Now That You Mention It: A Novel

Excerpt. © Reprinted by permission. All rights reserved.

Now That You Mention It By Kristan Higgins

CHAPTER 1

The first thought I had after I died was: How will my dog cope with this?

The second thought: I hope we can still go with open casket.

Third thought: I have nothing to wear to my funeral.

Fourth: I'll never meet Daniel Radcliffe now.

Fifth: Did Bobby just break up with me?

Let me back up an hour or so.

It was a quiet night at Boston City Hospital — for me. It usually was. While I worked at New England's biggest and busiest hospital, I was a gastroenterologist. Most of our patients were diagnosed in the office before things get too critical — everyone freaks out if they can't eat or poop, after all. So aside from the occasional emergencies — hemorrhages or burst gallbladders — it's a pretty mellow field.

It's also a field with a low mortality rate.

I had just checked the four patients my practice had on the unit — two elderly women, both impacted, sent in by their nursing homes for enemas, basically; one small bowel obstruction, resolving nicely on a clear-liquid diet; and one case of ulcerative colitis which my colleague would operate on tomorrow.

"So more fiber, Mrs. DeStefano, okay? Lay off the pasta and add some greens," I said to one of the impacted patients.

"Honey, I'm Italian. Lay off the pasta, please. I'd rather die."

"Well, eat more greens and a little less pasta." She was ninety-six, after all. "You don't want to get all bound up again, do you? Hospitals are no fun."

"Are you married?" she asked.

"Not yet." My face felt weird, as it always did when I fake-smiled. "But I have a very nice boyfriend."

"Is he Italian?"

"Irish-American."

"Can't win them all," she said. "Come to my house. You're too skinny. I'll cook you pasta fagiole that will make you cry, it's so good."

"Sounds like heaven." I didn't point out that she no longer lived in a house. And that no matter how sweet the little old lady might be, I didn't visit strangers, even strangers who thought I was skinny, bless their hearts. "Get some rest tonight," I said. "I'll check on you tomorrow, okay?"

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, M.D., 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 11, 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 bellyache, looks sick, number 11."

"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 11 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 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 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.

"Thank you," I said. "I'll order up some antibiotics, but he should be right as rain. In the future, big guy, eat more carefully, okay? This could've done a lot of damage. It could've slipped through into your liver, and that would've been really bad."

"Thank you so much, Doctor," the mom said. "We had no idea!" "My pleasure," I said. "He seems like a great kid."

I pulled off my gloves, shook her hand, tousled Caden's hair and went out to write the prescription.

Felt a little heroic.

If left untreated, that toothpick could've caused sepsis. It could've been fatal. Though it didn't happen too often, I think I could firmly say I'd saved a life tonight.

Just then the doors to the ambulance bay burst open, and a pack of people ran down the hall next to a gurney. "Drive up gunshot to throat" barked someone — Bobby, it was my honey! "Extensive blood loss in vehicle, get the Level One infuser running with four units of O positive. Call the blood bank for a mass transfusion pack, and call Trauma Code for Room One, now! Stop sitting on your asses, people! Move!"

The place exploded with action, people running in every direction, doing as their lord commanded. I inched toward the room where the action was, hypnotized. Good God. It looked like half the man's throat was missing, a meaty hole about the size of a fist, Bobby's hand inside it.

"I'm clamping his carotid with my fucking fingers!" Bobby yelled. "Where the hell is the surgeon?"

Indeed, Bobby's arm was drenched in blood, his scrubs sprayed with arterial spatter. The rest of the team buzzed around the patient, cutting off his clothes, inserting lines.

"No, you can't intubate, idiot!" Bobby barked at an intern. "Can you not see my hand in his throat? Bag him, you moron!"

I sure didn't miss residency. The ER doctors had been brutal.

Dr. McKnight from Surgery burst in, pulling on her gloves, a face shield already in place to protect her from blood-borne diseases. Someone draped her in a gown. "Clamp," she snapped. "Now!" If there was anyone more, ah, self confident than an ER doc, it was a surgeon. "Keep your hand there, Bobby, and don't even breathe. You lose your grip, he bleeds out in five seconds. How the hell did he make it here with a pulse?"

