"Dr. Isles? Mr. Ibrahim, your 1:30, is in room 4. I went ahead and took his vitals," a medical assistant, Rachel Forbes, placed a file on the partition between the hallway and the reception desk in the BMC Head and Neck Cancer wing. She wore her hair in a tight, functional ponytail, and her French tips clicked the finish in a sound that Maura had always characterized as professional.
"Thank you, Rachel," the doctor said, her smile tight, but genuine. Her legs, long and lithe in her gray slacks, carried her toward the other woman, who admired her loose burgundy blouse. Two days in and her fashion sense had incited both ire and desire in her colleagues – Rachel happened to fall into the camp of the latter.
"You're probably going to get tired of hearing this, but you look great, Doctor. I know some of the older girls here have been giving you a hard time behind your back, but they're just jealous that you look better in designer clothes than most of us ever could," the young woman said with amiability, "one day I'm gonna ask you for some pointers."
Maura was sobered by the kindness. "Well, thank you," she took the file, making sure to grin a little wider this time. "And I'll look forward to it." She rifled through the notes in the file of her new patient, who had been treated by her predecessor, the now-retired Dr. Paulsen. Word was that he was a surly man, fiery and easily riled, but also charismatic and caring.
It was a lot to live up to for someone who had dealt with social anxiety her whole life. "It says here the general otolaryngologist refused to operate. Did Dr. Paulsen know this, or was this note made after his retirement?" She asked, information her primary barrier against fear.
"He knew," Rachel answered. "He told Mr. Ibrahim that we would take a look and see what we could do. I think the poor guy's at the end of his rope, here, and is just hoping for some kind of help."
"Alright," Maura nodded. "Thanks Rachel," with that, she powerwalked down the hall and to the left. At the fourth door down, the muffled tap of her heels morphed into a powerful clack, and she gave internal thanks for the linoleum that signaled Mr. Ibrahim to her arrival – this left less onus on her words and actions to get the job done.
The man, 75 and showing it, grinned widely at her as she took a seat in the swiveling chair by the operating bed. "You're the new doctor, I presume?"
She returned his smile, and held out her hand. "I am. Dr. Maura Isles, Mr. Ibrahim, nice to meet you." With each patient and each handshake, it got a little easier, a little more fluid.
He took it, and shook with vigor. She noticed his pressed slacks and ironed plaid shirt, and the hat next to him on the bed. It all juxtaposed his tired eyes, puffy nasojugal folds, and sunken cheeks. His hands reminded her of her mothers, but older: all skin and veins with a few added sunspots. "I've gotta say, you're quite the improvement over Dr. Paulsen in the looks department," he chuckled.
As he settled into more comfortable speech, she immediately noted the problem: his voice was hoarse and reedy, much beyond what the voice of a man his age should have been.
"Well, thank you. Now, tell me what it is that brought you to our offices today," she crossed her legs as she processed the notes on his chart.
"My voice… I lost it about a month ago and can't seem to get it back, and my other ENT won't consider any kind of surgery," Mr. Ibrahim explained, more in a croak than in phonation.
"And is that because of the spur on your C2 vertebra?" Maura asked, rising, her white labcoat a contrast to the deep color of her top. It accentuated her authority. She outfitted her hands with blue latex gloves and pulled out a tongue depressor and a laryngeal mirror, as well as a forehead light. When she affixed it to her head and turned it on, she approached the man sitting on her table.
"I… I think so. It looks like a big bump over my voicebox," he answered. He chuckled in insecurity, but she paid it little mind.
"Alright. I'm going to take a look in your oral cavity, ok? I'm just going to use this mirror to view as much as I can," she explained and he nodded. Maura depressed his tongue and reached the mirror to the back of his throat with practice. However, she saw nothing but exactly what he described: a big bump not-so-conveniently covering his vocal cords. "My goodness, that's really occluding our view of the vocal folds, isn't it?" she remarked.
"That's what the other doctor said," Mr. Ibrahim commented. He hung his head.
"Don't get so discouraged just yet," Maura said, moving about the exam room to ready the equipment she needed. "Just because your other physician refused to operate doesn't mean there aren't potential other options, especially if what I suspect is true. Can you do me a favor and relocate to that chair there, please? I would like to get a closer look at your larynx," she pointed to the blue medical chair in a corner of the large room, where a flexible endoscope hung on the wall near it. It looked like a videogame joystick with a cord attached to the end, but always reminded Maura of an anglerfish, the way it narrowed at its tip and lit up into the darkness of the nasal cavity.
"This gonna hurt?" Mr. Ibrahim asked, intending it as a joke but the tremble in his already diplophonic voice belied his worry.
"Not at all. In fact, I am going to spray a numbing agent in your nares and then you won't feel a thing," she assured him.
"That's what I like to hear," said he in his rough voice. He smiled and nodded toward her, and she approached in her chair.
After swabbing his nostrils with the agent, she readied the flexible endoscope. "Perfect. We'll give that five minutes, and then take a look at your vocal folds through your nose with this little light."
"So, Dr. Isles," the man strained to say, "what makes a girl like yourself want to look down old men's throats all day?"
Maura laughed, grateful for his humor meant to put her at ease. "You know what, Mr. Ibrahim? I truly enjoy giving people like you their voice back."
"I'm glad you're here, then," he responded quietly, eyes glassed with newfound respect for the otolaryngologist.
She accepted his comment with grace and quiet. The five minutes passed, and her gloved hands grasped the body of the scope. "Ok, I'm going to feed the flexible endoscope through your nose and see if we can't move past that spur." He took the entrance of the scope in his nostril swimmingly, and Maura watched its descent into his throat. "Ah hah," she breathed, more to herself than to her patient. "It is indeed a hemorrhagic polyp."
"That doesn't sound good," Mr. Ibrahim stuttered, his palms sweating.
"It's not life-threatening. Fortunately, it's not the largest I've seen," Maura explained, not moving her eyes from the screen where his vocal folds were displayed. "I can see why your previous physician refused to operate, and I don't think I could either. But, I can definitely remove it here in the office. It will take a little longer to heal, and you'll be more sore than if I surgically removed it, but it shouldn't be a problem."
"Oh thank God," he said as she removed the scope and her gloves.
"Let me call Rachel in here to assist me and we'll snip the polyp straight away, ok?" Maura asked, walking toward the door. Her patient nodded in acquiescence and she left. The two women returned shortly after, and while Rachel stabilized the scope, Maura used curved scissors to snip the round, blood-filled mass on his vocal cords – bulbous, red, and wet on white muscle fibers. With sure fingers, she symphonied forceps through tissue, mesmerized by the bleeding that usually signaled pathology, metaphor now flipped by the expert curl of her hand – this flowing red represented the first step in his healing.
Her patient, uncomfortable but not in agony, looked at her in gratitude as she had instructed him not to speak. She had him wait for a few minutes for the paperwork to process, and once he made his follow-up appointment, Maura and Rachel breathed a sigh of relief.
"Well, that wasn't such a bad first week, was it, Dr. Isles?" Rachel chuckled, straightening the papers on her desk.
"Definitely not," Maura answered, running a hand through her hair. "I want to thank you for all your help this week-" she began, when she felt a buzz at her hip.
"Is everything alright, Doctor?" Rachel asked. Her eyes scrutinized her superior, who fumbled in her lab coat.
Maura finally found the pager in her left pocket. "Not for someone out there," she clarified, pointing out their window to the trauma wing across the way. "I'm being called in for a trauma consult."
A/N: This is the last chapter before they meet. Thank you for all the follows! Read and review, because I love to hear what you think!