Series: Snapshots of the Past
Story: Back Home Again
Chapter 20
Disclaimer: See Chapter 1
Previously: Jed and Abbey shared a special New Year's Eve celebration
Summary: When Abbey gets the upper-hand, Kyle has a warning for her; after months of studying, it's time to take the USMLE
- - -
"Okay, so anyone want to venture a guess?"
Dr. Kyle Nelson stood in front the students in that smug, calculating way he usually did to intimidate them. He used his pen to doodle unimportant facts down on his clipboard in an unsuccessful effort to appear prominent and professional. But this meeting was different. This time, Kyle wasn't calling all the shots. The confusing case of Bruce Caldwell drew the attention of many doctors, and so for this round, the patient's attending physician was eager to hear the observations.
Dr. Joe Brady sat quietly while the group explored the diagnostic process.
"Anyone?" Kyle asked again.
"His fingers are swollen," one of the students began. "He has arthritis, he's complaining of pain and fatigue."
"I didn't ask for a review of the symptoms," Kyle replied coolly. "We already know about his numerous complaints and we also have the results of his tests. Given the information that you have, what would be your diagnosis?"
Unsure that her assumption was correct, Abbey repressed her desire to answer while she analyzed the symptoms once more in her mind.
"Could be just arthritis," another student suggested.
"No, it couldn't." Of that, Abbey was sure. "His antinuclear antibody is positive."
"ANA doesn't give us a definitive answer, Bartlet. It could be a false positive," Kyle reminded her.
She countered his argument with the research she had done since Amy tipped her off days earlier. "False positive readings generally fall into the 1:80 category. His is 1:10240. The higher the titer, the greater the chance of an autoimmune disease."
"Bartlet is right for once." His voice was saturated in arrogance. "And so Bruce Caldwell's diagnosis appears to be Rheumatoid Arthritis."
"I disagree, Doctor," Abbey quickly replied.
"I beg your pardon?"
"It's not RA. At least, in my opinion. He has calcium deposits under his skin and the skin around his arms and fingers is extremely tight and dry."
"So he has dry skin."
She didn't need consultation to continue. "Also, his ANA isn't the only thing that tested positive. So did the SCL-70."
"Are you suggesting lung disease?"
"As the result of Scleroderma." Was she being overconfident, she wondered. "...possibly," she added.
"This, students, is what's known as the Zebra theory. The number one rule in medicine is that the most likely diagnosis is the correct diagnosis. Inexperienced physicians end up looking for hidden symptoms or outlandish causes and create drama and mystery where there isn't any, in an attempt to diagnose extremely rare diseases - like Scleroderma, a disease that affects so few people that most have never even heard of it, a disease that primarily affects women, not men, and certainly not men like Bruce Caldwell. It's interesting the way you led us down that road, Bartlet." He walked past her only to spin around and confront her once more. "But you're wrong."
"Actually, Dr. Nelson, she's absolutely correct." Kyle and Abbey both gasped at Dr. Brady's admission. "Scleroderma is my diagnosis as well for all the reasons she stated and ones that she left out, which I have outlined here on my chart, if you'd like to take a look, maybe educate yourself on the disease." That little dig brought a smile to Abbey's face, though his conclusion was even more satisfying. "Very well done, Bartlet."
"Thank you. I have done research on Scleroderma and I even copied a few pages from a pamphlet I picked up." She passed the literature around to her peers and even smirked when Kyle rejected his. "It is a rare disease, but being rare doesn't mean it's nonexistent."
"Excellent point," Brady congratulated her once again.
As the students filed out, Abbey brushed by Kyle, briefly stopping to whisper in his year. "I know you're just a resident, Doctor, but the least you can do is PRETEND to be a competent one." She echoed the same words he spewed at her during her last rotation.
Kyle grinded his teeth together to suppress the anger that churned through his ice cold veins. The fact that he felt humiliated was only the tip of the iceberg. His biggest complaint was that it was a woman who outsmarted him, a woman who was able to turn the head and interest of his superior, and a woman who managed to help educate the other students, the ones for which he was responsible.
