Now That You Mention It

I left the room, my heels tapping on the shiny tile floors... I always dressed for work, having come to my love of clothes later than most. I adjusted my white doctor’s coat, which still gave me a thrill—Nora Stuart, MD, Department of Gastroenterology stitched over my heart.

I could do computer work, I supposed. The nurses would love me for it. My rounds were finished, and I was just killing time, hoping that for once, Bobby would be ready to leave at the end of his shift. He worked in the ER, so the answer was usually no.

But I really didn’t want to go home alone, even if Boomer, our giant Bernese mountain dog mutt, would be there. Boomer, the bright spot in my increasingly gray life.

No. My life was fine. It was great. Best not to navel-gaze right now. Maybe I’d call Roseline, my best friend here in Boston, an obstetrician. Even better, maybe she’d be on call, and I could help deliver a baby. I texted her, but she immediately responded that she was at her in-laws’ for dinner and contemplating homicide.

Too bad. Roseline understood the grayness. Then again, maybe I’d been leaning on her too much. I wrote back suggesting various ways to dispose of the bodies, then stuck my phone in my pocket.

I ambled over to the nurses’ station. Ah, lovely. Del, one of my favorite CNAs, was sitting there, lollipop in his mouth, going through a pile of papers. “Hey, buddy,” I said.

“Dr. Nora! How’s it going?”

“Great! How are you? How’d the date go the other night?”

He leaned back in his chair, a huge smile coming over his face. “She’s the one,” he said smugly. “I knew it the second she smiled at me.”

“Really?”

“Really. I mean, she looked up, and I practically got down on one knee. It was like we’d known each other forever. Like we were made for each other, special order, you know?”

“Sure!” I said, a bit too emphatically. “Same with Bobby and me.”

Del’s smile faltered just a little.

Just then, an overhead page went off. “Attention, please. Attention, please. Dr. Stuart, Dr. Nora Stuart, to ER Eleven, stat.”

I jumped. “Oh! That’s me!” A GI call to the ER was rare enough to still be thrilling. “Off I go, then. Bye, Del!”

I ran down the hall, feeling very badass, one hand over my stethoscope so it wouldn’t bounce, wondering what the call was. Foreign body in esophagus (choking, in other words)? Hemorrhagic lower GI bleeding? Always exciting. More common in a city ER would be esophageal varices due to alcoholism or hepatitis—blood vessels in the throat that burst and can cause the patient to bleed to death.

I loved going to the ER. Gastroenterology was just as important as emergency medicine, but no one wrote shows about my specialty, did they? The ER was where the cool kids hung out, and my boyfriend was their king. Bobby often said there was little the emergency department couldn’t fix—but if they’d paged me, well, then... I was the captain now.

I ran down the stairs into the ER, over to the triage nurse. Ellen looked up and said, “Twelve-year-old with a bellyache, looks sick, number eleven.”

“Thanks, Ellen!” She failed to smile back. Bobby loved her, but to me, she was as charming as the Dementors in Harry Potter, always looking for some happiness to smite.

To Exam Room Eleven I went, walking briskly but not running. The ER was fairly quiet tonight; the usual suspects—the elderly, a few kids, a few addicts, a guy with a bloody hand who smiled as I walked past.

Gastroenterology...well. Someone had to do it, right? And I liked it, mostly. Ninety percent of my patients got better. The colonoscopies...believe it or not, there was a Zen to them. But yeah, it didn’t make the best party chatter. I couldn’t count the number of flinches I got when I told people what my field was, but they sure cared when they had an ulcer, didn’t they?

Jabrielle, one of the newer ER residents, stood outside the exam room. She was a little too infatuated with Bobby, as demonstrated when she gazed deeply into his eyes at the last party we’d gone to, one of those we can’t break eye contact because this conversation is so intense situations. Jabrielle was also irritatingly beautiful.

“Are you the GI consult?” she asked, failing to recognize me. Again.

“Yes,” I said. “I’m Nora. We’ve met. Three times.” She still looked blank. “Bobby’s girlfriend?”

“Oh. Right. Anyway, I suspect appendicitis, but his pain is a little more midline. We’re waiting on labs. I was going to scan him, but the attending wanted the consult to see if we can avoid the CT.”

The patient looked young for twelve, his skin ashen, face drawn with pain. We didn’t want to expose him to radiation from the CT scan if we didn’t have to. “Hi, bud,” I said. “We’re gonna take good care of you, okay?” I smiled at the mother as I washed my hands. “I’m Dr. Stuart. Sorry your son is having trouble.” I glanced at the chart. Caden Lackley, no trauma, eating mostly normally until today, acute abdominal pain, fever, nausea and vomiting. “Any diarrhea or mushy poop, Caden?” Like I said, not the best party chatter.

“No,” he answered.

“Okay. Let’s take a look.”

I felt his stomach, which was tight, one of the signs for appendicitis. But the pain wasn’t in the expected place; in fact, it wasn’t anywhere near McBurney’s point in his lower right abdomen. “It’s not his appendix,” I said.

Jabrielle pursed her perfect lips, irritated that she’d been wrong. All the ER docs were this way, hating when we specialists disagreed with them.

The kid sucked in a sharp breath as I palpated just under his ribs on the right side. There was no pain on the left. I rolled him to his side and tapped on his back to check for kidney problems, but he didn’t react.

He was probably too young for gallstones. Pancreatitis, maybe, but again, given his age, it was a bit unlikely. It wouldn’t be Crohn’s disease without diarrhea. “How long has your stomach been hurting, Caden?”

“Since Sunday.”

That was a nice specific answer. Today was Thursday, so five days of stomach pain. “Has it stopped and started?”

“No. It’s been there the whole time.”

I thought a second. “Did you eat anything different over the weekend?”

“We went to a party at my sister’s,” the mom said. “There was a lot of food, but nothing he hasn’t had before.”

“Anything with small bones in it? Fish, chicken?”

They looked at each other. “No. Nothing with bones,” she said.

“How about a toothpick?” I asked.

“Yeah,” he said. “Those scallops wrapped in bacon.”

Bingo. “Did you maybe swallow a toothpick?” I asked.

“I don’t think so,” he said.

“He was eating them like popcorn,” his mother said.

“Well, they are fantastic.” I smiled. “Sometimes people can swallow things without noticing it, Caden, so I’m going to do an endoscopy. Basically, you get some nice relaxing medicine, I slip a tiny camera into your stomach and look around and maybe I’ll see a toothpick. Sound like fun?”

It did to me.

I told Jabrielle to give him some Versed to relax him, then sprayed his throat with lidocaine to numb it, so he wouldn’t gag. His mom sat next to him, holding his hand.

“This won’t hurt a bit,” I said, then I got to work, sliding the scope into his throat, talking quietly through it, looking up at the screen as Caden’s esophagus and stomach were revealed. Healthy tissue, the beautiful web of blood vessels, the grayish walls of the stomach pulsing and moving with life.

And there, in the lower part of the stomach, I saw the toothpick, now black from stomach acid, sticking out of his duodenal wall. Using the endoscopy forceps, I gently grabbed it and slowly pulled it out. “Ta-da,” I said, holding it up so my patient could see. “We got it, Caden. You’ll feel a lot better tomorrow.”

“Good call,” Jabrielle murmured.