Past Pains

Ruins of the Ellis Island Hospital

A deafening shriek reverberated again off of the tiled walls and metal tables, the sound of pain and fear made all the more palpable as it echoed around the cold, hard surfaces and magnified until it shook the very core of anyone listening. 

The staff inside that room did not make eye contact with each other over their masks. To acknowledge anyone’s humanity, even their own, would only serve to distract from the task at hand.

*****************************************

This is another shot from inside the ruins of the Ellis Island hospital. Several areas contain art by JR, a French artist. Generally speaking, I prefer my ruins untouched but this image seemed to enhance the spooky feel rather than detract from it.

It is disconcerting to stand in the empty rooms and corridors imagining the hustle and bustle of a busy hospital. There are times you can almost feel the brush of someone passing or hear the echoes of fear and hope whispering off of the crumbling walls. 

I ran into some photos of the hospital taken in areas that I did not get to see when I was there and it makes me want to go back, to somehow have more access. I wonder what that would take? 

Have you ever felt drawn to a place in a way you cannot explain? 


Dread 

Morgue at Ellis Island hospital

I dread going back to work after being off for a vacation, even if it was only for a few days. 

I know, I know. I’m not alone, am I? 

The thing is, I never know what my in basket is going to look like. After a regular weekend I can walk in to find 50-70 items on my virtual EHR (electronic health record) desktop. After a week of vacation it may be 150 or more. 

Please God, let it be manageable!!!!

When one of my partners is off, it is a full on life/death struggle to keep my head above water and I am certain they have experienced the same frantic craziness trying to keep up with my stuff while I’m out. 

Patients get crabby when their physician is gone and there will invariably be several fires to put out. Did the clinic roof leak again? Did my office manager actually reschedule the patients that I saw were on my schedule last Monday? Did that woman’s MRI get done? What did it show? 

It was not enough that I worried about everything all week. Oh, no. Now I have to face up to it in the morning.

Gah.

I won’t be sleeping well tonight.

*****************************************

The photo above is what is left of the morgue inside the ruins of the hospital on Ellis Island. It was a teaching hospital so autopsies were done in this theater. On the left is where the bodies where stored. I took the hard hat tour and got some really great images. I wish I could have gotten to see some of the upper floors, like where the ORs were. Maybe someday…. 

Take Me Higher

Entrance to St. Peter's Basilica at the Vatican.
The young woman glanced down at the distinguished, gray haired gentleman propped up on pillows as she hung the bag of potassium from the IV pole at the head of the bed. 

He was more handsome in person than he appeared on TV, she decided.

“This might burn going in,” she murmured. “The computer says your level was a smidge too low.” They were piloting a new AI program that made treatment decisions instead of doctors. It was said to be more effective and more reliable, better outcomes.

The patient looked up at her from his newspaper and nodded, winking. “Thanks for the heads up.” A great wracking cough rattled through his chest at that moment, leaving him gasping for breath. He sat down the paper. There was his face on the front page in an article talking about his admission to this very hospital for pneumonia.

“That sounds… better?” It was a statement and a question. She looked at him hopefully.

“Oh, believe me, I do feel better than I did yesterday.” He spit out the great glob of yellow phlegm that had caught in his throat, then wiped his mouth.

“On the mend, then!” She smiled down at her VIP patient. Her shift was approaching its end and she felt some degree of melancholia about that. Rubbing elbows with the rich and famous was quite fun.

Illness was the great leveler, after all.

She couldn’t wait to tell her fiancé! 

And her mom. 

And her best friend. 

Technically she was not supposed to tell anyone about this fellow, privacy laws and all that, but how could she be expected to keep a secret like this? She had really met him, spoken to him, touched him. The part she would not tell anyone about was the number in her pocket. He had slipped it to her after telling her she was beautiful and that he would like to hook up sometime. She patted her scrubs absently to make sure the paper was still there. Not that she would ever take him up on it, mind you.

Power was sexy…. but phlegm? Not so much.

