The Perfect Treatment. Rebecca Lang
about your general health? Your appetite?’ For the next little while she questioned him about the present, then went on to his medical history, starting from as early in his life as he could remember. Apparently he was one of those men who took his bodily functioning, his health, entirely for granted, having only a very rudimentary knowledge of the anatomy and physiology of the human body.
Abby filled in a requisition form for a chest X-ray, to be done that day in the hospital. If she didn’t get it done now he might never come back, especially if he got scared—any more scared than he was now. She did not want to give him a hint that he might have lung cancer, the possible diagnosis that was uppermost in her mind. He could also have chronic emphysema, a lung disease brought on by repeated chest infections, as well as by smoking. This disease also affected the heart.
She also filled in requisition forms for some basic blood work, to be done in the hospital labs. Chronic smokers were often anemic, as well as suffering from various vitamin deficiencies, as they were frequently poorly nourished. Smoking tended to dull the appetite and become a substitute for food.
‘I want you to have a routine chest X-ray this morning, Mr Barlow,’ she said, ‘as soon as we’ve finished seeing you here. I’ll call them to fit you in right away.’ There was no way she was going to let him get out of the hospital without one. ‘And I want to have some blood tests done as well, then we’ll see you here two weeks from now with the results.’
‘Ok,’ he said, a certain bravado in his voice. ‘Have I got bronchitis?’
‘I’ll be better able to answer that question maybe when I’ve examined you,’ she said, ‘which I’m going to do right now. I want to listen to your chest, take your blood pressure, and so on. I’d rather wait for the chest X-ray before saying anything definite.’
The lungs did not expand well. Abby listened to the breath sounds in those lungs as she placed her stethoscope here and there on her patient’s chest when he was lying on the examination couch a few minutes later. It was probable that he did have a chronic lung disease, bronchitis or emphysema, which did not rule out cancer as well. There was also the possibility of tuberculosis, which was increasing in prevalence these days.
When she had done a very thorough examination, she lifted the telephone to tell the receptionist that she was ready for Dr Wharton to see her patient.
‘He’s just gone in with one of the other young doctors,’ Sue informed her. ‘Dr Contini might be free between his cases. Would you like him?’
‘Oh…um…yes, if that’s all right with Dr Wharton.’ Abby felt herself to be a little flustered, not a state to which she was accustomed. Indeed, she prided herself on her sang froid.
‘Dr Wharton’s in full agreement,’ Sue said chirpily, giving Abby the impression that the receptionist was coming under the influence of the new head of medicine. ‘He’s running late, and Dr Contini wants to learn the ropes here.’
While waiting for Dr Contini, Abby called the X-ray department to make an appointment for Gary Barlow, stressing that she needed it done that morning, soon. As a chest X-ray could be done very quickly, they gave her a time which would coincide with the end of Mr Barlow’s appointment in Outpatients. Considering that he might leave the hospital without the X-ray she resolved to escort him to the X-ray department herself.
She was also keeping a close eye on the time, mindful of her obligation to go to 2 East.
Dr Contini came in after a peremptory knock. ‘What can I do for you, Dr Gibson?’ Again he reminded her of a racehorse, lean yet muscular, with a graceful, contained power.
‘Would you confirm my physical findings, please, Dr Contini?’ she said, handing him her written notes. ‘That’s what Dr Wharton does. Here’s the history.’
She watched his dark head as he bent over her notes on the desk, his arms propping him up as he stood reading intently, yet ready to take flight.
‘You take a good history, Dr Gibson,’ he said, looking up suddenly.
‘Of course,’ she said, pursing her lips a little. ‘I’m well known for my good histories…among other things. I’ve pencilled in my provisional diagnosis.’ Moving over next to him, she put her finger on what she had written, not wanting to say anything in front of Mr Barlow. Quickly, she moved back, oddly aware as she did so that Blake Contini knew she was distancing herself from him.
With an astute look, he smiled at her slightly—there seemed to be a sadness in that look. Instantly she regretted her pursed mouth, her touch of primness, which wasn’t really ‘her’. Then that name came to mind again…Kaitlin. Who was she? His wife, perhaps? A child? The words that Mrs Ryles had uttered echoed in her mind. ‘Any change there?’ the woman had said. His dead voice had answered, ‘No, nothing.’
Abby knew then that she did not want him to be married, to be committed. It meant that her own resolve was weakening. And she had another year to go of training. ‘I appreciate this,’ she said. ‘There might be something that I’ve overlooked.’
‘We’ll see,’ he said, taking a stethoscope from the pocket of his lab coat. ‘Hello, Mr Barlow. I’m Dr Contini. I understand you have a chronic cough.’
It was five minutes after eleven o’clock when she arrived breathlessly on 2 East, having managed to escort Mr Barlow to X-Ray, just to make sure he would actually go there, and to see two more patients as well.
‘If you’re looking for Dr Contini,’ a nurse said, ‘he’s down that way. Room six.’ She gestured down the corridor of the general medical floor.
‘Thanks.’
‘We’re keeping that patient, Mr Simmons, in isolation,’ the nurse said. ‘You’ll find the stuff you have to put on in the anteroom.’
There was a small glass panel in the door of room six, through which Abby could see Blake Contini, dressed in a gown, cap and mask, talking to the patient.
Mr Ralph Simmons, a man in his early sixties, had a diagnosis of acute myelogenous leukemia, a disease which left him anemic and generally debilitated and thus more susceptible than normal to infections which he might pick up from other people. Abby put on a gown in the small anteroom, covering her own clothes, then a disposable cap that covered her hair and a face mask. Last, she put on a pair of latex gloves.
‘Ah, Dr Gibson,’ Dr Contini said, as she let herself into the room, his eyes going over her quickly. ‘We’ve been waiting for you. I’ve told Mr Simmons to expect you.’
‘Good morning.’ Ralph Simmons smiled tiredly at Abby.
‘Good morning,’ she answered, moving to stand near Blake Contini at the bedside. He held the patient’s chart.
Mr Simmons lay on the only bed in the room. He was a large man, who had most likely once been very fit and muscular, Abby surmised as she looked at him. He seemed to be still in reasonable shape, although very pale and tired-looking.
‘Did you have time to read the computer printout I gave you earlier?’ Dr Contini asked.
‘Yes, I did.’
‘Good. Here’s the case-history chart.’ He handed it to her so that she could read about their patient in more detail, see the results of the blood tests that had been done so far in order to make the diagnosis and assess the degree of development of the disease. ‘Mr Simmons knows his diagnosis.’
He meant, Abby supposed, that they could talk reasonably freely about it in front of the patient.
‘How are you feeling, Mr Simmons?’ she asked.
‘Tired,’ he said. ‘Very, very tired.’
Before Abby had entered medical school she had been under the impression that it was children who commonly suffered from the various types of leukemia that were known—only later had she discovered that it was just as common in adults, right up to the elderly. In fact,