Be Still

My head bumped the table with a loud thud; I woke up, of course. I raised my head and quickly looked around. To my relief, the library was empty. I was alone at the table with four textbooks spread out before me.

I sighed and looked down at the textbook directly on top. Physiology. Normally I got excited about physiology, and I rarely fell asleep while studying. But I had felt out of sorts the past few days, as if I was coming down with something. I probably was. Infections spread easily among students in close quarters. Libraries, cafeterias, and classrooms were all rampant breeding grounds for infectious agents, especially for medical students facing the constant stresses of exams.

I closed the book and piled it on top of the others and glanced at the clock. I had been studying for four and a half hours; the first four had been productive, the final half hour had not. Time for a break, it seemed. I knew my books would be safe if I left; the vast majority of my free time had been spent here since I began medical school four months ago. I stood up quickly and was surprised as a wave of dizziness hit me and the room began to blacken. I caught the back of the chair before I fell, stumbling sideways. I paused for a moment as my field of view resumed its normal lighting and the room stopped spinning.

I allowed myself to stand straight up again, more carefully. I guessed that I had stood up too quickly after sitting for too long. I glanced around and was assured that no one had seen my little episode, and ambled my way up the stairs and across the walkway that connected the medical school to the hospital, to the cafeteria.

It was mostly quiet, save for a group of porters that were on break and sitting at a table, laughing loudly and conversing in French. A few isolated nurses and residents were sitting by themselves taking a break, enjoying a coffee, or having a snack.

I strolled into the food area and walked over to the refrigerators; if I was getting sick I should get some fluids, I thought. I slid the door open and chose a bottle of apple juice. The bottle seemed to be stuck; I pulled hard on it and was surprised when it suddenly gave way. The plastic bottle slipped through my fingers and onto the floor. As I bent down to pick it up, I was again suddenly overcome by a wave of dizziness. I gasped and reached toward the glass door for support. Even so, I stumbled forward.

"Whoa, there," A deep voice from behind me said, and I found myself quickly secured by a strong pair of arms. One arm was firmly wrapped around my chest under my arms, the other arm was parallel to mine, the owner's hand grasping my wrist.

I automatically turned my head to look at who had caught me but I was immediately taken by the spinning room. Another gasp left my lips and I closed my eyes tightly for a few seconds as I tried unsuccessfully to stand up. I felt myself flush, but at the same time, I broke into a cold sweat as beads of moisture formed on my forehead.

"Take a moment," the deep voice said, whose owner, I registered, was young and male. My heart thumped irregularly, as it was wont to do, particularly under stressful circumstances. He waited patiently for me to recover which took a few seconds, but in my embarrassment, felt like hours.

I took a deep breath and tried again, opening my eyes. The room was no longer moving. I felt the strength in my legs again and slowly stood myself up. The man behind me did not let go until I was fully upright. He released his hold on me as I turned around, still keeping his arm nearby, in case of a repeat event.

"Thank you," I began, and was stunned into silence as I looked up into a pair of striking green eyes. I felt my face grow warm as I registered the attractiveness of the man in front of me. I quickly closed my mouth, hoping he had not noticed that my jaw had perceptibly dropped. He was tall with a fair complexion, and his short sandy brown hair fell into slight waves. His features were chiseled, perfectly proportioned. His greatest asset by far, however, were his eyes; they were noticeably green, even in the poor fluorescent lighting of the cafeteria. A stethoscope was slung around his neck and over his shoulders. Even dressed in blue scrubs and a white coat I could see he had a muscular build. Embarrassed, I mumbled my thanks again and glanced behind me for the nearest exit.

"Wait," he said, sensing my attempt to escape, and held out my bottle of apple juice. I hadn't even seen him pick it up. I blushed again and accepted the bottle gratefully. I felt my heart skip again as his fingers brushed mine. He looked at me curiously, but his expression seemed to convey concern.

"I think I'm a little dehydrated," I said sheepishly.

