This fictional story is a work of complete fiction. Any resemblance to living persons or the departed is a coincidence. This story eventually includes descriptions of sex between adult males. If you are a minor or if this material is illegal where you live, or if this material offends you, do not read it. Please donate to Nifty. Click on the donation box on the Nifty web site to pay your share of their expenses to provide these stories for you. Remember that authors depend on feedback for improvement and encouragement. All rights reserved.
James Robert Nolgren MD: Nolgren MD, Intern-2
James came back to the present, startled. He had gone to take a bite of his French fry, passing it somewhere over his left shoulder with his mouth open, missing the mark by inches. His eyes had been de-focused during his little fantasy.
An instant course correction didn't hide anything and Lawrence, watching, was amused, and grinned.
"You have a lot on your mind, James?"
"Uh, sure. I've got a lot to do before rounds in the morning. See you around."
He rose, realizing as he did that he felt a little regret he couldn't stay and talk.
The rest of the afternoon and evening was spent examining patients now back on the ward, reviewing charts, making notes about questions to ask the students, introducing himself, and talking to the patients, forging relationships, sometimes with disappointed patients who were already mourning their last 'wonderful' doctor who had moved on to other pastures.
"Why Dr. Gorginski was so attentive and so kind and he was able to figure out just what was wrong with me.
He discussed my case carefully every day I was here in the hospital...in his office downstairs, no less. He came in every day at six am when I hadn't even had breakfast yet to examine me."
"I have rare problems that have puzzled doctors for years. I guess he's got pretty big shoes to fill. Why, he told me I was the first patient he'd ever seen or read about with impetigo of the right molar."
"My medical history is a mile long and not many doctors take the time to listen. I just don't know what I'll do without him supervising my case." James thought, "I'll just bet a lot of doctors give her a wide berth."
He gritted his teeth, remembering an intern who had told a group of students that patients who talked about 'my case' usually didn't have much of one, with exceptions which proved the rule. He'd met Dr. Gorginski as a student and could testify to the six am part. The hospital tolerated the doctor, however, because he cultivated a reputation for collecting and pleasing wealthy patients with wealthy friends, all of whom paid their entire hospital bill in cash.
It was the thing in some circles in town to say to one's friend that Doctor Gorginski had done a 'full', frightfully costly workup on 'my case'. Some mention of the 'awful' cost of medical care, 'but isn't it worth every penny?' usually followed that tidbit as they discussed their Jimmy Choo footgear.
He fell into bed at two am feeling ready to roll at six am, heard the alarm, jumped out of bed, leapt into the warm shower, toweled dry, dressed and raced to the hospital to find rounds delayed to 7:45 am.
The 2nd Year's car had a flat tire being changed at the moment by her brother-in-law. She had phoned the change in to the unit secretary. Breakfast was called for and he raced downstairs for waffles or cinnamon-pecan rolls or something. He joined the line just behind a guy with a bubble butt in tight slacks carrying a long white coat over his left arm just so. The guy turned, looked back and it was old 'green eyes hisself' smiling at him again.
"Hey stud, did ya get some sleep?"
What! This guy didn't know him well enough to address him in familiar terms. James was an MD now and had a reputation to build. On the other hand, old 'green-eyes' here, the dental student, was still smiling and didn't seem to mean anything by it. He'd let it go this once.
"A little," was his reply. "You?"
"All night long, man." James tried to parse that but didn't ask what activity had taken all night long to finish and was a little reluctant to ask as it didn't involve him. There it was again. Why in hell was he thinking this way. He was pretty sure he liked to play in the playpen.
They ate breakfast and discussed anesthesia and socks. In the context of sandals and shoes. The anesthesiologists wore sandals for some reason and a variety of socks, since being barefoot in the OR was verboten. Someone on high, perhaps the OR Head nurse, had decreed socks if sandals were worn.
The discussion that morning at breakfast centered on the sock pattern and weight of sock, surreal as it must have sounded to their tablemates. The subject of on-call rooms and schedules just didn't come up so nothing else arose either.
He was on-call in house on Thursday night and was reviewing the ward schedule for the week. He looked over at the on-call list to confirm his name and saw the second on-call doc's name...was Lawrence. The original name had been lined out and Lawrence's name penciled in.
