By Katrina Johnston
Margaret Boylan listened beside the doctorâ€™s room, waiting for the on-duty radiologist, a certain ill-tempered Dr. Andrew Parsons, to vanish. She paced a few steps. She hovered and listened while she pretended to hunt for a specific patientâ€™s chart in the archived stacks. She muttered: â€œRude, oppressive, a nasty dictator.â€ She could hear him on the other side, finishing up his work and shuffling about inside the doctorâ€™s room. â€œMiserable old coot!â€
Margaret couldnâ€™t comprehend exactly why some of the other staffers thought he was peachy. Most of the on-duty radiologists conceded that Dr. Parsons demonstrated the gifts of a fine diagnostician. He maintained a loyal following amongst his own patients. But when it came to the support staff at the clinic, especially the clerical workers like Margaret, well, heâ€™d never be voted anyoneâ€™s Mr. Congeniality, or most likely to impress either.
Margaret exhaled. â€œDictator,â€ seemed the perfect title because it was Dr. Parsonâ€™s duty to study the diagnostic images and then â€˜dictateâ€™ the formal reports. She tilted her head close to his door, expecting he would take his leave via the other access, the lobby entrance. Only then would it be safe to enter.
Success. She exhaled, identifying the departure sounds, the whoosh of forced air and the re-latching click of the outer door. The miserable dictator had vacated. She pushed open the clinic door and let herself inside the radiologistâ€™s inner sanctum.
Several radiologists rotated through the clinic; usually a new one every few days. They shared the work space. Inside the doctorâ€™s room, four viewing screens loomed on the wall. Dr. Parsons had not bothered to shut down his recent images. Margaret noted the MRI of a brain and part of a cervical spine. The other screens glowed with shoulder ultrasounds; multiple jagged lines, ragged etchings on black which only the experts could discern as bone, muscle or degenerative change.
Dr. Parsons doesnâ€™t even bother to flip a switch or two? Margaret hustled over and logged off. She snapped the view screen toggles and the images faded to black. She gingerly swept away tissues, cough drop wrappers and his mealy orange peels. Parsons must think Iâ€™m his personal maid. She straightened the raggedy stack of the completed files – her new transcription – and she carried these from the room and back through the busy clinic.
How could she best deal with Dr. Andrew Parsons? She wondered. She felt intimidated whenever she encountered him. Avoidance worked, but not well, and all that walking on egg shells wasnâ€™t helpful or efficient.
When she was new to the clinic, sheâ€™d gone boldly in to consult with him.
â€œWhat is it now?â€ Heâ€™d shouted when she knocked. She flinched but still she ventured all the way inside the room. Heâ€™d drilled his attention straight to the front, his fingers on the hand-held microphone ready to dismiss her with a definitive click. â€œAnd you want…?â€ On the view screen, a glowing PA chest x-ray.
She placed a newly transcribed report on the table by his right elbow.
â€œThis patient,â€ Margaret started off, and then she took a deep breath and began again. â€œThis patient had a hip replacement back in 2008. Your dictation doesnâ€™t match. Youâ€™ve indicated a regular hip with arthritic features and bone loss. Looks like a mix-up.â€
â€œDonâ€™t bother me with your petty clerical details. Check with the techs.â€
Sheâ€™d already done. Marney didnâ€™t know. The other techs – Gail and Katherine – couldnâ€™t help. Margaret had almost gone in to consult with the ultrasonographers, but x-ray and ultrasound reports couldnâ€™t possibly be inter-mixed. Or could they?
â€œBut, Dr. Parsons,â€ Margaret continued. â€œAnother patientâ€™s report is also totally in error. If I could just access your computer in here, you know, have a look – Iâ€™ll quickly find out whoâ€™s who.â€
She hesitated. â€œBut, itâ€™s a bad mix-up.â€
â€œNo,â€ he said. â€œFind another way.â€
â€œOnly take a moment. I need to check the I.D. number, the one you say as youâ€™re dictating the report. Itâ€™s necessary to…â€
â€œIâ€™ve no time for your idiot file numbers, or idiot typists either.â€ He waved a hand back in her general direction. â€œLeave,â€ he said, as if Margaret was a bothersome piece of fluff.
â€œBut Dr. Parsons, I canâ€™t ….â€
â€œNo,â€ he said. And, then he clicked the hand-held microphone off-and-on in a tempo of dismissive noise. â€œYou have some problems with your hearing? I said leave!â€
She grabbed the printed report and fled.
