Marla Mears Quartermaine was ready to burst into tears when she saw her paunchy pooch bulge out as she stood in front of the mirror. Was Hugh Lars blind? How could he not understand how much she needed a tummy tuck redo? Fortunately, she was only three days away from seeing Dr. Tyler to arrange exactly that. Unfortunately, before that she first had to figure out how to fit into a cocktail dress in time for the evening's ELQ Shareholder's Meeting. Perhaps if she didn't eat anything and took an extra dose of her pills it would be ok. Perhaps…
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Dr. Alan Quartermaine smiled as he watched his middle daughter efficiently cut tangents between the course marking flags as she entered final loop around the west soccer practice field. With approximately one kilometer left, Emily was leading the race and on pace to break 17:30, the course record. "Great Job Em! Stay strong!" he called as the rest of the Quartermaine collective echoed similar encouraging sentiments.
"Is she usually so far ahead of that girl from Sutton?" AJ Quartermaine asked referring to the girl in second place more than fifty meters behind.
"This year she is! Believe it or not, we're growing up AJ!" Allison Quartermaine schooled her brother.
Alan chuckled at the comment and the idea that his son seemed even more terrified by the concept than he and Monica were, at least most days. Despite that, he was still grateful for the connection his children had.
"While that may be true, you're still always going to be my baby sisters. So maybe just don't forget that," AJ returned.
"As if you would possibly let us," Allison said with a smile.
Alan found himself smiling as well as Emily sprinted back past them on her way to the finish line and victory.
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Dr. Julie Devlin yawned, took a moment to orient herself, and then glanced at her watch. It was almost 9:30 which was basically the latest she had ever slept since starting internship four months earlier. When she glanced to her left, she wasn't surprised to see her cousin Ian sitting in a chair by the window.
"Is your head feeling better?" Ian asked once he realized she was awake.
"Yeah, I'm surprised they didn't wake me up at six o'clock for the repeat scan. I can't imagine Dr. Jones wants to be stuck here waiting for a reading," Julie said.
"Technically as a neurosurgeon shouldn't he be reading his own scans?" Ian asked.
"Oh, probably but I'm sure no one is brave enough to tell him that. He has a short fuse. He completely reamed my roommate the first week of internship," Julie said.
"Why?"
"She let a patient leave AMA. But it isn't like you can keep someone against their will if they have decision making capacity and aren't a danger to to themselves."
"Right, so why did he ream her?"
"I guess that PCGH has a policy that patients are supposed to be seen by an attending before leaving AMA," Julie said.
"Ok, but like you said if they want to leave can she really keep them?"
"Right, and I think it was really less that they left and more that the on-call neurosurgeon failed to see a trauma patient within two hours of ED arrival. I suspect Dr. Jones knew that the case would get reviewed because it was an AMA and then the fact that he failed to see the patient in a timely fashion would be noted."
"This Dr. Jones sounds like a jerk," Ian said.
"I think he is but supposedly he is just going through a lot. His daughter died a few years ago and I guess his wife divorced him after he ended up in bed with one of the Physical Therapy Techs."
"More than I wanted to know. But I guess another reason I'm glad I didn't apply here for residency," Ian said.
Julie wondered if the top reason he hadn't wanted to apply to PCGH was because her father was there. She was afraid to ask that question. "You probably wouldn't have much interaction with Dr. Jones as an IM resident," she said.
Ian shrugged his shoulders. "Probably not I'm sure Dr. Jones isn't the only malignant jerk on staff."
"True but a lot of the attendings are great! Dr. Alan Quartermaine is the most patient pediatric and trauma surgeon. Dr. Carmichael in the ED was great too and even let me do a few lumbar punctures. All of the pediatric attendings are great and I've seen some cool stuff like Kawasaki's Disease and Histiocytosis," Julie said.
"If you're happy, then I really am happy for you. I think my dad was just concerned about you being at the same hospital as your father," Ian said.
"I know, and I had the same concerns initially, but I think I want to do Pediatric Cardiology and the opportunity to work with Dr. Monica Quartermaine is hard to pass up. So, my father and I have a deal; we fake a healthy father daughter relationship in public and he stays far out of my way as much as he can," Julie said.
"I really hope that works, for you," Ian said.
Julie nodded. She hoped it did too!
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I am surrounded by idiots! Idiots! Rachel Berlin decided as she vomited thick green material and watched the nurses mill about in panic mode. Despite how horrible she felt, it was almost entertaining in a surreal way. Almost…
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At Community Commons, Dr. Gail Baldwin gave her granddaughter a hug. "That was amazing!"
