The Doctor Is Always In
Caution: This Romantic Sex Story contains strong sexual content, including Ma/Fa, Fa/Fa, Consensual,
Desc: Romantic Sex Story: Chapter 1 - A new emergency medical resident makes a bad mistake, putting a patient at risk. His efforts to assuage his guilt bring them much closer on a personal level.
It was the first week of my first year of residency. Five years earlier, I was employed at this hospital as a paramedic and decided I wanted to go all the way. I did well in med school, served my internship across town at University Hospital and felt incredibly lucky to have landed an emergency medical residency here. After all, there were only two positions available and the competition was stiff.
I'd just come on duty at 7AM, when the charge nurse told me I was wanted in the director's office. On a Sunday? I hurried down the hall and knocked on his open door. He was standing beside his desk in jeans and a T-shirt, reading a chart. The picture was completely out of character for the reigning god of EMS.
"Come in, Dr. Butcher. Please close the door and have a seat."
Dr. Peter O'Malley, author of three textbooks on emergency medicine and now Chief of Emergency Services, seemed all smiles and cordiality. For some reason, it didn't feel reassuring. He'd been very personable when he interviewed me for the position but I'd already been warned by one of the staff physicians and several nurses to beware of that pleasant demeanor because it could be intended to put me off my guard before he laid into me about some stupid little mistake I might have committed. I wondered again what in the world could have brought him into the hospital on a Sunday morning.
"Thanks, Dr. O'Malley. One of the nurses said you wanted to see me."
His smile broadened and that was even more ominous.
"That's right. First, may I officially welcome you aboard and congratulate you for persevering through medical school and your internship. I suppose by now you've heard every conceivable joke and pun about your last name and I don't doubt you'll hear the same trite remarks for the rest of your professional life. Still, I suppose it might have been worse; you might have chosen surgery as your specialty."
"Thank you, sir and, yes, I've heard that one too."
The smile wilted a bit.
He sat in the squeaky chair behind his desk and leaned forward, folding his hands like he was about to impart some nugget of profound wisdom. "I just wanted to give you a heads-up about one of your cases that will be reviewed at Tuesday's M&M conference."
He picked up the chart he'd been reading and leaned back, looking it over again for a few seconds. "Mmm, it says here that last Friday night, you saw a twenty-four year-old Hispanic female who was brought in by a friend, complaining of lower abdominal pain increasing in severity over three days. After the standard work-up and X-rays, you diagnosed pelvic inflammatory disease and discharged her with a prescription for antibiotics. Am I right so far?"
I recalled the case clearly. I remarked to the triage nurse about the woman overdoing it on the perfume and makeup and being dressed for business, if you know what I mean. She was practically a stereotypical hooker, although she never admitted to it. The diagnosis of STD's and PID was so common among her ilk that the treatment regimen was basic ABC's. I remember being a bit irritated because she was assigned to me right at the end of my shift, and I had to stay over an extra forty-five minutes to finish her chart. Normally, I wouldn't have minded, but I had to call my date and tell her I'd be late meeting her at the restaurant. She wasn't happy.
"Yes sir. The nurse did a vaginal swab and the lab confirmed chlamydia. I prescribed a course of doxycycline for seven days and told her to check in with the clinic if the pain wasn't better by tomorrow. She said she'd been seen at one of the satellite clinics about two months ago for similar symptoms and they told her she had gonorrhea. It cleared up with a course of antibiotics."
"So I see. And what was the patient's condition on discharge?"
"Well, she still had some supra-pubic tenderness, although it had eased up with NSAIDs and she was mildly febrile with a temp of 37.8. She had a pretty high blood alcohol level but the friend who brought her to the hospital said she'd make sure she got home OK. I gave her enough doxycycline for two days along with the prescription."
"Right. So far, so good. Um, tell me Dr. Butcher, what did her pregnancy test show?"
It bothered me that he kept calling me Doctor or Dr. butcher instead of my first name, giving the conversation a distinct air of formality, like this wasn't just a casual inquiry.
"Well, when I asked her about her last period, she said it had just ended a couple of days earlier."
"Well, if she'd just finished her period, she wouldn't be pregnant, so I didn't order a test."
"Not even as a precaution?"
