perceive only negative occurrences while discounting anything positive that happens."
"I'm not depressed," Robert put in sullenly.
Unwilling to argue the point, De Raad said, "I want you to tell me one good experience you had in the last day or so. Can you do that?"
*****
The previous day: Friday -- 8:07 am . . .
Robert picked up a newspaper and a pack of M&Ms at the newsstand near the El stop closest to his house. Eyeing the weirdly washed out color of the candy package, he grumbled to himself, "Stupid colorless M&Ms promotion – what bonehead thought THAT was a good idea?"
Since the El stop was about a mile from home, Robert usually just drove in to work. But, lately, he was trying to avoid driving in city traffic. Both the Jeep and the Jag had manual transmissions, which were a hassle, especially with the Utah arm still "in the shop". His prostheticist had given him a loaner – a body-powered prosthesis – that he could use to brace the wheel while shifting. But, as Elizabeth had remarked, "That's not even remotely safe."
Thinking of Elizabeth's amusingly appalled tone made him smile. As he handed his money to the girl behind the counter, he added a wink to the smile. The cashier was twenty-something, a little heavy but reasonably pretty, with a tight sweater that showed off her assets admirably. Robert wasn't flirting with her in any serious way; she was too young, and not really up to his pulchritude standards. He just liked the ego-boost when women responded positively to his advances. And when, instead, they got offended – well, that was fun too.
Sweater-girl did neither. Momentarily, fear and revulsion crossed her face as her eyes flicked down toward the counter. She recovered quickly, giving him a weak smile and a "Have a nice day."
Robert took his change, dropped it and the M&Ms into his pocket, then tucked the newspaper under his hook and left without a word.
*****
10:31 am
After sitting through morning lecture and having a quick caffeine/study session with Neela and Lester, Abby Lockhart started her shift in the ER. It was a quiet morning, so far. Abby walked by the exam rooms to see where she could be useful. As she approached Exam 2, she heard a woman's voice raised in an angry tone.
The door opened, as the woman continued, almost yelling, ". . . don't talk to me about 'quality of life'! What do you think we've been doing the last twelve years? We've been making her life as good as possible! And you doctors come in here and tell us . . ."
Dr. Romano, exiting the room, cut her off with, "Someone will be in to discuss your options with you shortly." Then he closed the door behind him. Spying Abby, he shrugged and gave her a "whatever" look. She raised her eyebrows as her lips pursed into a half-smile, and said nothing. After a beat, he barked, "Are you Doctor Abby or Nurse Abby now?"
"I'm a med student until four. Hopefully I won't have to pull any nursing shifts until the weekend."
"Hey, maybe we can get you little buttons that say "D.A." and "N.A." . . .," he teased.
"And how about 'A.A.' – 'Abby Abby' – for the times when I'm not supposed to be working, but you won't let me leave. That way we could cover all the major twelve-step programs," she shot back sarcastically.
Romano laughed, "Ooooh . . . I like it."
"I'm kidding!" Abby put in, realizing that she should know better than to give him ideas. "Or, you know, you could just read the schedule."
Romano dismissed that idea with a wave of his hand, as charged off toward the Admit area.
Abby observed that Dr. Romano seemed to be in a good mood, for now. In the past weeks he'd been vacillating between mocking the staff in an almost friendly way and being nastily critical of everything they did. Though the unpredictability was unsettling, the ER had lived through out-of-control- enraged-Romano and almost-catatonically-withdrawn-Romano. In comparison, moody-cranky-Romano wasn't too bad.
Abby smiled as she caught herself thinking of her evil boss in somewhat affectionate terms. She mused, 'When did I stop despising him?'
She supposed it had been a gradual process and that Susan's tolerant attitude had rubbed off on her a bit. But the turning point had been just after Carter returned from Africa. There John was, with his beautiful new girlfriend and baby-to-be. Everyone was so happy to see him. Susan had offered to hate him for a while, as a best friend should, but Abby told her it was OK, she didn't have to do that. No, Abby was going to suck it up and be mature. When the other staff members saw that she was taking the high road, they followed suit, putting everybody at ease to enjoy the new developments in Carter's life. It was all very adult, very civil.
But there was one glorious exception to all this maturity. Twice, during the short time between Carter's return and the start of Abby's NICU rotation, when speaking to Carter in Abby's presence, Romano had incorporated some particularly cheesy words and turns of phrase from Carter's break-up letter into his speech. His delivery was completely deadpan, the words perfectly integrated into the flow of conversation – so much so that at first Abby wasn't 100% sure it was intentional.