She walked out of the room and back to the nurses station where she charted her activities of the past hour or so in the EHR. She caught sight of the man’s wife getting off an elevator and she found herself watching with envy. The woman was beautiful in a way she herself could never hope to be. His wife walked purposefully, a blue coat draped elegantly over her arm, a slight smile curled on her lips. No one at the hospital had ever seen her smile before. They were all warned to stay out of her way.

He must have called to tell her he was feeling better.

The nurse glanced back at the computer screen. There was a new order for another six bags of potassium for the fellow in room 432. 

How odd.

A quick check of the blood test results reassured her. His potassium level was indeed very low.

She checked her watch. It would be another 30 minutes before she could hang the next one. The next shift would be kept busy, that was for sure.

*********************************

The papers and news stations all shouted about his death. Across every front page. Leading every news program.

He was dead.

She couldn’t believe it. How? He was getting better.

Then fear. 

Did she do something wrong?

*********************************

The voice on the other line spoke a greeting in Russian. 

“It is done?” she asked.

“Da,” the voice said gruffly then hung up.

She smiled to herself as she dropped the burner phone into the crackling fire and poured herself a glass of champagne.

Yes. Of course it was done. A simple hacking right under their noses and no one would ever know. Cardiac arrest from a potassium overdose. In the hospital. They would do everything possible to keep it hidden if it were discovered. No one wants to be the hospital that killed someone like him…

It was a beautiful, elegant thing.

There would be no other women. 

Veracity


He chuckled to himself. Potassium level?

Let’s make this one 6.5….

He hit enter then scanned down the list. 

Ahhh… a 90 year old woman. Perfect!

This time he picked the sodium level. 

126

In thirty minutes he had changed the results on over three dozen patients. Just one or two per provider, not enough to cause much of a stir…. Since none of the docs at the various system clinics spoke to each other.

*******************************

Potassium level 6.5? No eveidence of hemolysis noted. Damn.

She sighed and dialed the patient’s number, hoping he would pick up.

“Hello?” a male voice said

“Mr. James?”

“That’s me…”

“This is Dr. Stephens. I was calling to discuss your lab results. Do you have a second?”

“Sure, Doc!”

“Your potassium is showing as rather elevated. Most of the time this ends up being an error but at this level, if it is true, it can kill you. We need to get it rechecked. The best place to do that is the ER. They will recheck the levels and do an EKG and if it is really elevated they can bring it down.”

“Are you sure?”

“Yes, sir. I know going to the ER is not a cheap proposition but I don’t feel like at this level we have much of a choice.”

He sighed audibly. “Ok, Doc. If you say so. Should I go right now?”

“Yes. I’ll call ahead and let them know you are coming and why.”

She had alerted the lab to these abnormal results several times. Each and every time it seemed they were proven false. It had been occurring since the mandate that all providers had to use the system laboratory instead of sending their samples to an outside place. Invariably she was told it must be a problem with the way staff was drawing the blood. 

Only it wasn’t… She knew that was not possible.

*********************************

The board gave a standing ovation. Revenue for the system had reached an all time high. It had been a banner quarter. Things had been looking grim for so long….

A nondescript figure in a dark suit with a light blue silk tie sat silently in the corner, arms crossed, smiling to himself. 

The Cost of Protection

Carved flowers on a Victorian tombstone.
There have been several times over my career that I have had to step in to protect a patient from their family. Each and every time it gets nasty. It takes a certain kind of person to abuse their child or to molest a mentally challenged adult or neglect an elderly person to the point they have maggots in their wounds. Those kinds of people fight and they fight dirty.

I marvel at how some attorneys can look at the facts of a situation and defend it by attacking and terrorizing the physician who had to make the call. It is exhausting and terrifying and can leave you questioning yourself and your judgement throughout the process:

Surprise subpoenas summoning you to appear in court in 60 minutes, requiring you to cancel all of your afternoon clinic appointments at the last minute.

Threats of lawsuits.

Antagonist depositions. 

Lies and accusations made publically.  

