AN: I have no idea how many chapters are left. This fic gets longer and longer every time I work on it! Many thanks to those who continually read and review-and keep requesting this story be finished. I definitely wouldn't keep working on it without your feedback!
There was a reason, he mused dryly; that he'd never gone into GI. Or Urology, nephrology, endocrinology, hepatology—or even considered any field but neurology. The human body was disgusting in a lot of ways. Particularly the GI tract. At least for the most part, there weren't too many ways to get your hands into someone's brain. On the way down, Dr. Wilson had filled him in on Dr. House's plans for him for his first day. Observe and participate with GI, the path lab and the radiology department. As they'd walked, Dr. Wilson had explained. Dr. House didn't like 'sloppy seconds' as referring to test results. He liked all new labs, images and procedures. Results could be missed unless the person running the tests was completely open to finding just about anything. Tests could be skewed by the perspective of the person running them. Time lost. Lives lost. Eric readily agreed, and Dr. Wilson escorted him to the second floor and deposited him near the Op wards with a wave to the scrub rooms. Out of instinct, he'd checked the schedule and the name of the attending given to him and groaned to himself. He was late. Hurrying through his scrub, he gowned up with a nurse's help and moved briskly onto the floor. Wrinkling his nose behind the surgical mask, Eric stepped into the second procedure room to find the GI attending, a nurse, and an elderly patient all waiting for him. Introductions were quickly made, and Eric stepped closer to the patient's bedside as the nurse logged into the patient's electronic chart and made a series of notations on the templates.
"Good of you to join us, Dr.-"
"Foreman. Eric Foreman." Eric inclined his head in what he hoped was a friendly way. He made certain his eyes met those of the patient, as well. "I'm sorry to be late, I was not aware I would be observing this morning."
"You're the new Diagnostics fellow?" The GI doctor—Gilbertson-asked quietly. On the other side of the bed, the nurse was speaking to the patient as she readied a syringe. She held it out to Gilbertson; who took it and administered it wordlessly.
"Yes." Eric answered definitively.
"Don't envy you." Gilbertson said. Eric felt his hackles rise; prepared to defend Dr. House's reputation when the control arm of the endoscope was thrust in his face. Feeling his anger melt into confusion, he couldn't stop himself from asking the obvious question.
"What's this?" he asked dumbly.
"Olympus endoscope. TJF-Q180V."
"I mean, why are you-"
Gilbertson sighed, heavily. "House likes his fellows to be hands on. You work for him, you do the dirty work. That means the rest of us do too. Come on, I have a full schedule today."
Feeling shocked, Eric took the scope reflexively. He'd been prepared to observe, not participate. Gilbertson and the nurse together rolled the nurse into the right lateral decubitus position, and Eric silently thanked God that it was an EGD and not a colonoscopy. He took a deep breath to steady himself, and watched as the nurse slid the mouth guard into place. At her nod, and Gilbertson's pointed look—he slid the video end of the scope into the patient's mouth.
As it was his first attempt at an endoscopy, Gilbertson's hands joined his on the scope. Using the video images on the screen, together they gently avoided the trachea and took the scope down the esophagus and into the stomach. Finding nothing there of interest, Gilbertson pressed on into the duodenum. It was here he paused, and Eric waited; relinquishing his hold on the scope to Gilbertson's more experienced hands.
A lesion was centered on the screen; slowly bubbling blood. Gilbertson moved the scope about the duodenal bulb; craning the scope for multiple angles and firing away with the camera on the trigger of the arm. When he finished documenting the images, he motioned Eric to resume his own exploration. Together, they slid the biopsy forceps into the hollow center of the scope and removed several pieces of tissue for pathology. As they were retrieved, the nurse slid each of them into containers and tidily labeled them for the path lab.
Biopsies set aside, Gilbertson nudged Eric with his shoulder. "Normally at this point, I wouldn't ask you what should be done. I'd tell you, and we'd be done. Withdraw the scope and roll the patient into post op. Go onto the next patient. But I know that's not what House wants."
Eric blinked, feeling once again like a first year resident. "What do you mean, what Dr. House wants?"
Gilbertson's expressions were limited only to the exasperation in his voice, and his pencil thin eyebrows above the mask line. But Eric realized he probably didn't need to see the sneer on his face. He felt as though Gilbertson were angry with him instead of Dr. House, and he didn't like the feeling. Particularly when he was unable to distinguish why.
"Bleeding lesion located in the duodenal bulb. Poorly visualized due to the location and size. Biopsies taken to rule out any pathology. What do we do about the lesion, Dr. Foreman?" Gilbertson asked coldly.
Eric felt shocked; all he could conjure was a blank. But then his mind stuttered into gear, and he spoke hesitantly. "60cc of epinephrine to stop the bleeding?"
"That a question?" Gilbertson barked, and Eric felt his anger flare again.