"Would you mind if I take a look at you before you go?" The doctor said, "I'll leave you alone when I feel sure you're going to be okay," he promised. His comforting smile never left his handsome face. My face grew warm again.

I was still embarrassed but flattered that he would be so concerned. "Uh, sure," I stammered stupidly in a small voice. Inside I was already kicking myself. I had just made a fool of myself in front of someone who very well could be my attending physician one day. Not only that but he was gorgeous. Instead of impressing him with my vast medical knowledge I had caught his attention by almost falling flat on my face.

He purchased a small yogurt cup and a coffee. "This way," he said, after I made my purchase. I noted how easily he held the yogurt and coffee in one hand; he placed his other hand on the small of my back and led me down the hallway and up the escalator to a small examining room in the Emergency Department. He closed the door behind us and placed his coffee and yogurt on the side table.

"I apologize, we haven't made formal introductions. I'm Nathan Wesley. I'm the ED resident on call tonight." He offered his hand.

"Amanda Olson." We shook hands. I found myself finally regaining my composure. "I'm a medical student here. Thank you for earlier," I said, with feeling.

"The pleasure's mine. You looked a little unsteady when you were standing there so I headed over. I was just about to ask if you were okay when you had your episode," Nathan said, pure professionalism in his tone. "Is this the first time this has happened?"

I understood that Nathan was already taking mental notes on my history. I conceded, and sat down on the examining table; the fresh paper crackled beneath me. "Not the first time today, but it's not part of my usual routine," I responded, a little embarrassed, "Earlier when was studying at the library, I stood up and I almost blacked out, but I thought I had stood up too quickly after sitting for so long." I forced a smile to keep the mood light.

Dr Wesley nodded and strolled over. "How do you feel now?" He asked as he reached his hands up and palpated along my jawline, beginning under my ears and working his way to my chin. He also gently ran his fingers down my neck and applied light pressure as he felt along my collarbone for swollen lymph nodes.

"Back to normal," I said, "At the moment." I had to concentrate on his questions as he was touching me. I felt my heart accelerate with every finger contact.

I made an effort to look straight ahead as Dr Wesley took out a penlight and looked into my eyes. The temptation was far too great though. He was checking my pupillary light reflexes; I was staring into the depths of his emerald-green eyes. Suddenly I realized the penlight was off; his eyes were no longer examining my pupils, but staring straight back into mine. I felt strangely exposed, as though he were gazing into the depths of my soul. Flustered, I turned my head and cleared my throat, as if I were suppressing a cough.

He seemed not to notice and continued his examination, checking my blood pressure, temperature, and pulse rate. Did he notice my heart was racing? He looked into my mouth and my ears.

"I really hate to keep you. I'm sure you're quite busy," I said, trying to sound casual but feeling guilty that there were people who were much more ill waiting for hours in the waiting room.

"It's actually uncharacteristically quiet tonight. I have a few patients awaiting test results, but not much else. Don't worry, if I'm paged for something urgent, you'll know." Dr Wesley reassured me. "Now I'd like to do a more thorough examination of your heart. I felt a few irregular beats earlier when I caught you. I want to rule out anything cardiac related that might be causing your syncopal episodes," he continued, "Would you please lie back on the bed and remove your shirt?" Dr Wesley offered me a gown and turned around to allow me to undress.

I nodded obediently and unbuttoned my shirt, covering my body with the gown that he offered me, and lay down on the bed on my back. He approached from the right side of the bed, as a physician conducting a proper examination would do. I tried to take some slow, deep breaths to appear relaxed. Unbelievably, my heart began to beat even faster. My body betrayed me as I felt a shiver of anticipation.

"Are you cold?" He murmured gently.

I couldn't speak, just shook my head.