But then Romano had shot her a sideways glance, as if checking to make sure that she knew he was mocking Carter, not her. Carter appeared thoroughly perplexed and uncomfortable. Abby managed to get out of the room before cracking the hell up. It was simultaneously the sweetest and the strangest thing anybody had done for her in a long time. After that, despite Romano's abhorrent treatment of her in the past and continuing rudeness, Abby just couldn't hate him.
From down the hall came a familiar bellow, "Hey, it's 'Doctor Abby', not 'Doorstop Abby' – Let's get a move on!"
'Doesn't mean I can't want to slap him upside his little bald head . . ,' she thought, hurrying to catch up.
Abby and Romano approached the Admit Desk, where Susan Lewis was sorting through charts, passing them off to various residents. Holding out the chart of the patient in the room he'd just left, Romano said, "Got another one for ya."
"Scared kid?" Susan asked gently. Not infrequently, young children got wigged out by Romano's prosthesis, especially when he wasn't wearing a cosmetic hand. Romano was unfailingly decent when that happened – he passed those patients off to other doctors without complaint.
"Uh, no. Pissed off Grandma."
Susan's sympathetic expression hardened into annoyance. "What did you do?"
"She, uh, might have overheard me mention that her darling grandchild has the mental capacity of a cabbage." Romano's expression was slightly sheepish, but Abby got the impression that he wasn't really sorry for the indiscretion.
"Brilliant," Susan scoffed. "Fine, I'll take her. But I'm giving you one of my cases that I hate. Let's see, we've got explosive diarrhea, oozing pustules, homeless guy with . . ."
"I'm not taking any of those," Romano said, his mouth set in an unyielding line.
Susan gave him a dirty look, then her expression brightened, "OK, here's 6- year old twins, skin rash, no fever."
"What's the catch?" Romano inquired, suspicious.
"Oh, nothing. They're just annoying. They've got this creepy 'Village of the Damned' thing going."
Accepting the charts, Romano shrugged, "I can do annoying." Susan and Abby shared a smirk as he turned to head toward the exam rooms.
After stopping off at Romano's locker, where he put the plastic hand covering over his hook, Romano and Abby entered the exam room. Inside was a mother with four children: six year old twin boys and two girls, about 4 and 2 years old. The twins were identical, but really, all four children strongly resembled each other – pale skin, white-blond hair, blue eyes. The boys wore matching clothing, and the girls' clothes were similarly styled and hued.
Reading the charts, Abby presented, "Travis and Trevor spent the weekend with a family friend and came home with a rash – itching, but no vomiting or other signs of illness. Their sisters, Taylor and Tyler, are asymptomatic so far." She had to raise her voice toward the end, as the older of the girls started crying and the younger one banged her shoes on the bottom of her chair.
"The twins can't go back to school until this is taken care of, and my HMO couldn't give me an appointment until next Tuesday," the harried mother explained. She ineffectually hushed the boys, who had begun bickering and trying to step on each other's toes, and added, "I brought Taylor and Tyler too, in case it's contagious." Taylor, the four-year-old, took this as her cue to scream louder, and Mom withdrew with her to a corner of the room, soothing, "The doctors aren't going to give you a shot, honey, it's OK . . ." The two-year-old stayed where she was, contentedly kicking her chair and watching her brothers with owlish eyes.
"Alright," Romano began brusquely, "Which of you is Travis, and which is Trevor?"
"I'm Travis." "No I am." "He's Trevor." *hee hee hee*
"Let's try again: Travis. Trevor." Romano ordered in a stern don't-mess- with-me tone.
More giggling: "I'm Trevor." "So am I." "No you're not."
Abby sighed. Mom was busy consoling Taylor (or was it Tyler?), so she wouldn't be much help. Abby supposed they could just go ahead with the exam and sort the names out later, though she didn't like letting the bratty behavior win out.
Romano addressed the boys, "Fine. Arnold, you sit there. Arthur, show me your rash."
The boys looked confused. One said, "My name isn't Arthur . . ."
Romano repeated his instructions, this time pointing to each of them in turn, "Brandon, sit. Bradley, let me see your rash."
Now they were catching on. 'Bradley' laughed and complained, "I wanna be Brandon."
"Too late, Cornelius," Romano replied, keeping a straight face.