"Um, it didn't seem necessary. She didn't have any insurance and the test would have just piled on more expense."
He shot me a perturbed look, "Doctor, whether or not she had insurance is irrelevant. We're an emergency department, not a private clinic, and I'd call that kind of thinking penny wise and pound foolish. Now, as for her pregnancy status, apparently, you missed an important lesson way back in medical school. For your information, it isn't that terribly uncommon for a woman to menstruate or appear to menstruate after she's been impregnated. On another note, didn't you say she had a high blood alcohol level?"
"Yes, her BA was .16 if I recall correctly."
"And you say she appeared drunk."
He tossed the chart onto his desk, crossed his arms over his chest and glared at me. "So tell me, Dr. Butcher, in your vast experience as an emergency physician, do you consider intoxicated people to be reliable historians?"
"No, I guess not."
The old man rolled his eyes up toward the ceiling and I knew I was in for a verbal flogging. "You guess not. Let me offer you a little rule to live by, Dr. Butcher. When any woman of childbearing age presents with lower abdominal pain and tenderness not of traumatic origin, especially if she has impaired cognitive capacity, and especially if she has a recent history of a sexually transmitted disease like gonorrhea, she will be tested for pregnancy. That omission wasn't just a little brain fart, Doctor. And aside from neglecting to order an important diagnostic test, you violated a protocol by discharging a patient who was, by your own admission, clearly intoxicated."
My heart sank and I knew I had stepped right in the middle of it. "Oh no, don't tell me she came back!"
"Ah, but I'm afraid I must. Less than three hours ago, this young lady was brought in by ambulance and admitted with severe abdominal pain, hypotension and a hematocrit of 22. Had she waited until tomorrow to go to the clinic as per your instructions, she might well have bypassed it and gone right on down to the morgue. The attending physician read her chart from Friday night's visit and called me at home to express his concerns with your assessment and treatment."
I covered my face with my hands and groaned, "Ruptured ectopic pregnancy!" I hadn't made a stupid little mistake, I'd made a huge, potentially catastrophic mistake!
"Very good, Doctor! Your diagnosis is right on the money, even if it's two days late. Now, the good news is that she's doing reasonably well following surgery and a few units of blood. That's right, Doctor, you can breathe easier because she didn't die as a result of your mental lapse. The bad news is that you're going to present this case at M&M and then you're going to stand there in front of all those doctors, nurses and paramedics and take your medicine. It won't be pleasant."
M&M is medical-speak for morbidity and mortality conference. The emergency staff meets every Tuesday morning to review any cases that are particularly interesting, especially if someone (like me) did or didn't do something that turns out to be problematic.
As much as it embarrassed me to even think it, if the patient had been someone of a higher station in life and if I hadn't been in such a hurry to leave, I would have probably done the damned test and nailed the relatively straightforward diagnosis. Instead, here I was, practically brand new in the business and I'd already committed a stupid fucking boner that could haunt me for the rest of my career. My god, I thought, what if she had died?
I took a deep breath and said, "Yes sir. I see now, that I committed a serious error, and I can promise you it won't happen again."
There wasn't a trace of the smile left. His voice rose and his face began to turn red. "It had damned well better not happen again! If it does, you won't have to worry about presenting it at the next M&M because you won't be employed by this hospital. I won't tolerate sloppy work from my staff and that fact had better be firmly planted in your brain when you walk out that door! The only reason you're still employed at this moment is that your staff attending should have ripped you a new asshole for even thinking about cutting this patient loose in such a condition! Is everything perfectly clear to you now, Dr. Butcher?
"It is, sir."
He took a deep breath to calm himself, leaned back in his squeaky chair and reclaimed his crocodile smile. "Good! Now, at the end of your shift in the ER today, you will report to Dr. Jane Willard up in labor and delivery. She's kindly consented to give you some much-needed tutoring on everything you did wrong since you were either absent or asleep during the gynecology rotation during your internship.
"And one last thing, Doctor. As you must be aware, residencies in my department aren't easy to come by. Don't make me regret offering it to you. Now go away!"
Dr. Estep was waiting outside in the hallway. He was the staff attending that night and no doubt knew what he was in for. He avoided my eyes as I passed him on my way back to the ER.
