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As soon as the patient was transferred from the ambo stretcher, Frank was at the head of the bed, barking out orders. The middle-aged male patient had fallen 4 stories at a construction site he worked at.
“Mel, check lung sliding and then do an e-fast. I’ve got the airway.” He tilted the patient’s head back. “Jesse, vitals?”
“Pulse is 135 and rising, BP’s 80 over 56, and pulse ox is 92 and dropping.” As always, Jesse was a steady rock in the chaos of the ER. “Trauma panel?”
With a few sniffs and a facial grimace, Frank slid the ET tube down the patient’s throat. There was relatively little blood on the outside, but Frank knew the patient was in a bad way. “Yup, and activate MTP.” Then, “Okay, I’m in. Check end-tidal CO2.”
“Yellow means yes!” someone called out.
Mel looked up from where she was checking the patient’s lungs with the ultrasound. “Right lung is up and moving well, but the left has a significant hemothorax.”
“I need a chest tube tray and a stool, please. Mel, do the e-fast, and can someone find out where the hell Garcia is? A stool was slid in behind Frank and he sat down, giving his neck a few quick jerks to the side.
Suddenly, Ogilvie was right behind Frank. “Can I do it? I haven’t done a chest tube yet.” The new med student was a bit…rough around the corners. A real gunner, but in the worst way.
“You can stand here and I’ll show you one first.” Frank narrated every step of what he was doing as he inserted the chest tube, throwing in his personal tricks along the way. Ogilvie asked questions and gave stats that no one asked for. A typical gunner.
Garcia slid into the room as Frank finished the chest tube, all her usual iciness present. “Surgery here,” she called out. “What maiming do I need to fix today?”
Ogilvie piped up before anyone else could. “45-year-old male with a 4 storey fall-”
“Hush, I want to hear from an adult.” Garcia cut him off with a glare. She re-directed her focus to Langdon. “Twitchy, why are you cutting into my patient?”
“400 ccs of blood output from the left lung already. We’ve started MTP and sent a trauma panel.” He looked over to Mel. “The e-fast-”
“-The e-fast is positive for free fluid by the spleen, liver, both kidneys,” she finished. “Foley is positive for blood too.”
“Who knew that the ground was hard,” Garcia said sarcastically. She glanced at the monitors. “Okay, we’ll take him now and try to put humpty dumpty back together again.”
Frank could feel Ogilvie staring at him from across the hub. After Garcia had taken the trauma patient up to surgery, Frank had deposited himself into a squeaky wheely chair to try and catch up on some charting before everything was chaotic again. Mel had joined Santos with a child patient who had some mysterious symptoms.
Eventually, Frank couldn’t focus. “You need something, Ogilvie?”
Apparently, that was all the invitation Ogilvie needed to launch into one of his gunner monologues. “It’s very interesting that you’re a doctor with tics. It’s Tourette’s syndrome, right? I’ve heard about it but never seen it in person, which doesn’t track with 1% statistic that is quoted in recent papers.”
“Uh,” Frank managed to get out, not so eloquently.
Ogilvie continued on. “There was an explosion of diagnoses of Tourette’s syndrome, among other neurological conditions, in the early years of the pandemic. It occurred mostly in teenage and young adult women.” He looked excited as he spoke. “It’s theorized that it’s mostly psychosomatic, or women just looking for attention, which, knowing women, is likely correct.”
“You? Know women?”
Frank looked up behind him. At some point, Dana had appeared, and she looked less than impressed.
Ogilvie nodded. “I’ve read a lot of papers about the psychology of women, and how they are more likely to present with psychosomatic symptoms than men.”
“Well, uh, those figures are skewed because men’s complaints are often taken more seriously.” Frank finally found his voice again. “Doctors are more likely to label a woman’s symptoms as psychosomatic without further testing.”
Looking annoyed at having his ‘facts’ rebutted, Ogilvie went back to the original topic. “But you have Tourette’s, right? Probably diagnosed as a child, rough tics in teenage years before calming down in your twenties.” He didn’t even seem to take a breath between sentences. “You have very classic motor and vocal tics. Do you have coprolalia or copropraxia?”
Dana cut in before Frank could. “Don’t you have something you need to be doing, Ogilvie?”
Frank’s neck ticced backwards and Ogilvie’s eyes lit up. “Like that! That’s a classic Tourette’s tic.”
“Go find an attending to bother,” Dana instructed, her voice hard. “Or another resident. Or go consult the morgue staff, just get out of here.”
Despite Ogilvie not looking shameful, he dutifully left the hub in search of someone else to bother. Frank did a couple squeaky sniffs in a row and flexed his wrists over the keyboard.
“You okay, hon?” Dana sat down on the edge of the desk beside Frank. “I’ll kick his ass if you want me to.”
Frank smiled, the corners of his mouth quirking up a bit. “I appreciate the offer, but it’s not the first time someone’s been an asshole about my Tourette’s and it’s probably not the last.” He sighed as his neck ticced backwards again. “Talking about my tics always makes them worse.”
“You should take a break, call Abby and see what her and the kids are up to,” Dana suggested. “Take a breather.”
“Look at all this charting.” He gestured to the computer, wrists locking dystonically for a moment. “Abby would like it even better if I didn’t have to stay late to complete my charting. Bedtimes are still a bitch.”
Two hours later and Frank found himself treating a patient with Ogilvie once again peering over his shoulder. The patient was an older male from a long-term care home. He had been in a vegetative state for over a decade, and, since he was seemingly unresponsive, the med student took it as an opportunity to pepper Frank with more questions about his Tourette’s.