Nothing in medical school prepares you for this sort of thing. Physicians have malpractice insurance but this is not malpractice. There is no one to walk you through it unless you hire your own expensive attorney.

Eventually you are vindicated but not before your life is made a holy living hell. It takes a toll on your family and friends as well, as you cannot discuss it with anyone else. The process can drag on for months or even years.

You are isolated and alone.

Fortunately, all of my experiences have been before social media. I have seen, of late, some unbelievably ugly online attacks made on physicians who are only doing their duty and trying to protect the vulnerable. It appalls me how quick the rest of the world is to jump onto the hate the doctor bandwagon when they do not know the whole story. Physicians are not allowed to defend themselves due to privacy laws. The rest of the world will never know the whole story.

What some people seem to forget is that our role as physicians is to assess the situation and make a recommendation. We are required by law to report suspected abuse. We are not omniscient super humans and maybe we don’t always get it right. All we can do is our best. In the end is up to the courts to decide guilt or innocence. 

The price we pay to do so is often very, very high….

Founders Keepers

There is a term in population genetics called the founder’s effect and I have caught myself thinking about it a lot lately.

Basically, in a founder’s effect a small subset of a population is isolated from the larger population. For instance, maybe seven people went on a three hour boat tour but instead ended up stranded on a deserted island. The Professor and Mary Ann mate and reproduce, as people are wont to do, and several generations later the resulting population on that island looks very different from the larger population that it originated from. There is a loss of genetic variation and certain traits get reproduced at a greater rate than you would find elsewhere. Sometimes this is benign, like with a greater proportion of blue eyes or brown hair. Sometimes it is bad, like when you have a higher predisposition to develop colon cancer or maybe a higher rate of growing an extra leg out of your backside…

EPIC is one of the largest electronic health record in the US. It is highly customizable. Therein lies its power AND its weakness.

Keep in mind that I have only a small part of the picture and I am making certain assumptions, but here is what I have gathered:

When a healthcare system decides to go with EPIC there is a build out, or personalization, that occurs. The EHR that I see is very different from the one used by a physician in another healthcare system across town or in one across the country even though they are all called EPIC. 

From that initial build out, there are changes made as the product is tweaked. For instance, when we went live, we had to enter our password to log in but then had to enter it again with each and every note we signed, every single order we placed. Hundreds of times a day I was typing in my password. Now? I only type it in to log on. Good thing, too, as I was at risk of destroying expensive equipment.

I have staff in my clinic who have worked for three other major hospital systems in the area who also use EPIC. What they describe is much, much easier to use than what we have currently. In fact, they regularly threaten to leave and go back to those other organizations so they can feel at peace again.

How does that happen? 

How do they have such different products? 

Because they are all starting with a basic product. It is thrown out onto a deserted island with a few people making decisions and then everyone waits to see what you get down the road. 

The founder’s effect.

No one from the other hospital systems is sharing what works for them from what I can tell. There is no collaboration. So each one has parts that work well and other areas not so much. Why can’t we help each other?

THEN you have smaller islands. We are a small clinic in a huge system. We did not get support staff who came out to help us after going live until the following week and then only for two days. The bigger clinics? They had trainers there on day one. Some clinics never got anyone. Training classes done before had very little to do with the reality of the EPIC we were presented with on day one. So we have muddled through figuring out our own work arounds. Some good. Some bad. We need an infusion of fresh genetic material to correct our problems. 

That only works well when you have someone visiting your island to add to your gene pool and that only works if that person is genetically diverse themselves. Getting people to leave their islands is difficult. Distance to travel, time constraints, don’t know how to swim, etc… 

So we get this perpetuation of problems and errors… fractured systems. It has been really interesting to watch from my vantage point at the bottom, looking up. I wonder what this will look like in six months.

Reading Into Things


“I don’t want to see the oncologist you referred me to. I checked the online ratings and he got some pretty bad reviews. Find me someone else,” the phone message read.
The patient had multiple myeloma. The specialist I had picked was the best in the area for this condition. I had no idea what the reviews said. I just knew that this patient wanted to live. 