"No." he said more firmly. "60cc epi to stop the bleeding. Did the patient have any other symptoms of GI distress?"
"Positive hemoccult in stool. Family history of colon cancer." Gilbertson wagged his fingers at the nurse as she held out a syringe with the epinephrine. He made note of the dose before injecting it into the scope. Watching the screen intently, Eric passively left his hands on the scope while Gilbertson maneuvered them into position and injected the epi. As they watched, the oozing slowed and stopped over a series of minutes. Apparently satisfied, Gilbertson released the scope and motioned for Eric to withdraw it.
He did so, and set the scope aside for the technicians to take and sterilize. Gilbertson and the nurse returned the patient to her recumbent position; and while the nurse covered the patient and guided them back into recovery, Gilbertson took over the computer and quickly signed out of the patient's chart.
"Come on, Dr. Foreman." he said gruffly. "Dictation room's down the hall."
Eric nodded, snapping his gloves off and removing his mask as Gilbertson did the same. Piercing brown eyes, pencil thin eyebrows. With an ungainly nose set in a thin face; Gilbertson was not a handsome man. He was neither tall nor short; nor fat or thin. He was, Eric decided; absolutely forgettable. He moved deftly down the hall, and Eric studied him intently as he trailed behind. Gilbertson was undoubtedly one of those doctors who ran a successful practice during the day and went home at night to his wife and kids. Played golf. Went to conferences. Enjoyed fishing. He'd probably published a paper or two; occasionally contributed to research. He seemed stalwart in his approach to medicine. And static in his approach to Dr. House.
Opening the door to the dictation room, he escorted Eric in and waved him to a desk beneath a window. The computer was already on, and booted to a particular patient; though Eric could not distinguish between the woman he'd scoped and the name on the screen.
Olson, Mabel J. 10/7/1938.
He remembered the woman's prone form in the bed; the way she had been curled into decubitus; the mousy gray-brown hair pulled back into a messy ponytail at the nape of her neck.
Mabel. Maybe.
Eric shrugged to himself as Gilbertson sat down beside him and held out a can of Coke.
"Thanks." Eric said quietly.
"You do an endoscopy before?" Gilbertson opened his own can before sipping it. Pulling the keyboard tray toward him, he moved from one template into another while he waited for Eric's answer.
"No. I did my residency in neurology."
"Oh, so that explains it. You neuro' guys are always pretty good at procedures."
Eric sipped at his own coke, and slouched back into the hard plastic chair. He smiled then; grateful for the unspoken compliment.
"Thanks."
Gilbertson gave him a sly look. "Don't thank me yet." he said coolly as he moved around in Mabel's chart. Opening the result templates, he clicked a series of radio buttons to autofill the rough margins of the EGD report. He entered Eric's name beneath his own as attending. Sliding the keyboard over, he motioned for Eric to take over.
"Seeing as you did the procedure, you get to dictate. When you're done, come on back and scrub again. Mr. Neil's colonoscopy is scheduled for 10:30. You'll do that with Dr. Weinberg."
Eric hid his distaste behind the can of Coke as Gilbertson gave him a smug look and the disappeared, presumably back to read the case notes for his next procedure. Glancing at his watch, Eric was unsurprised to find it was already five after ten. He'd always marveled at the number of procedures GI managed to do in a day. On average, any procedure involving the brain was a lengthy and complicated process. But the GI docs could punch out close to fifteen endoscopies—both upper and lower—in a day. He'd heard of one doc at Mayo punching out twenty. Seizing the keyboard, he maneuvered back to the admitting notes and briefly read through them before returning to the dictation templates. It wasn't ideal—he felt uneasy about being so thoroughly involved in her care when he'd done little more than move the scope—but he felt confident in choosing his words to reflect his role.
'66 y/o female w/hx of NSAID use presented with acute blood loss anemia. There was a lesion that could not be visualized due to its position in the apex of the bulb which appeared to be the source of her blood loss and melena. This was injected with 60cc of epi and the bleeding had ceased by the end of the procedure.
Recommendations:
Keep NPO in case repeat EGD needed, serial HgB for blood loss and ongoing bleeding. Con't BID PPI, send H pylori IgG and treat if +.'
He studied the screen thoughtfully, re-reading his choice of words carefully. Satisfied, he clicked the template and smiled to himself when the 'Eric Foreman, M.D.' autofilled for his e-signature. Signing out of the templates, he locked the computer.
Throwing back the rest of his Coke, he rose to his feet and made his way back to the procedure rooms in search of Dr. Weinberg. Passing by the schedule listed on the whiteboard, he felt his heart sink at the sheer number of procedures he was signed up to observe.
And participate in.
Gritting his teeth, he crumpled the can with one hand before throwing it into the recycle bin by the door. Five more.
Only five.