The intern bowl had moved from the spring to just before Thanksgiving over the years. Allison's class was excited for the day and waited anxiously in the locker room to be given the directions.
"Grandma, do I get to help," Everly asked, she was out of school for a professional development day.
"You do," Teddy assured, "you're going to be my partner."
"What are we doing," Everly asked.
"You're helping me with the EKG station,' Teddy replied, "I talked to your dad and he's okay with it. If you want you can be hooked up to the machine, or you can sit on the bed with stickers and just watch. Do you want to watch how your heart is working or should I use a sample set?"
"What do I have to do to see my heart," Everly asked.
"We're going to see what it's doing using lines on paper," Teddy replied, "your job will be to let me put the stickers on you and sit with me. I will do the stickers myself. It's up to you, Ev you decide what you want to do, it's your body."
"Can auntie Ava do it," Everly asked.
"She's not here today princess," Teddy replied, "I can do it or Auntie Annie or you can just hang out. It's your choice if you do it today but then you have to come next week for Dr McKidd to do it."
"Is it just the sticker thing not the overnight thing," Everly asked, "or the cold sticky one?"
"The stickers," Teddy replied, 'there's 12 of them. Then you can watch a movie, read or colour or just hang out with me."
"I can do stickers without mommy," Everly replied, "but no more."
"We won't do any more I promise," Teddy replied.
"Who has to see me without clothes," Everly asked.
"Me," Teddy replied, 'and only if you want to. Everly, we will do it if you want to and only if you want to. It's your body and your choice."
"You can do the stickers and auntie Nee," Everly replied.
"Okay," Teddy replied, "and when you've had enough you tell me and we stop that second."
"Okay," Everly replied.
Teddy stood up to lead Everly to the room.
"My legs hurt, can I ride," Everly asked.
"We'll have to get you a wheelchair, you're too tall for me to carry now," Teddy replied, she found Everly was hard to carry comfortably over long distances now, it was a combination of Everly's growth and Teddy's own ageing.
"It's in grandpa's office he piggy backed me," Everly replied.
"It's just down the hall, let's walk there," Teddy replied.
"Carry me," Everly asked.
"I can try," Teddy agreed.
"Piggy back," Everly suggested.
"Okay," Teddy relented.
Teddy piggybacked Everly back to Owen's office and let them in to grab Everly's wheelchair. Teddy wasn't sure Everly really needed it today but they had just gotten her a new chair that Everly had helped pick the colours of and for the first time it had been fully customised to the little girl. Everly was comfortable in her chair for the first time and the hospital was a safe place for her to use it, the wheelchair didn't look out of place here.
They made their way to Teddy's station and got set up. Teddy put Everly's favourite show on Netflix for her to watch while she attached the wires. Teddy didn't fully connect the wires yet, there was only one intern she wanted to see the true reading, instead she had her basket of teaching samples to use.
"Grandma can we go to Disney Land," Everly asked.
"That's a mom and dad decision," Teddy replied, "grandpa and I are planning a little trip for you and Henry and Heather at spring break. But where we're going is a surprise. It's driving distance and something you can do on your own."
"Do I have to try skiing again," Everly asked.
"I think you should try with the sit ski again," Teddy replied.
"It's hard," Everly complained.
"I know," Teddy assured, "tell your mom."
"She always looks sad when I can't do things." Everly said.
"She does," Teddy agreed, "but it's not your job to worry about it. You do what you love and makes you happy."
"I won't be a surgeon," Everly said, "I can't stand at a table and use both hands that long."
"And you don't have to be," Teddy said, "you get to choose what makes you happy and excited."
Allison's group made their way to the starting line and opened their envelopes. Allison read the clue twice then sprinted through the tunnel to the skills lab.
"Dr Blouin," Josh greeted.
"Dr Riggs," Allison replied.
"You have 2 minutes to show me how to drape for an appendectomy," Josh commanded, "every 10 seconds you go over is a one minute time penalty."