At supper he sat with Lawrence. He worked on the unit until 8 p.m., went to the on-call room, knocked, entered and there, reading a dental magazine was Lawrence, shirtless, clean scrubs on, chest just magnificent, looking up at him. Self-conscious, James took off his scrubs to change into clean ones for the night, hung his bag and a few personals on the wall hook, displaying his own chest for a minute and out of the corner of his eye, saw Lawrence ogling the view.
He looked at Lawrence and heard words out of his own mouth, "Hey, you've got a nice chest there. Do you work out?"
"Every day when I can make the time."
"Nice." His mouth apparently, wasn't being supervised by the large neuronal mass behind his eyes, but by the one in his cock. James's mouth went dry and his heart began to race. He'd said it and couldn't take it back.
Lawrence grinned and said, "You like?"
James drew his hand across Lawrence's muscles, felt his pecs and biceps, ran his hands down his belly to his scrub pants. A small moan escaped Lawrence's throat and they stepped closer to each other, their heads a few inches apart, Lawrence now reaching out to touch James. They explored and finally looked at each other, looked down, looked back up and James raised his chin a little and tilted his head a bit. Lawrence slowly closed in and they kissed. James' mouth opened and Lawrence's tongue began to dance with his.
James hands reached around Lawrence and drew him even closer to himself. "Can you come out and play?"
"I can. There's a warm shower in there and soft fluffy white towels and soap."
"I'm new at this. Maybe you had better choose what you like to do and I'll learn the ropes as we go along. Will it hurt?"
"Maybe. A little. But then it will feel so good you'll wonder why you didn't do it sooner. That's what all the books say."
"Don't you know by experience?"
"You're my first. How would I know this?"
The two men locked the on-call room door, stepped into the warm shower, washed each other leaving slippery soap here and there. James could hardly think, but he found himself quite able to feel and he liked Lawrence's body. A lot. Hearts pounding, two men kissing, licking, sucking...finally Lawrence turned James around and made love to him.
James eventually relaxed and he told Lawrence to go ahead.
They slept in one bed that night. There were no calls. The door remained locked until the alarm rang at 6 am when they each showered alone, dressed, kissed and separately walked down to breakfast which they ate together. Anyone looking at them would have thought they were ships passing in the night. They weren't ships. They hadn't passed each other in the night. James and Lawrence had met...and melded.
The attending showed that day for rounds and asked Beryl, one of the brighter medical students, to discuss the differential diagnosis of pelvic pain. Her patient had presented with that symptom. She correctly replied that pelvic pain could be divided, in general, into acute onset and chronic duration.
Acute pain (she narrowed her answer to the current patient's problem) could include trauma, infection, ectopic pregnancy, ruptured ovarian cyst, torsion of an ovary, torsion of another pelvic mass, among other causes and the various causes of pain associated with bladder pain including ureteral obstruction, urolithiasis (stones), GU tract infections, among others less common...
...and bowel pain, including appendicitis, partial and complete obstructions, torsions, ruptured diverticula and not forgetting hernias and the range of pain associated with Crohn's disease and the discomfort of irritable bowel syndrome among others less common.
As she launched into the chronic causes of pelvic pain, the attending winced internally, hoping this display of knowledge would end before his own IBS and/or full bladder kicked in.
Why the hell had he had two grande cups of scalding coffee both with real cream at Starbuck's this morning along with a large hot breakfast sandwich with eggs and cheese at Bigbucks this morning anyway?
He also winced internally, seeing into the future and his replacement right in front of him. Maybe he would switch to ice-cold Scotch for breakfast or something.
This student knew her stuff in a way he never had...it came out of her mouth as if she was reading a textbook, unimpeded by emotion or hesitation, the way real attendings were supposed to be able to do.
As Beryl wound down, there weren't very many questions to ask about the patient and the workup was done and the diagnosis established already since red cells in the urine without white cells, abrupt onset of one-sided (unilateral) pain in the mid-back, moving downward around the flank to the front, then heading down to the bladder area, resolving with iv fluids, pain medications, and oh-by-the-way, the ultrasound showing a small rock in the ureter...had met pretty much all the criteria for ureterolithiasis (stone in the ureter) moving down from the kidney.