No one saw the battle with her tears. Sheâ€™d loitered for a time among the archives, sniffed and fought to regain composure. â€œHeâ€™s the idiot,â€ she told the stacks. Soon she pulled herself together because there was no one else to transcribe the reports. â€œNot a typist,â€ she announced to the tiers of old files. â€œIâ€™m the transcriptionist.â€
Heâ€™d dictated the wrong identifier of course. Whoâ€™s the idiot? Really?
Today, Margaret decided, sheâ€™d just have to manage. If it concerned the accuracy of a patientâ€™s information, sheâ€™d simply crash straight into Dr. Parsons.
The clinic was as busy as ever. Reception hummed with a crowd of new patients checking in. Six others, garbed uncomfortably in paper, sat waiting outside the change rooms, attentive for a summons for x-ray or ultrasound. The MRI thumped like a regular drum. That monster was housed in a separate suite of offices far down the hall. The whole clinic thumped. Margaret walked in-time. Ta dum. Ta dum. Ta dum.
Back safely inside the transcription room, her domain, Margaret set the load of files down and plugged into the digital audio system. She loved her job.
The medical words sang like a strange poetry: extracorporeal shock-wave lithotripsy, endoscopic retrograde cholangiopancreatography, single photon emission computed tomography – and normal. The most prolific word Margaret ever transcribed – normal. Sometimes, a patientâ€™s entire report consisted of that one single word. Normal.
Occasionally, the doctorâ€™s dictations surprised her. Dr. Trelane had missed a twin pregnancy; sheâ€™d gone straight in to see him. Oops. Yep, two foetuses: one in front, one in back. Sheâ€™d laughed nervously. Dr. Trelane laughed and then heâ€™d cheerfully corrected his own error. Another radiologist, Dr. Penway, rambled on about prostate trouble. But, Margaret found the patient was actually an 82-year-old female. Oops again. Good thing they had her for backup.
Margaret listened carefully to the dictated material. On another occasion, Dr. Murphy had fallen asleep right in the middle. He trailed off for over 20 minutes and Margaret had to pace through dead air until he eventually woke up. Then there was Dr. Copperstaff. That one deserved an academy award for mumbles. He had given a patient an unusual substance. Margaret heard â€˜limages.â€™ After her usual detective work, she discovered the doctor had administered lemon juice. Yep, good thing they had Margaret to catch their mistakes.
On a cold December afternoon near Christmas, Dr. Parsons was back dictating in the radiologistâ€™s room. Essentially the clinic was closed: no appointments and the rest of the staff had booked off early to attend a Christmas party. Margaret opted to stay behind and work to reduce the mountain of transcription grown huge because theyâ€™d been quite busy. Dr. Parsons had just better stay in his own little cubby and Iâ€™ll stay in mine, she thought. Heâ€™d probably not venture past the transcription room. If he did, sheâ€™d keep her back turned, her attention on her own work, just like he did.
She toiled for a two-hour stretch before she took a breather. She went into the lunch room and dumped a small scoop into the coffee maker, which dripped a shallow couple of inches into the base of the pyrex pot. I only need enough for me, she thought as she carried her mug back to the transcription room. Then it happened.
Margaret tripped and reeled forward like an out-of-control acrobat. She crashed heavily against the sharp-edged countertop, extending both hands to stop the tumble, but down she went. Coffee spewed on the walls and splotched dark dribbles onto the carpet. The mug shattered. Margaret groaned. She pulled herself up. A bolt of pain stabbed at her left elbow. â€œOh no,â€ she said out loud. She couldnâ€™t move her arm. The elbow screamed with pain. She gnashed her teeth and looked down. The arm appeared okay. It looked normal, but it buzzed a hot ember of agony. She dragged her arm carefully toward her body and cradled it against her abdomen. She crawled onto the chair. Hold still, please hold absolutely still.
What was she going to do now? Sheâ€™d have to get to the emergency room – thatâ€™s what sheâ€™d have to do. She eyed the phone. With one good arm, she reached out. Think clearly now. The taxi number was emblazoned in her memory. After all, sheâ€™d called cabs for numerous patients. Yep, got it. The taxi would be along in about 30 minutes. Christmas time. They were busy.
Next step: Shut down her computer. Margaret did. Next, she thought, focusing on one step at a time, sheâ€™d have to tell Dr. Parsons she was leaving, so she hauled herself to stand. Yep, she could walk.
He sat there dictating.