I felt like a complete idiot. I owed the woman a profound apology, but I knew I dared not say a word to her. I had no idea if she had a clue that I'd screwed up, and saying anything to her could open me and the hospital up to some big-time liability. Shit! Double shit!
My shift in the ER wasn't all that eventful; one cardiac arrest that was too far gone to save, some multiple systems trauma from an auto/motorcycle collision and the usual collection of aches, pains, scrapes, cuts, drunks and dopers, most of whom should have been seen in one of the satellite clinics. Needless to say, Estep scrutinized every one of my cases with a very critical eye.
At 3:30, I showed up at Dr. Willard's office on the third floor for my remedial training in gynecology. Her door was open so I stepped in and introduced myself, "Hi, Dr. Willard. I'm Ken Butcher from the ER. Dr. O'Malley directed me to report to you for some tuning up."
She looked up from what she was reading and laughed, "Well, I suppose that's one way to put it." She waved toward a chair loaded with books and folders. "Just drop that stuff on the floor."
"So, let's get off on the right foot, Ken. First of all, you can call me Jane since we're colleagues and secondly, I'm not planning to beat you up because, if I know Peter, he's already done that. That said, the mistake you made is the kind of thing that causes malpractice attorneys to have wet dreams. If Peter was angry, it's because he had a right to be. You put the patient, his department and the hospital at risk. The woman might have died."
I studied my shoes and admitted, "I can't say that I blame him for being pissed. There's no justification for the way I screwed up."
She at least made a stab at being conciliatory, "Ken, if this is the worst mistake you ever make in your career, you could be considered some kind of phenom. It's an unfortunate near-certainty that, as a medical practitioner, sooner or later you'll be at least partially responsible for a patient's death. You get no pats on the back because this one didn't die, but if you learn from your mistake, you'll be a better doctor. So tell me, Ken, what's the most common cause of ectopic pregnancy?"
"Um, STD's, primarily gonorrhea, if I recall correctly."
"Good! So, you're not completely ignorant. Now, let's talk about belly pain in young women."
So that's what we did for two hours. By the time I left to go home, I was wishing she'd been my professor of OB/GYN in med school. There was no way I was ever going to make that mistake again.
I headed down the hallway toward the elevator but impulsively decided to take a detour up one flight of stairs to the surgical floor to peek in on the woman who'd suffered from my mismanagement. I just had to satisfy myself that she was going to be OK. I checked in with the nurse and got a peek at her chart. Everything looked good.
When I stuck my head through the door to her room, she just happened to be looking in that direction and locked eyes with me. A rush of guilt gave me second thoughts about what I was doing, so I waved and tried to make a quick exit, but she stopped me with, "Hey, Doctor?"
I stepped back into the room, "Hi! How are you feeling?"
She had a pretty face and I wondered why she'd been wearing so much makeup when she came in that night. She didn't need it.
"Sore, but a lot better now. Aren't you're the doctor who saw me Friday night? Dr. Butcher?"
Busted! Did she already know what I'd done?
"Um, yeah, that was me."
Her smile was friendly enough. "I'm glad you stopped by. I just wanted to apologize for being such a drunken mess. Me and some of my girlfriends were out barhopping and I guess I overdid it a little. I think I was trying to kill the pain in my tummy with booze." She giggled and immediately cringed from the discomfort it caused. "I must've looked like a common streetwalker."
Now I felt even worse. Here she was apologizing to the guy who almost cost her her life. "Ms. Sanchez, please don't feel that way. We can't always look our best, especially when we're feeling the kind of pain you must have been experiencing. I'm sorry the treatment I prescribed didn't do the job."
OK, that was as close as I dared come to exposing my own culpability. If there had been an attorney walking by her door, he'd already be handing her his card and mentally shopping for a new Lexus.
"I thought it did work for a while because I felt a little better when I got home. But then it started getting worse and worse, and early this morning, it woke me up. I was so weak and I hurt so bad that I couldn't hardly get out of bed. When my mom came in to find out what I was groaning about, she said I looked like a ghost and called the ambulance. Lucky thing, huh?"
"Yeah, lucky thing. Well, you get some rest now Ms. Sanchez. Maybe I'll pop in and see you again before you leave."