"Who am I?" the other boy pestered.
"Conrad," Romano said flatly, as he examined him. 'Conrad' giggled.
A few minutes later, Romano and Abby had ascertained that 'Milton' and 'Mitchell' had poison ivy. Romano wrote a prescription and told their mother that a nurse would be in if she had any questions about applying the topical treatment. As he left, he nodded at each of the boys, "Trevor. Travis."
Outside the room, walking back toward the Admit area, it hit Abby and she laughed, "You knew who was who all along?"
"Yeah," he grinned, "I was just messing with them. I watched where the baby sister looked when I said their names."
Abby shook her head, smiling. Distracted by another case coming in, Romano tossed out, "Don't trust anybody over thirty . . . months." Then he darted off, leaving Abby once again in his dust.
Abby wondered aloud, "Am I the only one who's not even a little bit surprised that he gets along well with hyperactive children?"
*****
2:31 pm
Susan Lewis studied her patient's lab results as Dr. Romano ran through the woman's surgical needs with Neela and Lester. The patient, an assault victim, had multiple stab wounds, including deep punctures to the abdomen. Since she was an obvious surgical candidate, Susan had paged surgery. They sent down a new-ish resident, Dr. Lotz, whom Romano completely ignored. Flustered, Lotz left in a huff, saying that she would be back in a minute. Susan would have felt more sympathy for her, had Lotz not been a size two with perfect hair. 'OK, I'm shallow. Sue me.'
"Mr. Lester, what do you want to ascertain next?" Romano queried.
"Check for sub-cu air," Lester answered, checking. "Negative," he reported.
"Alright, Miss Rasgotra, how are you going to control the bleeding?"
"Clamp the main artery, and can we put in temporary sutures to . . ."
As Neela spoke, the doors swung open and Dr. Dorsett entered, followed by Dr. Lotz. "You could do that, little lady, but I've got a better idea," Dorsett said cheerfully. Unaware of, or unconcerned by, the hostile glare Romano was shooting his way, Dorsett addressed Lotz, "Let me show you something. Here, give me your hand."
Dorsett guided Lotz's hand to a place inside the patient's abdomen where she could control the bleeding manually. She gazed at him adoringly, enthralled.
Romano, obviously less enchanted by the display, interrupted, "News flash, Don Juan: It's a patient, not a prop to help you pick up chicks."
Ignoring Romano, Dorsett continued, "We'll just be on our way, then."
"The hell you will," Romano said firmly, "Not like that you won't."
"Look, you called for a consult. I'm here. I have the situation under control," Dorsett snapped, "Why don't you just let me do my job and get back to yours?"
"Because you're doing a half-assed job of it, that's why," Romano retorted, sneering. "Transporting the patient like that increases the risk of infection. Plus, your little groupie's never done this maneuver before, so I'm not convinced she'll have full control of the bleeding."
"Doing it this way saves time," Dorsett shot back, "time that we're now wasting discussing the matter."
Carter poked his head in the door and asked, "Is there a problem?"
Nobody answered him. Susan shook her head almost imperceptibly, indicating that he should hold off and not get involved. John seemed to think that Romano-damage-control was his duty. But in this situation, at least, Susan felt his input would be counterproductive: 'We don't need four attendings fighting over one patient.'
Keeping her tone light, Susan interrupted the combatants "OK, enough with the macho pissing contest. How much time are we talking about?" She looked to Romano for a reply, as did Lester and Neela. Carter and Lotz looked to Dorsett. They responded simultaneously,
Romano: "Ten minutes."
Dorsett: "Twenty minutes."
Romano smirked, "If it takes you that long, 'Fast Eddie' is a misnomer."
Susan rolled her eyes. Then she addressed Dorsett, "That's not much time, and the patient is stable. How about we do it the old-fashioned way and get on with our lives?"
Dorsett replied, "It's not your call, any more than it is his," looking over at Romano dismissively.
"Yeah, it is," Romano corrected angrily. "I may not have any say in what procedures you perform later, but it's my business how the patient is prepped for transport before she leaves the unit. If I deem the transport isn't safe – 'cuz, for instance, Barbie Doll's got her hand stuck inside the patient's belly – I'm not releasing her to you."
Addressing Susan, Dorsett appealed, "Is he serious?"
Susan nodded, adding, "And incredibly stubborn." Barely suppressing a smirk, she continued, "If you can't work this out with Dr. Romano, we can always ask your boss, Dr. Corday, to settle it."