Cased and pain solved. The attending excused himself to 'make a phone call.' Which turned out to be a good thing for himself and, ironically, for the next student.
The next case was presented by the least likely student to amaze and 'Tommy' Dahl didn't disappoint anyone. This 'lady', Tommy said, without mentioning her age, gravida status, para status, or aborta status, 'got pain' (he didn't describe the characteristics of the pain (sharp, dull, sudden or gradual onset), and came into the hospital (he didn't mention the presence or absence of fever or other symptoms) brought by ambulance on 'I think it was Tuesday night' (he didn't mention through the ER or direct admit). Her last period isn't known (he didn't say he hadn't asked her when it began and if it was late or not) and she has a normal CBC (blood count) except the hemoglobin which is 7 grams per deciliter (foreshortened to '7' and the Tommy didn't mention her normal hemoglobin or whether she'd had one in the last few months to compare this one to.
Tommy was now looking around the group for a sympathetic face and not finding one realized that his presentation hadn't gone well, making him seem even less of a prize. James didn't feel sorry for him.
A poor presentation was a sign of a disorganized mind, a lack of thought or pure laziness...and it was his job in the next few months to bring this guy's 'processes' up to snuff so he didn't kill anyone in the future. He was on it.
"Now we need to fill in some holes here," James said. "Have you examined the patient?"
"Not yet, the breakfast line was pretty long."
"Next patient you get, you need to be here at 5 am to workup your patient and be able to present the patient properly with all the details. Don't let me down again, capisce?"
"Yes, sir."
The other students were just grateful it wasn't them on the block but lost no opportunity to flesh out details and make observations to let James and the 2nd year and the senior and the attending know that they knew the questions to ask with the implication (probably true) that they wouldn't have made a hash out of the presentation or the workup.
James knew he would have to take over as a beginning teacher right now and limit the obvious damage and infighting getting ready to boil over so incipiently. He decided to strut out his own stuff, an example to Tommy if Tommy was indeed listening and learning. James was very much on top of the case and had been since admission.
"This patient is a 20 year old Caucasian female, G5, P4, Ab0 with sudden onset onset of left lower quadrant pain at 4 pm Tuesday, sharp, spreading through her abdomen associated with symptoms of mild shock with blood pressure 90 over 75, pulse 110, respirations 35, afebrile. Internal Medicine is following her for her co-morbidity, adult onset diabetes."
"Her last menstrual period began 7 days late. In the Emergency Room last night, she had IV fluids started, a pregnancy test which was faintly positive, decreased bowel sounds, rebound tenderness worst in the left lower quadrant of the abdomen but really now present all over the abdomen which is slightly distended."
"My diagnosis is ruptured, slowly leaking left tubal (ectopic) pregnancy which is a surgical emergency. This patient should be heading for the OR as soon as possible. The option of methotrexate therapy for the drug treatment of this lesion is not viable because there is now blood in the belly and the required serum progesterone level can't be done in time. Her first urgent priority for treatment is to get her hemorrhage stopped."
"The pregnancy test has been repeated and verified. An ultrasound early this morning shows free fluid in the belly and the outline of a sac in the L tube and no pregnancy visible in the uterine cavity. I put the patient at NPO (nothing by mouth) at midnight anticipating the decision for urgent surgery this morning and watched her vital signs like a hawk during the early morning hours."
The senior whistled, coughed a bit...he had lost track of this one and didn't want the attending to notice that. He rumbled a little and opined that he agreed with the diagnosis until proven otherwise at surgery and being a senior, those in rank below him sagely nodded their heads and the attending, now back from his other duty took 4 seconds before he picked up the phone, called the OR and spoke with the Head nurse, who routinely expected urgent cases.
...As did the Anesthesia department. The Anesthesia assistant was now placing new tubes and masks in the room, surgical nurses were prepping a room rapidly, pulling gown packs, gloves, and surgical instrument packs, tearing them open and placing them on sterile fields on tables.
On the ward, the patient was signing a surgical consent and was being wheeled down the hall to the OR. The 2nd Year was thinking she owed James a gold star for not verbalizing that she had missed this one and James was thinking she owed him that gold star and felt pretty good at having her back.
"Karma will out," he thought. And then he thought he might get through the year.