Allison nodded.
"Go," Josh commanded.
Allison and the other two doctors in the room raced to a mannequin and draped them as fast as they could.
"Dr Riggs,' Melina yelled.
"Dr Riggs," Steven yelled.
"Josh," Allison shouted as the timer went off.
"Go," Josh said scanning all of their work, "you need to see the chief on the cat walk."
They ran but Allison stumbelled going up the stairs. She paused to shake it off knowing she was falling behind. She had to finish, she didn't have to win. The prize of choosing a surgery wasn't the end all be all to Allison. She was seeing great surgeries daily, she had connections to attendings. She needed to finish and finish strong. After catching her breath she rushed to the cat walk to do the next task for Megan. Looking at Allison Megan could see she was shaken.
"Blouin breathe," Megan said softly.
"I'm okay," Allison assured.
"You're limping what's wrong," Megan asked.
"I fell in the stampede up the stairs," Allison admitted, "smashed my knee and shin on the stairs. I'll be fine. I've had worse."
"Do you need treatment," Megan asked.
"No I have to finish," Allison said, "show Everly that we don't give up. I know she's here with my mom."
"She is," Megan agreed, "answer my question and she's your next stop."
"Okay," Allison replied.
"Name three causes of traumatic injury," Megan stated.
"Penetrating injury from stabbing, crush injuries from being squished between two objects at speed or high pressure and burns from exposure to high heat or chemicals," Allison listed.
"Go," Megan replied, "EKG lab."
Allison made her way to the lab and saw the group that had been ahead of her.
"Mom," Everly smiled from the bed seeing Allison jog into the room.
"Hi Ev," Allison beamed, 'dr Altman."
"Dr Blouin you need to make a diagnosis from this EKG strip alone with out conducting a phiscal examination of Everly," Teddy passed Allison the paper.
Allison paused and traced lines out one at a time with her finger. She thought she saw the pattern associated with a valve not sealing properly but she needed time to think which valve. Was Everly a clue? Was her daughter part of it or an adorable decoy? Allison glanced at her fellow interns who appeared to be puzzled, they were all here, the whole class was in the room now.
"There's a problem with the aortic valve," Allison said, "I'd need an echo to see it and get a visual or a CT."
"Good Blouin," Teddy replied, "you've narrowed it down, think what it could be."
The other interns froze. Allison had been the first to speak but Teddy, her own mother had sent her back to try again. They had seen Allison brought into surgeries they didn't have a chance at, that attendings knew her by name, that the head of cardio had a special nickname for Allison. Her parents were huge names in the hospital so was her sister but here she was being shut down and sent back.
Allison looked at her daughter giggling on the bed playing some sort of game on the tablet with Teddy she decided to take a short in the dark, "aortic regug related to a bicuspid aortic valve?"
"Yes," Teddy replied.
"How did you," Melina asked.
"Grandma can I be done now mom's done," Everly said.
"For now," Teddy replied, "they still need to put the 48 hour monitor on you but mom will go with you later for that."
"I'll take you for that as soon as I'm done princess," Allison assured.
"Dr Blouin you can head to the west parking lot, Lot C and meet Dr Hunt," Teddy directed.
A few others made guesses and Teddy sent them on their way. This group needed some serious cardio time, they were behind in their cardio skills. She missed the days where interns were fighting to get into day to day cardio, the last few years they had wanted flashier robotic programs and high tech advancements. Teddy knew that they had to have basics, they needed to know how to do things the old fashioned way, to cut, to use their eyes and their hands. She knew that they needed both because one day it would be a patient's life depending on the surgeon's ability to do it by hand. She was going to have to talk to Annie about how to make cardio appealing to the young surgeons. Cardio programs were in decline, it was losing its appeal and they needed to change it. From what she had seen on Everly's EKG, the one she had chosen not to show anyone until the appointment later, Everly would need heart surgery soon, the valve was likely deteriorating and becoming a problem. Teddy hoped that Ev was a candidate for the minimally invasive option and wouldn't need to be on bypass.