As Susan suspected, Dorsett was not keen on that idea. He reluctantly agreed to clamp off the bleeders before transport. Gesturing toward Neela and Lester, he grumbled at Romano, "Dr. Lotz gets to do it, not the med students. That's why I came down here in the first place – you won't let my resident do anything."
Romano smiled with mock-innocence, "I thought you liked medical students, seeing as how you're married to one."
The look on Dorsett's face, and Lotz's, was priceless.
*****
6:22 pm
"Dammit," Robert swore softly, as he dropped a stitch while suturing a long laceration on an elderly woman's arm. His progress was painfully slow. Even with his myoelectric prosthesis, this task would be difficult. Without it, it was next to impossible. But he couldn't bring himself to give up.
A fire in a long term care facility had flooded the ER with casualties, many of the injuries due not to the fire itself, but rather to inept evacuation procedures. After caring for the few critical cases, they were left with numerous patients with mild smoke inhalation, plus lacerations and contusions from their rapid exit. Romano's current charge was among those with minor injuries. Since she was in a persistent vegetative state, she wasn't bothered by how long the procedure was taking. But the delay in closing the wound wasn't good for her, and Romano was acutely aware that they needed to free up the bed for another patient.
Any minute now, he knew, some staff member would creep in here and awkwardly point out the obvious: that Romano should let somebody else finish up. He could save face by handing off the job to someone more capable before that happened. Knowing this did not motivate him to do so. He felt intensely frustrated by his physical limitations as well as by his inability to give in and do the dignified thing for a change.
Additionally, at the moment, he was in quite a bit of pain. Normally, during the day, the phantom pain manifested itself as a dull ache or occasional cramping sensations in his missing limb – annoying, but something he could ignore if he kept himself busy. In the last couple of weeks, however, it had intensified to a moderate ache with intermittent intervals of bone-deep agony. After researching the subject, he had concluded that the worsened symptoms were most likely due to the fact that he did not have the prosthesis to which he'd become habituated. Hopefully the problem would abate when he got his Utah arm back.
Which didn't help much for right now. Right now, he just wanted to go home. And drink. A lot. 'God, I'm not even halfway done with her . . .'
Idly, Robert wondered which staff member would be coerced by the others into doing the dirty deed of prompting him to pass off his patient. He hoped it would be Pratt. He really felt like laying into somebody, and Pratt was always his favorite victim. 'Ah, hell, with my luck it'll probably be Carter.' The young attending would be polite and reasonable, with just a hint of condescending smugness. Robert much preferred Pratt's in-your-face antagonism.
A quiet knock, and the door slowly opened to reveal . . . Neela. Robert groaned inwardly. It wasn't like he never yelled at the girl, but she was his last choice as a rage-target.
Neela made eye contact briefly, her nervous expression changing to concern as she read the distress in her supervisor's eyes. Then she looked down, paused a moment, and smiled shyly as she put a glove on her left hand only. She gazed up at Robert again, walked across the room, and slipped in front of him on his left side. Without discussion, she started using her left hand to do the jobs that his left hand would do: stabilizing the wound, moving the thread when needed, sometimes picking up stitches.
Robert broke into a surprised grin at the unexpected pleasure of being able to sew quickly and freely once again. He looked down at Neela with uncharacteristic warmth. She didn't see his expression. Her eyes were focused on what she was doing, features screwed in concentration. Working in tandem with someone like this was tricky; it would be impractical for complex tasks. Robert noted, amusedly, that it would be tough for him to do it with almost anybody but Neela, who was small enough that he could comfortably see over her shoulder. As his hand flew through the remaining stitches, he could almost hear his favorite British surgeon sarcastically suggesting a stepstool.
*****
Saturday morning – back in De Raad's den . . .
After a short pause, Robert responded to Karl's challenge with a smirk, "I got to bust Dorsett's balls yesterday. That was kind of fun."
De Raad frowned, trying to place the vaguely familiar name, "Dorsett . . ?"
Robert explained, "He's a surgeon. And an ass. Been at county a year or so now."
De Raad sighed, his lips quirking into a smile, "I thought we were trying to get away from spite as a motivator."
"This was more malice than spite," Robert clarified, grinning. As his colleague shook his head in mock-exasperation, he added, "Come to think of it, annoying you is kind of fun too."
"Remember how I said, before, that I wasn't telling you to shut up . . ?"