No amount of discussion would dissuade them. Even when I explained why I had chosen this specialist.

What do you look at when you are trying to pick a physician? What qualities are you looking for in a physician? Skill? Personality? What is the most important to you? How do you as a patient measure what is important? 

An interesting article I read the other day in the Journal of Medical Internet Research looked at cardiovascular surgeons in five states that allow reporting of outcomes data and compared the risk adjusted post-operative mortality rate with that physician’s online reviews from patients. 

Guess what?

There was no correlation. 

Now, here is something else provocative. In USA Today there is an article entitled, Don’t Want to Die Before Your Time? Get a Female Doctor. It is referencing a study published in JAMA today that found patients in the hospital who had female physicians were more likely to survive and less likely to be readmitted within 30 days of discharge.

“The researchers estimated that if male physicians could achieve the same results as their female colleagues, they would save an extra 32,000 lives among Medicare patients alone each year — a feat that would rival wiping out motor vehicle accident deaths nationwide.”

Practice differences between men and women translate into real, measurable differences in outcomes.

So, when we talk about income disparity between male and female physicians, one recent study showed that women are paid on average $20,000 less per year than their male counterparts

What a bargain, huh?

Impact: Chapter Seven

Chicago in lights

“Next.” 

I stepped forward to the granite counter top and managed a weak smile. The woman in the bank’s uniform half-smiled back at me. Her striped blue and red scarf was tied jauntily at her neck.

Like a flight attendant.

“How can I help you?” She sounded bored. In her mid fifties, the woman had amazing hair with just the right amount of wave and body. 

I felt the familiar envy. I stared at that hair, wishing my own head was not covered with the flat, lifeless, straight as a board hair I had been cursed with. It was a dull mousy brown until I started to dye it blonde. At least the blonde helped. Speaking of which, my roots were showing. I needed to make a hair appointment if I was going to have to start interviewing for jobs now.

Times of stress always left me to dwell on each of my own flaws. My thighs were probably going to come up next. Maybe the crows feet. I was getting old. I looked closely at the woman’s eyes. She had great skin, too. I focused on her chin looking for hairs. 

Please let there be whiskers. Please let there be whiskers.

Nope. Not a single one. 

Damn it.

“Ma’am?” Irritation was in her voice and any trace of smile had now left her face.

“Oh. Sorry.” I felt my cheeks flush. “I need to make a deposit.” 

I pulled the paper paycheck, my last paycheck, out of the envelope. “Wait. I forgot to sign it.” 

The woman raised an eyebrow and passed a ballpoint pen to me. It was attached to the counter by a chain that made a slapping noise with each stroke. Banks were always disconcerting… unearthly quiet despite the hard surfaces and volumes of people. I felt I was disturbing the peace just by scribbling my name.

I passed the signed check to the woman. Her name tag read Elyse.

She waited, expectantly. “Where’s your deposit slip?” She looked at me, incredulous.

It had been too long since I had manually deposited anything into my bank account. My checks had always been deposited electronically. 

“Um, I don’t have one.”

“What’s your account number?” I could tell she was holding back the disdain with great effort.

“You know what? I don’t know that either. I have my bank card, though. Can you pull it up from that?”

I pulled the card out of my keychain wallet and handed it over.

“Do you have some ID?”

I cringed self consciously as I showed her my awful driver’s license picture. It was from before the blonde. She nodded, handing it back, and I tucked it quickly into the safety of my billfold.

Curt typing ensued. Then a scowl at the screen. More typing. Finally, she looked up at me suspiciously. 

“It says here that you closed out that account yesterday.”

A wave of nausea came over me.

“What do you mean?”

“I mean that it says you were here yesterday and closed out the account.”

There was $20,000 in that account.

“Does it say if I took that money in check or cash?”

She manipulated her computer mouse and clicked twice.

“Cash.”

There was no way to trace it.

“What about my savings account?”

“Also closed out.” 