“I’m surprised the hospital doesn’t see you as a liability,” Ogilvie said after a rare moment of silence. “I mean, what if you tic while doing a chest tube and just shkrt! There goes someone’s lung.”
Frank frowned as he continued his exam.
Ogilvie continued on. “Or what if you have a series of obscene vocal tics while treating a paediatric case? Or tell a suicidal person to kill themselves?”
“I don’t have coprolalia,” Frank commented. He knew he should just dismiss Ogilvie; the med student wasn’t even helping with the exam. But he just didn’t want to make a whole deal out of the situation.
“Well not right now, but what if you develop it?” The patient grunted and Ogilvie stopped, momentarily forgetting that the sound was involuntary. “There’s so many things that could go wrong and yet here you are, in a job that means you are so hands on with patients.”
The patient’s only immediate issue was needing his feeding tube replaced, and after the exam, Frank was satisfied it could proceed with no issue. He stripped off his gloves. “Okay, Mr. Goldberg here is good to go for a new g-tube. Donnie’s gonna show you how to do it.”
And then, without further conversation, Frank walked out of the curtained treatment area. McKay exited a nearby treatment area at the same time.
They nodded to each other as they both headed to the hub to fill in orders and check on other patient’s results.
“So,” McKay said after a moment. “Ogilvie is sure interested in-”
“My capability to be an ER doc?” Frank groaned and flopped backwards in the chair he was on.
McKay shrugged, a smile creeping at the corners of her mouth. “I was gonna say he’s sure interested in Tourette’s, but that was me being polite.”
“Ever since that trauma this morning, he’s been all over me. Every time I turn around, he’s there with more hypotheticals about how I might tic and kill a patient.” He looked towards McKay. “You should have heard him this morning when he went on a whole speech about the rise on Tourette’s diagnoses at the beginning of the pandemic and how it’s because women are ‘attention seeking’.”
“Ew.” That made McKay’s mouth turn downwards into a frown. “Remind me not to bring him on to any sensitive cases.”
Frank sighed. “He’s just here for a sub-internship, right? He’s not here forever?”
“Oh god, I hope not.” McKay went quiet for a moment as new patient test results came in. One dinged loudly at her, demanding her attention. She typed for a moment before speaking up again. “You could let Robby know he’s harassing you.”
“That’s not-”
“It is harassment.” She stopped typing and turned to face him, waiting as his head jerked back a few times. “It’s him being ableist, it’s him being an asshole…he’s harassing you.”
Another series of neck tics gave him a moment to think before answering. “I can handle him myself,” he offered quietly. “I don’t need to run to Robby every time someone is a jerk.”
“And what if he harasses someone else? What if it’s not just ableism, but racism? What if he starts targeting people because of their religion? Sexual orientation?”
“Okay, okay!” Frank buried his face in his hands and groaned. “I get it.” His voice was muffled. “I’ll talk to Robby.”
“Good.” McKay logged off the computer. “Better do it now before you either pretend to forget, or actually do forget, because I’ve seen your sieve of a brain.”
Frank raised his head and glared at McKay. “Now who’s being ableist?”
Despite having a sieve for a brain (McKay was not the one to term his brain that- Frank had), there was no way Frank was going to forget he needed to talk to Robby. The anxiety of doing so curled around his heart and squeezed for the next hour.
It was shortly after he had almost talked himself out of speaking with Robby about it when he found himself out in the ambulance bay with the man, waiting for an ambulance to arrive.
“So,” Frank started, looking down at his gloved hands. “You worked with Ogilvie much?”
Robby glanced over at Frank. The resident was usually much more direct and confident when he spoke. “A little, not very much. Why?”
“There’s been some…concerns about how he treats people.” Frank still didn’t look up at Robby.
“Concerns from the patients? Or from the staff?”
A neck tic forced his head back, and Frank briefly saw Robby. The older doctor was studying him intently. “I hope he’s been civil with the patients.”
“So the staff then.” Pause. “Want to be a little more forthcoming about whatever this is?”
Frank pursed his lips and sniff-squeaked a few times. “He’s been less than sensitive when it comes to…you know, me.”
“You mean your Tourette’s.”
Frank nodded slowly. “I’m not telling you because I can’t handle it, because I can. I’ve been dealing with assholes my entire life.” He paused to accommodate a few more squeaky sniffs. “I’m concerned that how he acts with me could be how he acts with other people, staff or patients, and I don’t want that to happen.”
Robby let his head lower so his chin was nearly touching his chest. “God,” he said with a shake. “You’d think someone working in healthcare would have more empathy than that.” He looked up and over at Frank again. “Do you know if he’s said anything else to anyone?”
“No idea,” Frank said as he finally looked up to meet Robby’s eyes. “I do know he has some…interesting ideas about women and healthcare, if his rant about women and psychosomatic issues is anything to go by.”
And there was the classic eye crinkle Robby got when he was concerned.
When it stayed silent for a moment longer than Frank could stand, he started talking again. “I’m not telling you this to get him in trouble or anything, it’s just...” he trailed off as he tried to think of what he wanted to say and how he should say it.
They both stayed silent for a minute. Frank wished the ambulance they were waiting on would hurry up and end this awkward conversation already.
“Thanks for bringing it up with me,” Robby said eventually, looking up at the blue sky. “I’ll deal with it.”
“Good.” Frank could finally hear the ambulance getting close to them, sirens only whooping at intersections and cars that wouldn’t move. “Cause honestly, Robby, if he suggests one more scenario where my tics are gonna kill someone, I might test those theories on him.”