She smiled and said, "I hope you do. Bye!" Then she added, "Um, do you get teased a lot about your name?"
"Afraid so, Ms. Sanchez. We all have our little crosses to bear."
The M&M was every bit as embarrassing as Dr. O'Malley promised it would be. Not that my peers were rude or insulting; they weren't, but then, they didn't need to be. You don't have to be openly called a moron to hear that implicit assumption in their questions. Every single reference to proper procedure assumed testing for pregnancy as a given for a patient with Ms. Sanchez's presentation. My case was the very first one on the program and by the time I took my seat, I was wishing I could crawl under a rug and disappear. I couldn't, though, because I had to sit through another hour's worth of cases. It didn't ease my guilt one iota that Rick Estep took even more heat than I did for letting it get by him.
As I walked toward the ER afterward, Dr. O'Malley overtook me in the hallway and put his hand on my shoulder. "As painful as that was, Ken, it was still better than explaining your misstep to a jury in a malpractice trial. Now, put it behind you and get on with being the good doctor I know you are."
"Yes sir, that's my plan."
I'd resolved to put Anita Sanchez and our mutual close call behind me, but as the poet, Robert Burns once wrote, 'The best laid schemes o' mice an' men gang aft agley.' Less than two weeks later, we crossed paths again. This time she'd had the crap beat out of her.
When the paramedics rolled her into the trauma room, Dr. Estep stood back and told me to run the case. He'd be there if I hit any snags.
Her face was so swollen and bloody that I didn't even recognize who was strapped to the backboard until the triage nurse told me her name. I leaned over her with an ophthalmoscope to assess her pupils and retinas and asked, "Anita, who did this to you?"
She tried to crack a smile through her split, puffy lips and slurred, "Dr. Butcher, we can't go on meeting like this." Then, getting serious, she went on, "It was my ex-boyfriend, the same guy who gave me that infection and knocked me up."
"You need to hang out with a better class of people, Anita. Has he done this before?"
"A couple of times; not this bad, though. I found out he'd been dealing dope and spending the money on every whore on Federal Avenue, so I dumped him. He got pissed because I wouldn't let him in the house and he broke the door down. He dragged me into my bedroom and started beating on me and Mama called the cops. This time I signed a complaint and they hauled his ass off to jail. He's on parole so this will send him right back to prison."
I followed strict protocol every step of the way. I had the nurse call for radiology to do a cross-table cervical spine X-ray before removing the collar and sliding her off the board. The orderly cut off her clothes so she could be examined. The paramedics had already started an IV and drawn blood so the lab work was underway. The first thing I noticed when her belly was exposed was that one of the partially healed laparoscopy incisions had broken open and was bleeding.
"Are you in a lot of pain, Anita?"
She tried again to smile, "If I had my druthers, I'd rather be unconscious."
"Are you allergic to opiates?"
"I don't think so. Don't be stingy with it, OK?"
A detailed exam revealed bruising on her face, chest, belly and arms. I suspected broken ribs and a chest X-ray would later confirm it. With all the facial injuries, I knew there was a good chance her brain might be concussed and hoped it was no worse than that.
As if the beating she'd taken wasn't enough, she'd also been raped. He'd done it right there in front of her mother, and he still had his pants down around his ankles when the cops got there! When she told me that, I called in the charge nurse to do the evidence collection and counsel Anita on everything that had to be done to insure all the legal requirements were met. When she was done, I got the digital camera and photographed all the visible injuries. The animal that had done this to her was looking at a lot more than just a parole violation.
It was almost an hour later that she was transferred upstairs to surgery for repair of the damage done to the site of her previous operation. She was going to feel like warmed-over death for a few days but I thought she would be OK physically. Psychologically? Who knew?
Her looks hadn't improved all that much two days later when I dropped by her room to check on her. Her face was a puffy, purple blob and her eyes were swollen almost shut. When she saw me walk in the door, she squeaked and pulled the sheet up over her face. "Oh shit, don't look at me Dr. Butcher! I'm ugly!"
I had to laugh, "You certainly are, Anita, but that's all going to go away and you'll be right back to your usual pretty self before you know it. The human body is a wonder when it comes to repairing itself. The only scar will be a small one on your lip and a touch of lipgloss should cover that. Tell me how you're feeling."