I had scrimped and saved, trying to accumulate enough to eventually retire, hopefully sooner rather than later. I didn’t know how long I could keep up working as an ER physician. They had a high burnout rate after all.

It was gone. Every bit of it.

What was happening to me? Should I say something? Report it to the police? 

“That wasn’t me,” I said softly.

“Customers are not allowed to cash out accounts, particularly NOT accounts that large, without notice and without proper ID. I can assure you that you did indeed close out that account.”

“It was not me.”

A “Hmmmf…” of disbelief was all she uttered. The woman offered no other explanation, no further assistance. 

“Can I just cash this check, then?

“Fine,” she said sharply.

“In tens and twenties, please.”

I weighed my options as I watched her count out the bills, one by one. Four thousand dollars was not going to last me very long. Not in Chicago. 

Not anywhere, really.

At least I had paid the month’s rent last week. I was good there. 

The wad of bills was thick. I registered that my work computer was still there as I stashed them at the bottom of my bag. That could be helpful. I wondered how long it would take for them to realize I still had the thing.

I walked the few blocks back to my apartment mulling things over. Who could I call for help? I needed advice. Six months ago I would have called my boyfriend. Well. I would have if my phone had been working, but now, even if we were still on speaking terms I realized I did not know his phone number. I had never had to know it despite texting and calling him thousands of times over the years we had been together. My phone made communication with him a no-brainer. 

There had to be someone else I could call. Surely. As I rode the elevator up to my floor, I wracked my brain but there was no one. I had no friends. Only work acquaintances. There was no one I was close enough to that I could call them up and confess that my world was falling apart. No one except for him. Having regular sex with someone allowed you certain lifelong privileges didn’t it?

Probably not, but I still had to try. 

Maybe I could look him up on the work computer if my password hadn’t been shut down already. Not his cell number, of course, but I could Google his office number. He’d be in clinic right now if it was not a hospital week. If wifi was not working in my apartment, and something in the pit of my stomach told me it would not be, I could find a Starbucks somewhere… 

I turned my key in the lock. It stuck a bit and I panicked as I jiggled the key and retried it. Finally the lock clicked and I pushed open the door, relief flooding through me. 

My relief was short lived, however. It evaporated when I saw what was waiting for me inside. Or rather, what was not waiting for me.

Nothing

There was nothing at all inside. Every scrap of furniture was gone. Every last one of my possessions, gone. All that remained were the indentations in the carpet where my couch and chairs and other furniture had once been.

I was exposed. Bare. Naked. Nothing was left of me. At least nothing of the me that I once was.

My life was being dismantled before my very eyes.

It was time to fight back.

———————————-

Want to know how we got to this point? Check out the other chapters of Impact:

Chapter One

Chapter Two

Chapter Three

Chapter Four

Chapter Five

Chapter Six

Outcomes

eileandoonancastle3cropped

His voice shook.

“She’s in ICU. I thought you should know.”

I felt my body grow cold. She and her family had been patients of mine for almost ten years. She was so young. Younger than me, in fact….

“They aren’t sure if she is going to make it.”

“What happened?” It was supposed to be a simple cyst removal.

“Her small intestine was perforated. They have her belly open, said they couldn’t close it yet.”

I had used a new surgeon, someone I had never used before, because the mass was blocking the tube from her kidney to her bladder, causing quite a bit of pain and endangering the kidney itself. She needed surgery quickly and no one that I typically used was available to work her in. 

“That’s just awful. Keep me posted on how she’s doing. I’ll be saying a prayer for her and for you.”

“Thanks, Doc.”

As I hung up, the guilt welled up. I felt personally responsible for the bad outcome, even though my hands weren’t the ones actually in her belly. MY hands had hit the referral button, signed the order. 

She trusted me. 

She ended up making it, but it took a huge toll on her both physically and emotionally and financially. It affected her relationship with her husband. It affected her kids. They had almost lost their mother and it left them all shaken and ungrounded for almost a year. Things are only now starting to look up.

