Comfort Zone

Chapter 5

Ursula Taylor came to Miriam's office later that morning, and handed her the pre-op request from a local plastic surgeon. It was a standard form, asking for a physical exam, labs, urine test, electrocardiogram and chest x-ray, but both women knew that the tests were most likely unnecessary.

Dr. Taylor shook her head. "So much of what we do in medicine is still because 'it's always been done that way,' and we learned it from our senior resident or other mentor. When I trained, I was just happy to memorize the conventional thing to do to treat asthma, for example. I don't remember asking if our treatments were based on solid science.

"Now I teach the residents evidence-based medicine, our new mantra. Question the status quo, I tell them, look at the research, the data from good clinical trials. I'm sure the pre-op orders of the future will look much different.

"I don't even remember the last time I had a chest x-ray or electrocardiogram."

"Well, it couldn't hurt," Miriam said, echoing what patients often said and smiling, because both women knew that overtesting sometimes could.

Miriam began her exam, hoping it was up to the exacting standards of Ursula Taylor. On the other hand, even the physical exam was now controversial. Some thought it was useless, adding little to the history; at its worse, it might even be harmful. Despite frequent hand-washing, how many dangerous germs was Miriam spreading to her patients while she examined them?

There was even scientific proof that she was endangering them when she shook hands, or (horrors!) hugged them, as she often did. A fist bump, or a warm smile, was recommended to reduce the amount of bacteria two people could pass between them with anything more intimate. Despite the evidence, Miriam had yet to change her behavior, and sometimes wondered who needed the contact more-- the patient or herself.

As expected, she found nothing wrong with the other doctor. Ursula Taylor is in much better shape than I am, she thought glumly. I've got to start jogging, or walking those 10,000 steps a day I tell my patients to take. She wondered where she'd put her fitness monitor while ordering the requested tests for her colleague.

"I have to run to a special emergency meeting with administration," Ursula said casually as she slipped on her shoes after the exam. Miriam struggled to contain her curiosity, but her colleague evidently read her face clearly.

"It's confidential of course. But you're my doctor now, so I know you can't share anything I say here," she laughed as she stood agilely up and leaned down toward Miriam, who instantly felt their roles reverse.

"Missing narcotics in anesthesia and maybe elsewhere," Ursula Taylor said with a low voice. "A patient complained he felt pain during a procedure and of course he turned out to be a big donor so we're launching a massive investigation, checking all the swipe-in records, interviewing those nearby, and so on. Patients do tend to complain, but one of the nurses told her supervisor there had been more complaints than usual over the past year, though they seem to have eased off in the last couple of months. You look as shocked as I felt, but it's not an uncommon problem. I know I can count on your discretion..."

Miriam raced to reassure the other doctor, inwardly wishing she could share the gossip. She walked her colleague out the door and promised to call with her results.

"Bless your heart," the next patient said, and Miriam flashed back to Herbie Winters. He was always saying that, and telling stories that started with "The crazy thing is..." He'd been in his sixties, debilitated from serious illnesses, but always had just enough energy to do some carpet cleaning for his bevy of elderly woman.

He sat with his ladies, and they always told him to come early, because "Herbie, we have to have our chat."

"All I want from you today is a few kind words," he'd say to Miriam.