Richard Mabry: Code Blue

Let it go. She plastered a smile on her face. "Let me look at the records Dr. Gladstone's office sent. Then I'll check you over. After that, we can talk about continuing your medications. I'm sure Dr. Gladstone did a good job, although I may suggest we tweak your medications a little bit."

She read through the chart, blessing Dr. Gladstone's old-fashioned, copperplate penmanship. Milton Nix, age fifty, occupation banker. You have to give him high marks for modesty, she thought. Most people would have put down "President of the First State Bank of Dainger."

"How've you been feeling, Mr. Nix? Any problems?" She glanced up and decided the man looked pretty much the same as when she sat across from him three months ago and virtually begged him for a loan to start her practice. At that time, the other banks in town had already turned her down, using a variety of excuses-no room in town for another family doctor; she had too much debt already in student loans; a woman doctor would never be successful in this town. Nix, unlike his counterparts at the First National and the Continental Banks, had finally decided to take a chance on her.

"I'm feeling fine, Dr. Sewell," Nix said. "But I've got a busy day. Can we get this thing moving?"

Okay, enough small talk. Back to the chart. Nix was five feet ten, one hundred fifty pounds. On the thin side, but his weight had been stable for years, so put aside thoughts of a cancer somewhere. Usual visits for coughs and colds. A couple of prostate infections. Congestive heart failure, controlled with Lanoxin and a beta-blocker.

"Mr. Nix, I don't find any electrocardiograms in here," Cathy said. "When was your last one?"

"Any what?"

Cathy regretted her error. Never drop into doctor-speak. She'd been taught that early in her training. "Did Dr. Gladstone do any heart tracings?"

Nix shook his head. "Don't remember. I think Doc probably did one or two at first, but on my last few visits he took my blood pressure, listened to my chest, poked and prodded a little, and wrote me a prescription. Can't you do the same thing?"

"Since this is your first visit here, I think it's best to get a little more information. Let me listen to your heart and lungs, and check your blood pressure. Then I'll have my nurse run a cardiogram. She'll draw some blood for a few lab tests. Nothing to worry about, but I think it's safer that way."

Mr. Nix grumbled his way out of the exam room and down the hall after Jane, who was already at work charming him. Cathy finished reading through the chart and decided that "Doc" Gladstone hadn't really done a bad job with Mr. Nix. She did see one minor change she wanted to make, though.

Cathy left the exam room and found Karen Pearson sitting in her office. She recalled Karen's first visit a month ago when the office still smelled of fresh paint.

"Dr. Sewell, I'm pregnant," Karen had said. "I've been seeing Dr. Harshman, but I've changed my mind. This is my first baby, and I want you to do the delivery."

Cathy had tried to be circumspect. The ethics of the matter aside, even to give the appearance of stealing the patient of an established physician was guaranteed to cause friction with the other doctors in the community. And she had a hard enough time in that area already.

Karen was insistent, though. She said that her current obstetrician lacked the bare minimum of consideration. "Every woman that Dr. Harshman's taken care of says they'd go to a veterinarian before they'd go back to him," was how she'd put it.

Finally, Cathy had put in a call to the administrator's office at Summers County General Hospital to ask if her request for obstetric privileges had been approved.

"Sorry, Doctor," the secretary said. "It's still in committee."

After that, Cathy's repeated calls were always met with an excuse. The paperwork got misplaced. One of the board members was out of town. They were checking precedents. Cathy knew why Karen was in her office today, and she dreaded giving her the answer.

"Karen, how are you doing?"

"I'm less than a month from my due date," Karen said. "Dr. Sewell, I'm still hoping you can take over my care. Do you have obstetrics privileges yet?"

Cathy felt her heart drop. She was sure Karen would know the answer just from the look on her face. "I'm sorry, Karen. I'm still trying. You know, we've been through this already. Why can't you stay with Dr. Harshman?"

"Oh, please, Dr. Sewell. You know very well what that man's reputation is. And now, he says I might need a Caesarean section. I was worried enough about him doing a regular delivery. I can't stand the thought of him doing a C-section. Can you do it, Dr. Sewell? Please?"

"I'm sorry, Karen. I wish I could help. But I'm having trouble getting privileges to do normal deliveries, and there's no way they'll let me do a C-section. Have you considered switching to Dr. Gaines?" Cathy said, naming the other obstetrician in Dainger.

"His practice is full. His nurse told me that I have a perfectly competent doctor and suggested I stick with him."

Cathy extended her hand to Karen, partly to help her from the chair and partly as a gesture of compassion. "I'll keep trying. Don't give up."

"I won't. I've been praying that you'd be the one to deliver my baby. God will take care of this."

Cathy bit offthe reply that was on the tip of her tongue. With words of assurance that sounded hollow in her ears, she left Karen and turned her attention to Milton Nix.

Jane met her in the hall and held out an EKG tracing."Mr. Nix is in exam room one."

Nix looked up when Cathy walked in. "Did that fancy test help you find anything that Doc Gladstone didn't figure out with his stethoscope?"

Cathy studied the tracing, looked at the chart once more, and made a decision. "I'll want to see what the blood chemistries show us, but at this point I think you're doing well. Your beta-blocker is okay, but I want to make a slight change in your other heart medicine. I see that your prescription has been for the brand-name drug, Lanoxin. I suspect that Dr. Gladstone wrote it that way years ago and just never changed it. If I write the prescription a bit differently, the pharmacist can give you a generic form and save you a little money."

Cathy could see Nix's lips open, then shut. If he had any complaints, he kept them to himself. He probably wasn't anxious to have anything changed in the regimen he'd been following for years, but this wasn't really much of a change. Besides, she figured the "saving money" part would win him over.

She reached for her prescription pad and dug into the pocket of her white coat. Where did that pen go? "Excuse me. I can't find my pen. I'll be right back."

Nix reached into his shirt pocket and pulled out two ballpoints."Here. They've got the bank's name on them. When you're through, leave 'em in the waiting room. Maybe I'll get some return on my investment for this trip after all." She might have been mistaken, but there seemed to be the ghost of a grin on his thin-lipped face as he handed the pens to her. Two in one day. That must be some kind of a record for Milton Nix.

She wrote the prescriptions exactly the way she'd been taught: carefully, with attention to legibility, calculating the number of pills that should be dispensed, double-checking the directions. She added refill instructions and signed the prescriptions before tearing them offthe pad and handing them to Nix.

"Just follow the directions on both of these, and call me if you have any questions."

As she passed the prescriptions to Nix, she noticed that the ink in the pen she'd been using was blue. She'd need to make sure she didn't use Milton's pens in the office anymore. That was another thing her mentors had emphasized. Use black ink. It photocopies better and gives a neater appearance. She could hear the voice of Dr. Seldin, the chief of internal medicine, saying, "If you're sloppy in little things, you'll be sloppy in the big ones too. Take the time to do it right."