I feel guilty when patients don’t like someone I refer them to. I feel that I have let them down. I feel guilty when I find a cancer, as if somehow it was my fault. I should have prevented it. Maybe I could have found it sooner somehow? And, yes, I feel responsible for surgical errors and outcomes.

So when I tell patients they need to see a different specialist than the one they picked out, I worry how far to push it when they aren’t agreeable. When I know a back surgeon is bad, how much do I tell a patient who is not listening to my gentle suggestions to seek a second opinion elsewhere? Where is the line professionally and legally? 

These are my thoughts on this Monday morning….. 

Impact: Chapter Six

Chicago elevated train.

I awoke to sunlight streaming in through the windows. I stretched lazily. There was nothing more blissful than waking up to bright, warm light on your face after a long shift. This was why I always opened the curtains before crawling under the covers. That, and there was something reassuring about waking up in the night to see the lights of the city outside. It helped with the loneliness.

My shift! OMG.

My heart leapt into my throat and I sat bolt upright in bed. I had picked up an extra shift. I was supposed to work today.

Why hadn’t the alarm gone off?!?!!?!?

I distinctly remembered setting the alarm. Did I do something wrong? The new phone lay on the empty pillow next to me. I snatched it up and after hitting the button over and over again found that it was dead. 

How? 

I checked the power chord. It was plugged into the phone and the wall properly. Last night should have been a clue when email wasn’t working, I realized. I picked up the land line phone beside my bed. I needed to call in but there was no dial tone. I punched a few numbers and clicked the receiver a several times. Nothing. I slammed the receiver down in frustration. 

Skidding to the bathroom, I flipped the light switch but no light. I tried every damn light switch in the apartment but none worked. The clock on the microwave was a black, empty space. The TV would not turn on. Soon it was clear that the power was off completely. 

There hadn’t been a storm, had there? 

I checked out the window. The streets looked dry.

The clock on the wall in the kitchen read 9:18. I wondered if it was right or not but remembered it was battery operated. I was so miserably late and this time I did not have a Good Samaritan excuse. They probably wouldn’t believe me about the power.

I threw on some clothes. I had a habit of sleeping naked. It felt good to strip off all vestiges of the day and lie beneath clean sheets but now I felt terribly vulnerable. 

Exposed.

What was going on?

I would have to sort out everything later. The first order of business was getting to the hospital. 

Brushing my teeth helped. So did splashing water on my face. Quickly, I pulled my hair back into a ponytail. There was no time for make up. I shoved my make-up bag into the satchel next to my computer and headed out the door. Maybe I would have time later to apply something. I didn’t want to scare the patients…

Without my phone, I could not summon Uber. I was going to have to use the train. I zipped around other people as I ran two blocks to the nearest station. I flashed my card at the till but the light did not turn green. I tried again. 

Still red. I was getting frustrated and contemplated just hopping over.

“Hey, lady, do you think you could maybe go through or get out of the way?” The voice behind me was irritated. I turned to see a blond twenty-something in a light gray suit wielding his briefcase with an air of self importance. He glared at me. He was probably running late, too. So was the middle aged woman behind him and the older woman behind her.

“It’s broken.”

He rolled his eyes and reached around me with his card. The light turned green and he pushed past muttering obscenities under his breath.

The woman behind him did the same. I tried my card again but still got a red light. 

Fine.

The bodies behind me were pressing forward. I backed up from the turnstile pushing past the line that had accumulated behind me and did a quick visual search for a kiosk. 

Something was wrong with my card. Maybe I had lost track of how much was on it? I found one of the vending machines and attempted to load more money onto it but the message flashed that the card was invalid. I tried to purchase a regular ticket using my bank card but it said that card was invalid. Then I tried my credit card but received the same message.

Damn it!

Precious minutes were wasting! I fished out some cash and purchased a ticket that way, then made my way to the platform. 

I found a seat in the corner of the train and stewed. How could it be possible that all of my cards were dead? I watched the faces of the other commuters, wondering if any of them was experiencing something similar. No. They all seemed calm.

I decided to distract myself by putting on some mascara and lipstick.