She lowered the sheet and sighed, "I guess I'll live, but I'd like to cut that bastard's balls off." She shook her head and went on, "I don't know why I keep getting hooked up with guys like that. I must have some kind of death wish or something."
"Maybe bad boys like him offer some promise of excitement. I couldn't say why some women are attracted to that kind of guy but I've often wondered about it. I guess good little boys like me must seem kind of vanilla by comparison."
She patted my arm. "Hey, any time you wanna step in and try your luck, you'll find me more than ready to give it a shot."
I put my hand on her shoulder and said, "That's a tempting offer but I'm afraid that would be a serious ethical violation on my part. I'm sure there are lots of good guys out there just waiting for a woman like you to walk into their lives."
"Yeah? Well, they must all be hiding under rocks because I sure haven't found any. Sometimes I wish I were into girls instead of boys."
I had to chuckle, "It would probably be a lot healthier. Anyhow, I'm glad to see you're recovering, Anita. I'll drop by and see you again before they send you home."
She took my hand and raised it to her bruised lips. "Bye, Dr. Butcher. I'm holding you to that promise."
I saw her again the morning she was discharged. The swelling had gone down and most of the bruises were fading to green. Neurology was satisfied that her brain was OK and the surgeon said her insides hadn't suffered any permanent damage. She was sitting up in bed finishing her breakfast when I walked in.
"Good morning, Anita. Ready to get out of this place?"
"I'll bet you are. According to your doctor, you should be able to go back to work in a week. In the meantime, take advantage and relax while your body does its healing thing."
She set her cup of coffee on the tray. "I wish I had a job to go back to. Yesterday, Mama said Mr. Perez, the guy who owns the tienda, the little store where I was working, called and said he needed somebody more reliable. I guess I'm officially among the unemployed now."
"I'm so sorry to hear that. But you seem like a pretty bright woman so I shouldn't think you'd have too much trouble finding another job."
She shook her head and said, "I guess you live in a different world than I do, Dr. Butcher. I'm a twenty-six year-old Latina with a high school education and no real skills. I suppose I could take up hooking but Mama would probably object. In my world, jobs are few and far between and the ones that are available don't pay shit, pardon my English."
I recalled my assumption that she was a prostitute the first time she came in and felt a little twinge of shame. "So why don't you go back to school? Isn't there some kind of profession you'd like to study for?"
"Sure there is! I'd love to go to nursing school but I wonder who's gonna pay for it."
"How about student loans and grants? I know those are available."
"Look, Dr. Butcher, I have to earn a living. Mama has zero income because she has a bad heart and she's too feeble to work a regular job. Besides, she's, um, not exactly legal so she doesn't get any Social Security. She lives with me and whatever I earn has to do for both of us. What I really need is to hit the lottery, but I'm at least smart enough not to fall for that fantasy. No, I'll find another shit job and Mama and I will get by on my shit salary." She grinned suggestively and added, "Unless you want to hire me as your personal assistant." She saw the flush on my face and laughed, "Just kidding, Dr. Butcher, just kidding!"
I took her hand and wished her the best. "Bye, Anita. Nothing personal but I hope we don't have occasion to meet again."
I started for the door but stopped to consider an idea. "Anita, do you speak Spanish?"
"Of course. That's about all Mama speaks and I didn't even speak English until I was four or five and starting school."
"Well, I just had a thought. We get a lot of patients through the ER who can't speak English and there's not always an interpreter around. It can get pretty frustrating at times. I've been trying to learn Spanish from a Rosetta Stone course, and it's helping, but it's going to take me forever to become fluent. Would you consider doing some tutoring for a few hours a week?"
She was interested. "You'll probably never get very good the way you're going about it; you have to be forced to speak it enough that you start to think in the language. It's called immersion. I could probably help you if you tell me where and how often you want to get together."
I took out a small notebook and wrote down my phone number. As I handed it to her, I tried out some of my halting, computer-course Spanish, "Aquí! Este es mi número de teléfono. Por favor, me llame."
That got a smile. "Muy bueno, Doctor. We need to work on your pronunciation but you got the right words and the grammar was correct."