Thirteen-year-old Emily Quartermaine blushed a little at her praise. "It was a good race; even though this is such a boring course. Our Sectional Championship is at the State Park in Deering which is a much better course."
"Will your race go past the waterfall?" five-year-old Serena asked her cousin.
"It goes past part of the Cascada Falls but not the ones out past the suspension bridge. We've run out there though on long runs and stuff and those are much cooler in my opinion," Emily said as her mother joined them with her younger sister, Katelyn in hand.
"So, I'm taking your little sister to swim team practice and your father's pager just went off so I have a feeling that AJ and Brenda will be marshalling your siblings and cousin in the direction of Kirk and Dylan's soccer game on Field 4 after your father dashes back to the hospital," Dr. Monica Quartermaine said.
"I need to do a cool down and I should stay and cheer for the boys' team, but I can find AJ at Kirk's game later to get a ride home," Emily said.
"That sounds like a plan. Congratulations again, we'll do something celebratory for lunch if your dad doesn't get stuck at the hospital forever," Monica said as she gave Emily a hug.
"Sure, and I'm actually sort of almost looking forward to the dinner tonight," Emily said.
"Tell your Grandfather that. He is always complaining this family doesn't appreciate all of the social events we're afforded the opportunity to attend," Monica said.
"But maybe leave out half of the qualifying words when I tell him that?" Emily asked.
Monica smiled. "Honesty is always important but if you were to just say that you were looking forward to tonight's dinner dance your grandfather would probably receive that better. Mom, I really need to go to get your granddaughter to the Health Club for Swim Team on time, but we will find some time Sunday afternoon for tea, and I am not on call on Wednesday," she said.
"Did Aunt Monica say that because she is on call every other day?" Serena asked.
"I'm sure sometimes she feels like that!" Emily said.
Dr. Gail Baldwin offered her elder granddaughter a conspiratorial smile. She didn't want to explain the significance of October 29th to Serena, at least not when she had no idea how it would go. Her husband had little faith that the grand jury would do anything other than indict. He was the attorney, but she was clinging to some hope that justice might finally be served.
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As she walked towards the parking lot at Rose Lawn, Celia Quartermaine blinked back tears. It was ironic in a way; for almost ten years she had trod along the same tree lined paths, past the same brick buildings but in the moment if she didn't know better, she could imagine she was on a college campus. Unfortunately, she knew all too well exactly what Rose Lawn Sanitarium was and was not.
Her mother had resided at the facility for almost ten years. She had been admitted in January 1988 after a suicide attempt that had lapsed into catatonic depression. Her cousin Tracy's husband, Dr. Ryan Grabler, had recommended Dr. Theodore Yang, one of his most promising former residents. But after a decade of escalating benzodiazepine doses and even Electroconvulsive Therapy her mother remained mute, rigid, and stuporous. So, as she made her way back to the parking lot after her visit, she asked the question which had plagued her for years. Was she was clinging to hope or just denying the inevitable? She was so afraid it was the latter. But truly what choice did she have?
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Dr. Alan Quartermaine toggled through Rachel Berlin's CT scan on the 5 East PACs and frowned
"So, what do you think?" Dr. Simone Hardy asked. She had explained over the phone that she had ordered the CT because she was concerned about a bowel obstruction.
Normally Alan would think that the obstruction question could have also been answered with an upright abdominal film and much less radiation. However, in this case it wouldn't have shown the areas of intussusception going into the jejunum so he supposed he shouldn't criticize. "It looks like the GJ tube is creating an intussusception into the jejunum. I can do an endoscopy to remove and replace it more proximally, but we may need to convert to plain gastrostomy tube, or I guess a surgical j-tube if she truly needs post-pyloric feeds," he said.
"I thought you placed a G-J because she did need post-pyloric feeds. Wasn't that the whole reason that Greene County Memorial Hospital transferred her here?" Dr. Hardy asked.
"The biopsies from the endoscopy all came back normal. My sense was that the gastroparesis was largely due to malnutrition so perhaps now that she has had established enteral nutrition for roughly ten days, she would tolerate a gastrostomy tube. I'll talk to her father and if removing the tube relieves the intussusception then I will try to place a shorter GJ tube," Alan said.
"Do you think that will work?" Dr. Hardy asked.
Alan really hoped it did because he wasn't looking forward to the conversation with Raymond Berlin if it didn't. "I hope so," he said.