His temper brewed under the surface of an eerily calm veneer. But it was only a matter of time before he'd fail to keep it concealed.
Abbey was riding high on a wave of self-assurance. With her confidence back, she was no longer afraid to offer her opinion, but her reluctance to hold back would begin a new chapter in her indignant relationship with Kyle.
Later, while examining another patient, red lights flashed in her head at Dr. Nelson's orders.
"Give her Phenergan, 50 mg," he said.
"Doctor, she has epilepsy," Abbey interfered. "You could kill her!"
Kyle dropped his clipboard, stunned by the authoritative tone of her voice. He picked up the chart and read it over once more, mentally taking note that Abbey's observation was correct. He demanded a different drug as he led the aspiring female physician into an empty adjoining room.
"That's twice today. Don't ever do that again," he warned her.
But Abbey's trust in her own medical knowledge wouldn't allow her to cower to his manipulation. "You were wrong - both about the diagnosis and the medication."
"Don't ever use that language in front of a patient! You just opened us up to one hell of a liability suit! You're a student, Bartlet! You're not an expert." He slammed his fist against the wall and took a deep, calming breath. "Why don't you go to nursing school and leave the real medicine to me?"
She sensed the conversation getting away from her, taking a turn she didn't want to take. "Get out of my way." His hand firmly planted on her shoulder, he held her back when she tried to walk around him.
"This is my career!" he taunted her in a low, threatening voice.
"And it's mine too!" she countered, staring right through his eyes as she tried to escape his grasp.
"You only get one warning. Don't ever do that again," he repeated with a strong shake which nearly knocked her off her feet as he pushed her back.
Her shoulder crashed into the cabinet beside her, but she rebounded quickly from the pain.
"Or you'll be sorry," he finished.
Emotionally paralyzed by his physical contact, her feet remained still while her body trembled. She tore off her lab coat and ran out the door only moments after he left.
- - -
Jed Bartlet had many talents, but at the root of all his skills was the extraordinary love he had for teaching. It had been a trait that, as an eight-year-old, earned him many friends. He tried desperately to hide his intellect for fear of losing the respect of others, much like his own father. But when a classmate needed help answering that all-too-difficult Algebra question or interpreting the complexities of Shakespearean literature, he would give of his own time selflessly, the most significant reward being the look on the person's face when they mastered the problem.
Twenty years later, standing in front of his Introduction to Global Economics class, he felt the same flash of gratification that inspired him as a boy. But on this day, he stopped his lecture prematurely when he caught a glimpse at the vision in the hallway. It was Abbey.
Hair tousled slightly, her eyes brimming with redness as they usually did when she was upset, he released his students early and rushed to his wife's side.
"I'm sorry. I shouldn't have interrupted your class," she said, her usual strong and secure demeanor quickly fading as they walked down the snowy concrete path across the campus.
"Don't be ridiculous. What happened?"
"It's nothing. I overreacted."
Jed stopped her with a hand to her arm. "To what?"
"I just had a run-in with Kyle Nelson again. We clashed earlier on a diagnosis, and then later on one of his orders. This time, he got a little physical. It kind of threw me for a loop."
"What do you mean physical?" His explosive temper was starting to rear its dangerous head. "Did that son of a bitch hurt you?"
"No, he just shook me up a little, literally." She chased after him as he rushed towards the parking lot. "Jed, wait! Please!"
"It stops here, Abbey! You told me not to go after him last time, but now he's gone too far. I don't care about your reservations this time!"
"No, you can't! Jed!"
Despite his reluctance, the recognizable pleading caused him to stop and approach her slowly. He couldn't leave her so vulnerable and upset. "Why don't you want me to go down there? What are you afraid of? Are you scared he'll retaliate?"
"Do you have any idea how hard it is for a woman to get through medical school? Do you know how many women begin and how many actually finish?"
"I'm beginning to learn."