â€œWhat is it now?â€
â€œIâ€™m afraid – Iâ€™m afraid Iâ€™ll have to leave. Iâ€™ve hurt my arm. Have to go to emerg-â€
He pushed his chair away from the console. â€œHow bad?â€
â€œExcruciating, I can hardly move. Well, I mean I donâ€™t want to move.â€
â€œFell against the desk. Splashed coffee all over the transcription room – all over the wall, but I canâ€™t worry about it now.â€
â€œWhereâ€™s it hurt?â€
â€œElbow, I mean – olecranon. The pain shoots up to my shoulder and down my forearm and into my fingers. Awful.â€
â€œCome here.â€ It was an order.
â€œBut, Iâ€™ve got a taxi coming. I need to get to St. Christopherâ€™s.â€
He said again. â€œCome here.â€ He pushed further back from the doctorâ€™s console and stood. She inched towards him like a frightened child. â€œCan you put your hand out, like this?â€ he said, and he extended his own arm as if he wanted to shake her hand in greeting.
Margaret tried to ease her arm away from her body. Fresh pain shot into her forearm and she whimpered.
â€œSlowly.â€ he said. â€œTry to do it smoothly and slowly. Donâ€™t jerk.â€
It was agony to pry the arm forward. Pain mixed with fear and fear magnified the pain. Margaret clenched her teeth and extended her hand to Dr. Parsons.
He bent over. He was tall. She hadnâ€™t realized how tall. He smelled of stale dust and old wool and oranges. He took Margaretâ€™s forearm in his own hands, cradled her wrist and supported her elbow. He ran exploring fingers along the back of her elbow and then along her upper arm; then her forearm.
â€œNo fracture,â€ he said. â€œRadius and ulna are intact. Steady. Hold yourself steady.â€ He repositioned his hands. With one quick motion, he rammed her forearm back; strong and fast and he twisted a decisive quarter turn. There was an audible crack and Margaret felt bone grind against cartilage or possibly other bone. Instantly, the pain subsided.
â€œYour elbow was out of joint. Itâ€™s common. Usually children.â€ He sat down and pulled a stack of files toward him. â€œSometimes trapped nerves or vessels in there, hence the pain. Simple manoeuvre to put it back. If you require further relief, take ibuprofen. No recurrence should be expected.â€ He turned away, picked up the microphone and clicked the display screen to reveal the next image.
â€œThank you!â€ Margaret said. She stood statue-still except for her arm which she wobbled slowly up and down, tentatively, testing, testing, until she swung it freely. â€œAmazing. I donâ€™t know what happened. It feels fine. I never thought ….â€
â€œLook,â€ Dr. Parsons said, â€œIâ€™ve still got to get through this pile. Letâ€™s just get on with our respective work – shall we?â€
â€œDr. Parsons, youâ€™ve just saved me a great deal of pain and going to the hospital and everything. So, I want to say a huge thank you. My arm – is normal.â€
He stared into the viewing consoles.
Margaret went back into the transcription room. She flexed her arm gingerly. Yep, it was certainly normal.
She looked at the coffee stains and the broken mug. Not too bad. She ran warm water into a dish rag and mopped the wall. She picked up the pieces. Nothing she could do about the carpet. She called and cancelled the taxi.
Dr. Parsons passed the transcription room doorway on his way into the lunchroom. â€œCoffee?â€
â€œIâ€™ll make some more,â€ she said.
She watched him walk back towards the radiologistâ€™s room. Okay, she admitted to herself, I can see why some people have decided heâ€™s okay – a good doctor with patients. And maybe heâ€™s a talented radiologist too. His dictation had always been clear and complete. Great English skills.
She tested her arm, raising it up and down like she was lifting an invisible weight. Yep, normal.
But, Dr. Parsons was still a miserable old loon.
Margaret decided sheâ€™d never hide again amongst the stacks of old archives, or wait until heâ€™d gone before she dared pick up the new work from the doctorâ€™s room. And, if she needed to ask Dr. Parsons something – she just would. That was normal. And, if he called her an idiot or commanded her to leave his presence – sheâ€™d just tell him heâ€™d better take a flying leap.
And Margaret plugged in to transcribe the next dictation.
Katrina Johnston is the winner of the CBC-Canada Writes True Winter Tale (2011). Other examples of her work are featured online and in print. The goal of her story-telling is to unlock and to better understand the magic of complex human connections. She lives in the historical neighbourhood of James Bay in Victoria, BC, Canada.