At the next stop a woman settled into the seat next to me. She looked like a talker. I scooted closer to the wall and crossed my arms across my chest, hoping the body language would send the clear message to leave me alone. I couldn’t bury my head in my phone since it wasn’t working. I felt exposed again.

“Good morning!” 

Clearly, she had not gotten the message.

“Morning,” I muttered.

“You look like you are having a bad day.” 

I glanced over at her and raised an eyebrow. 

“My daughter, Cordelia, does the same thing.”

“What?” I was puzzled.

“Wrinkles her forehead like you do.”

“Oh.” I hoped the clipped response would shut down the conversation. 

It didn’t.

“I work in real estate as a paralegal. It is the most dreary office ever, so small you would think it had once been a closet. I feel the life sucked out of me a little bit each day.” My brain flashed to the scene in The Dark Crystal where the Skeksis drain essence from the Podlings, leaving them dessicated, mindless zombies. “Where do you work?”

“In healthcare,” I said carefully. Admitting that I was a physician always opened me up to awkward questions.

“Oh how nice! What exactly do you do in healthcare?” She smiled.

“I’m in housekeeping at the hospital.” It was sort of true.

She squinted at me, then laughed. “That’s funny! I would have put you in management. You just never know about people.”

I shrugged.

“I get off up here,” she said, digging her purse. She handed me a business card. “If you ever need to buy some property…” She winked as the train stopped, then was gone.

I tucked the card into my bag next to the accident victim’s card, shaking my head. What a 24 hours this had been. 

The rest of the trip passed in blessed silence. 

At the correct stop, I exited and ran the remaining few blocks to the ER at Northwestern. I stoppped at the nurses’ station to catch my breath and survey the lay of land. I could see they were fully staffed. There was Dr. Prick, I mean Dr. Waters, back again to make everyone miserable. There were three other physicians seeing patients but they and the rest of the staff pointedly avoided making eye contact. I checked the board. I was not on the list for today. Then I realized my name had been erased from the rest of the week, replaced with Dr. Waters’ name. A sense of foreboding came over me.

“Dr. Benton!” It was the ER director, Dr. Boyack. Someone must have alerted him to my presence. “Why don’t you step into my office?”

Oh, god.

I followed him into the tiny office around the corner. He settled himself behind the desk, motioning to the chair across from him. The room was sparsely decorated except for an ivy plant by a window that looked out onto a brick wall and a framed illustration of a busty female robot stood on the corner of the desk. Eccentric was the word for him. He studied me for a moment, probably for dramatic effect, then leaned forward, steepling his fingers in front of his long beard. 

“We have decided to let you go, effective immediately.”

I let out the breath I hadn’t realized I was holding. A million panicked thoughts were racing through my brain. When I didn’t respond, he continued.

“You have excellent patient satisfaction scores. The staff loves you. But we need someone more reliable.”

Wait! I wanted to scream at him. This isn’t fair! But in his defense, I had a habit of running late. Getting used to the unpredictability of Chicago transportation had been difficult. If I had not already established a pattern of behavior, we would not be having this conversation. So instead I just nodded. 

I was not sure this day could get any worse but at least now I had time to figure out what was going on with my bank and credit cards and to try to get the power back on at my apartment. Oh, and the phone. That goddamn stupid phone that I had been forced to get after the men in suits had stolen my original. I fingered the cold screen in my pocket. I wanted to take the cursed thing out and stomp it to pieces right then and there. 

But I didn’t.

He pushed a long, white envelope across the desk. “Your last paycheck. I’ll need your badge and keys.” He smiled sympathetically.

I dug the items out of my bag and dropped them onto his desk, giving a satisfying clang as the metal and plastic hit the fake mahogany surface. I opened my mouth to speak but thought better of it, choosing instead to leave the office without a word. As I reached the door he called out to me.

“Hey, Dr. Benton?” I paused, looking over my shoulder. “Good luck. I have a feeling you are going to need it.”

Chapter One

Chapter Two 

Chapter Three

Chapter Four

Chapter Five