Allison finished the intern bowl in 5th out of her class of 50, it was a respectable spot, in the top 10% of her class but not first. She would have preferred to be top three but she had been off her game all day, the fall, and she could tell her mom wasn't telling her something. Something about Everly, what had happened? What was wrong?
She left the locker room after changing and met Everly and Asher outside Annie's office.
"Annie's," Asher asked.
"McKidd left," Allison replied, "he got a head of cardio position at another hospital."
Annie opened her door as soon as Asher knocked.
They quickly took seats not needing to be invited.
"What's wrong," Allison asked.
"Mama did an EKG today," Annie replied, "I have the results and we'll do a 48 hour Holter monitor test as well as an echo. But the EKG didn't look good. I want imaging of her valve and if needed we'll kick it over to Maggie or Christina to operate. From the EKG alone Mama and I think it's time we discuss surgical management of that valve."
"But they said it wouldn't be a problem until she's an adult," Asher said.
"It might not be," Annie assured, 'that's why we do the imaging. I also want to look at her full medication list some can affect cardiac function and a change in medication might fix what we're seeing."
"Auntie Nee is my heart sick," Everly asked.
"It might be," Annie admitted.
"Is it bad," Everly asked.
"We have to know what's going on first Ev," Annie replied, "I'm going to ask Dr Pierce to look with me. I love you so much that I'm too close to be your only heart doctor. I'm going to do it with Dr Pierce because two brains are better than one. I want to look at how your heart is working over a few days and do some scans and get pictures of it."
"Do I need surgery," Everly asked.
"Maybe," Annie replied, "that's why we need to look closer at your heart to make a decision about what is best for you. We're going to get all the information first. When we have all of the information we will make a decision."
"I don't like surgery," Everly replied.
"I know you don't," Asher replied.
"If we need to do it we will do it in a way that is as minimally invasive that means we will make as small of cuts as possible and do it so it hurts you less," Annie replied, "we will be as gentle as possible. Surgery is our last choice we will do everything else first. Everly we will only do it if we have to."
"But," Everly started.
"It's an if princess," Asher replied, "first we do all the tests then we will decide what's next. And mom and I are right here always"
"But I don't want to," Everly replied.
"It might not be a choice," Allison replied.
"It's my body," Everly argued.
"It is," Asher agreed.
"I don't want surgery," Everly said again.
"Let's do the tests and see if you even need it," Annie replied, "it's one possibility."
"If your heart isn't working well it might explain why you're really tired and finding walking and physio harder than normal," Allison offered, "we need to do the tests and find out what's going on."
"No cutting," Everly said.
"None," Allison promised, "stickers and pictures."
"You can do that princess," Asher assured, 'and we'll come with you."
"Okay off to the lab and we'll take a look," Annie replied, "have them do it and send me the results."
"Okay," Allison replied, taking a deep breath.
They made their way to get the imaging done with Asher carrying Everly.
"Allison," Melina started.
"I have to go," Allison replied, "my daughter needs to go get an echo."
"Allison,' Melina asked.
"I have to go," Allison replied.
They walked in silence the rest of the way and Allison and Asher sat in the waiting area.
"How was that thing this morning," Asher asked, "how did you do?"
"Fifth,' Allison shrugged, it didn't really matter now.
"Thats pretty good out of 50," Asher replied.
"But Annie and Josh were first and second their year," Allison huffed, "it's just another Allison the let down moment."
Annie texted Allison, "I'm sending Ev for blood work. I want to check her iron and B12."
"It would explain the fatigue," Allison agreed, "and is the easiest fix."
Allison looked through the window into the room, hating that they couldn't be with Everly. She took her hospital tablet out of her bag and found Everly in the system.
"What are you doing," Asher asked.