Then a nurse saw me gaping and closed the door. I wasn't ER staff, after all.

I snapped out of my awestruck stupor and closed my mouth. Janitorial was already mopping up the trail of blood, and half the residents — including Jabrielle, who shot me a dirty look, since I made her miss the good stuff with my boring endoscopy — hovered at the exam room window to see if the guy would make it.

The other patients in the unit were quiet in their exam stalls out of respect, it seemed — a TV-worthy trauma had just passed through their midst.

I wandered back to the triage desk. "Hi again, Ellen," I said. "That's some —"

"You done with that consult?" Ellen asked.

"Oh, yeah. Um ... he swallowed a toothpick. I did an endoscopy and —"

She gave me the stink-eye and picked up her phone. Right. She was busy, and I was an irritating doctor who made her life harder ... which was true for a lot of nurses, especially in the ER. All the more reason I bent over backward to make sure they knew I appreciated them. But Ellen wasn't the type to drink in the milk of human kindness, so I slunk to the computer and entered the report.

Just as I finished, the door to Bobby's exam room opened, and out came the team again, heading for the elevator up to the surgical floor. I could hear the beeping that indicated a regular heartbeat. Somehow, they'd saved his life, or at least given him a chance.

Dr. McKnight got on the elevator with the transport team, and as the doors closed, she called, "Nice work, people. Bobby, awesome job!"

The doors closed, and applause broke out throughout the department.

The next shift of ER staff was coming on, already aware that there'd been a good save, already jealous it hadn't happened on their shift.

Bobby and his team were in no hurry to pass the torch, either. They high-fived, made much ado about their bloody clothes, their part in the drama, Dr. McKnight's speedy and delicate end-to-end anastomosis.

Bobby didn't say much — he didn't have to, because it was clear he was their god.

Finally, his eyes stopped on me. I smiled, proud of him, even as that little irritating voice said it was about time he'd seen me.

"Oh, hey," he said. We'd been together long enough that I could tell he'd forgotten I was working tonight, too. "Uh ... we were gonna order a pizza and stick around to see how the patient's doing."

"Sure. Of course. Hey, Bobby, that was amazing. I saw a little bit."

He shrugged modestly. "Were you waiting for me?" he asked.

The irritation flared again. "No, I was on a consult. Twelve-year-old ate a toothpick. I scoped him and it doesn't look perfed. Think we caught it before he gets septic, too."

"Cool. Well, you want to hang out with us?"

I suppressed a sigh. I didn't. I wanted to go home and take a walk with Bobby and Boomer and get pad Thai. If we stayed here, I'd have to call Gus, our dog walker. I wanted to tell Bobby about my good call, my instincts of guessing what had caused the pain, which was what separated good doctors from mediocre.

But he was the one who'd had his hand in a man's throat.

"Sure," I said.

"Cool. Just let me get washed up." He left, stopping so the janitor could shake his hand.

Five minutes later, we went into the staff lounge, where the rest of the team was already in full adrenaline-junky chatter mode. More congratulations were given. More high fives. More jokes.

"Who's gonna get the pizza?" Jabrielle asked.

Everyone looked at me, the outsider. The boring gastroenterologist (who had also saved a life tonight, though that story wouldn't get aired).

"I'll do it," I said. "What would you like?"

Despite a magna cum laude degree from Tufts, a medical school at the same and a profession in which I earned a third more than my boyfriend, it seemed I was back in the days of waiting on customers at Scupper Island Clam Shack.

"Thanks, Nora," Bobby said. A couple other people paused in their self-praise to echo him.

"You bet." I walked through the ER, trying not to sigh.

In the hallway was a gurney. A young woman in a neck brace lay there, holding hands with a young man about the same age, also in a neck brace. College kids in a car accident, I'd guess. He leaned down so his forehead touched hers, and her hand went to his hair. They didn't' speak. They didn't have to. Their love was that palpable.

Bobby and I had been like that once, right after the Big Bad Event.

But not for a long, long time.

It made me feel ... gray.