"I've already learned. I'm barely holding on by the tips of my fingers. I'm trying to scratch and claw my way back to the top of my class. Jed, if you go down there now, you're going to make it even more difficult for me."
It was the 1970s and while women were breaking barriers and crashing through the glass ceilings in many professions, some of them were taunted and even intimidated into taking a likely detour from their chosen goals.
Abbey had heard about other female medical school students changing direction and entering nursing school instead. Aspiring lawyers, discouraged by not receiving the same respect offered to their male counterparts, often settled for careers as a paralegal. A student of Jed's strived towards the police academy, but dropped out when she was told she'd be better suited as a crossing guard instead of a detective. The Bartlets both knew that women who held on to their beliefs without abandoning their ambition sometimes had to make sacrifices just to succeed.
With her USMLE exam only days away, Abbey opted to forgo the hassle that accompanied a formal complaint in favor of devoting her time, energy, and concentration to getting through her exam and this rotation with her confidence still intact. It was a decision Jed didn't quite understand, but one that he didn't have to. His job was to simply support her. And that he did.
He folded her up into his arms and stroked her satiny strands of auburn hair as he comforted her. "I would give anything to make this easier on you. The way some men treat women, Abbey...if I could change it, I swear I would."
"I know."
And she did. Jed's dedication to celebrating equality for women is one of the first things Abbey had noticed about him. It was one of the first things she praised, and one of the first things that made her fall deeply, passionately in love.
His chin rested on top of her head after she pushed herself into him to secure her grip.
- - -
A few days passed and the sting of her confrontation with Kyle was slowly beginning to lose its prominent place in Abbey's thoughts. The sound of Jed and Liz laughing in the kitchen woke her from her sleep. With a quick glance at the clock, she realized it was time to start the day. And on this day, she would take step one of the three-step United States Medical Licensing Exam.
Jed heard her stirring around the bedroom and signaled Liz. The little girl wrapped both her small hands around the knob and opened the door slowly, smiling at her mother's face staring back at her.
"Good morning!" she called out.
"Good morning to you! Get over here and give me a kiss."
Liz ran to the edge of the bed and jumped on to the mattress. She leapt into Abbey's arms before she could catch her breath from the jolt.
"Daddy made breakfast."
"Mmm, I smell it. We'll have to go out there in a few minutes."
"Don't bother." Jed poked his head through the crack of the door before walking in with a tray full of Abbey's favorite breakfast treats.
"Jed, you didn't have to..."
"We wanted to. Didn't we, Lizzie?"
"Uh huh!"
"A big breakfast is going to help you ace this exam."
"No amount of food can do for me what you did." Jed set the tray in front of her and waved his hand dismissively. "I'm serious, Jed. All the all-night study sessions, the quizzes, those damn flashcards, and most importantly, the fact that you really believed in me...thank you." She tilted her head forward to kiss Liz. "And thank you too, Miss Lizzie. You were as big a help as your Daddy."
"Are you gonna pass?" the little girl asked.
"Of course she's going to pass - with flying colors!"
"I really think I am. I've never felt more confident," Abbey added.
"And when you get home tonight, I'm going to tell you all about Elliot Roush."
She began to sip a glass of orange juice. "Who is Elliot Roush?"
"He's an idiot."
"Daddy's been mad at him all morning." Liz took the piece of toast Abbey offered her.
"I better not have detected any snippiness in your voice, Lizzie, or I'm going to make you pay for the ice cream tonight."
She loved it when her father teased her. It was just another nuance of their close relationship.
"Anyway, he's a New Hampshire state legislator who needs to get his head out of his ass." His nostrils flaring, he sighed. "But we're not going to talk about him anymore this morning."
The tray was positioned between them until he moved it slightly to stretch out next to Abbey. Liz sat on her mother's lap and began filling her parents in on kindergarten gossip as Jed and Abbey shared another piece of toast while Abbey fed Liz a forkful of eggs.
The sweet interaction eased any residual anxiety Abbey had been feeling. All signs of stress now vanished and she was ready to tackle the exam that would determine her future.
TBC