"Following the notes and measurements as their imputed," Allison replied, "Ash I can't play the wait and see game. I have to know. I can't hide it working here. If she needs surgery. I don't think I can handle her needing heart surgery. She's only 8, shes been through so much and that scar."
"I know it's not fair to her," Asher agreed, "but your sister didn't seem sure it's surgical."
"She's doing the thing she teaches us to do to put parents at ease until she's finished testing," Allison replied, 'it's a dr trick. I do it."
"What are you thinking," Asher asked.
"I think it's surgical and Pierce will have to do it," Allison replied.
They brought Everly back after the scans.
"Do I need surgery," Everly asked.
"We don't know yet," Allison replied, "we have to get blood work and do the 48 hour monitor princess."
"I don't want blood work," Everly whined.
"I have to do some for my thyroid. Why don't we go down to the lab and do it together," Allison suggested.
"Fine,' Everly complained.
They walked down to the lab for the blood draws then made their way home. After dinner and bedtime Allison pulled up the chart again.
"It's not surgical,' Allison replied, "bad EKG this morning? Mom only did a mini one on her, maybe back for a full one."
"How do you know," Asher asked.
"The radiology report was rushed," Allison replied, "and the images, the valves are fine. They look healthy her aortic is still bicuspid but we know that but the video it's moving well."
"Thoughts Dr Mom," Asher asked.
"Medications," Allison replied, "we need to look at her meds. The muscle relaxant can affect the heart."
"Okay," Asher replied, "that's better than surgery. The issues could be fixed by taking her off that medication?"
"Changing it," Allison replied, "we'll taper it down over 3-4 months and closely watch her heart. There might be a point that it stops affecting it and still helps her move. Ash she's not okay, she's so tired these days. But her blood work is okay, anaemic but that's an easy fix, I am without the iron supplement, I know mom says she is and so is Annie. It's genetic. We can fix anaemia. Her B12, I don't like it's on the low side but diet changes and a supplement."
"Could we lose her," Asher asked.
"Not with this," Allison replied, "we can fix the anaemia and B12 easily. We talk to her team and make changes but it's not going to be surgical."
"Her stamina," Asher asked.
"We follow up on her iron," Allison replied, "change up her physio routine, push her a bit more. She's not doing PE at school, they don't like her on her bike for running club. So she's only doing physio and swimming."
"Your thing today what happened," Asher asked.
"Fifth top 10% I'm okay," Allison replied, "but I made a few mistakes early on, I was slow. I didn't need the prize though."
"What was it," Asher asked.
"Picking anything on any service to scrub in on and assist," Allison replied, "I get asked to scrub in all the time. I'm okay that way. Winning would have looked bad the chief is my aunt."
"Are you holding back," Asher asked.
"No but I'm being judged harshly by attendings, senior residents, other interns," Allison said, "Annie told me it happened to her. This is why I wanted to leave, why I wanted to go elsewhere. There's openings at Seattle Pres and Tacoma. I think I need to apply. I can't live in their shadows, Ash. I want to be me, I want to stop being judged by my past, by my sister and parents. I'm never going to measure up. I'll never be as good."
"Allie," Asher soothed, "let's not make rash decisions now. You're tired, today was hard, you're overworked. You have 4 days off coming, let's stay home as a family this weekend, relax and not worry about surgery or work."
"I don't think I want this anymore," Allison said, "it's not fair to you or Ev. I want to switch my residency to be a paediatrician. Ash I can't do this, I don't want to."
"Tonight is not the night to make the decision," Asher replied, "if you switch?"
"It's shorter days, fewer hours, less weekends," Allison replied, "3 years instead of 5. I'm worn out."
"I know you are," Asher replied, taking her in his arms, "Allie you're exhausted. You're going to have a bath, I'll bring you some tea then we'll go to bed and I will hold you until you fall asleep."
Allison nodded. Asher knew she was exhausted, a few days rest and she would be okay, she hadn't gone dark yet, this was tired and stressed. Allison would be okay.