He reached out with his right hand and placed it on my chest. His hands looked strong and capable, but they were gentle and warm as he expertly felt for any abnormal vibrations, or thrills. He applied only light pressure as he palpated my chest, methodically working his way from my upper chest, and down to my sternum. He paused for a moment before placing his palm under my left breast, searching for the apical pulse. I noted that his touch felt very professional as he searched, not sensual in any way. He properly kept me covered beneath the gown as he moved his hand underneath, even as he approached my breast. I could sense his confident manner as his fingers skimmed the surface of my skin in a way that had been thoroughly practiced. Dr Wesley's fingers found the point of maximal impulse, and he applied light, even pressure with his fingers only. I could feel my heartbeat as his fingers pressed against my pulsing ventricle. This time it was my heart that betrayed me, and I felt the familiar early beat, then pause of a premature ventricular contraction. His eyes were on mine as he continued to palpate the apex of my heart and feel the rhythm of it's beat. My heart skipped again.

"How do you feel?" He asked. "Any chest pain or dizziness? Shortness of breath?"

I shook my head again as I answered. "I feel the PVCs but I don't seem to have any other associated symptoms. At least, I never did before."

He nodded, but did not remove his hand from its place over my heart. He looked like he was concentrating or thinking. I saw that his gaze was just past my face, and I realized that he was counting the beats as he calculated my heart rate.

He removed his hand from my breast and reached for the stethoscope around his neck. He placed the earpieces in his ears and reached for the head of the stethoscope. Before he placed it on my chest though, he placed his fingers once again under my left breast to find the apical pulse once again. Once he did, his fingers were replaced by his cold stethoscope headpiece. This time he methodically moved the stethoscope head from bottom to top of my chest, as he listened to the mitral, tricuspid, pulmonic, and aortic valves of my heart. He paused at each valve, listening carefully for murmurs or other abnormal sounds within the normal heartbeat.

I took deep breaths and held my breath when he requested it, wondering what he was hearing that held his attention for so long. I'd never had any heart problems before, besides the premature beats. Finally he was finished, and resumed the rest of the examination, auscultating and palpating my abdomen, and listened to and percussed my lungs.

Dr Wesley turned away as he allowed me to put my shirt back on. I tried to sound light.

"So what's the verdict? Did you solve the mystery?"

The handsome doctor smiled. "Working on it. A little more history first; have you ever had your PVCs investigated, and has anyone ever told you that you had a heart murmur?"

"I have a murmur?" I asked, surprised. "No, no one's ever told me that before. Yes, I have a full workup for my PVCs, including a stress test and 48 hour Holter monitor. My PVCs were found to be benign, isolated premature beats. Mostly PVCs, a few PACs, one couplet." I shrugged.

Dr Wesley seemed impressed. "You seem pretty well informed. How long ago were those tests?"

"About a year ago," I said, recalling.

"Well, you do have a murmur, albeit a soft one. It may be nothing, but an echo would rule that out." Dr Wesley crossed his arms and rubbed at his chin thoughtfully. "Have you ever had an echocardiogram before?"

"No, but I'm familiar with the test."

"Good. Do you have a family physician?" asked Nathan Wesley.

"I don't," I admitted, "I'm not from here, I just came here for school."

"Well we can take care of the echo here at the hospital. Do you have a hospital card?" Dr Wesley already had the examination room door open. I withdrew it from my wallet and handed it to the young doctor; he took it smoothly and strolled from the room. "I'll take care of the paperwork," he said as he left. "Don't go anywhere, yet."

I was still sitting on the examination table, feeling unsteady, but this time for different reasons. A lot had happened in the space of a few minutes. Fainting spells. A heart murmur. A gorgeous, young resident. Those emerald green eyes. I took a deep breath and sighed.

"Get a grip," I thought to myself. "He's not interested in a medical student." I listened carefully for footfalls, any sign of his return. He didn't keep me waiting long. I admired his smooth, athletic walk as he strolled back into the room.

He handed me a sheet of paper. "All set," he declared, and smiled. I couldn't help but smile back. "Are you okay to head back to the library, or do you think you might have another episode?" He asked, his attractive face slightly tilted to the side.

"I think I can manage," I replied. I shifted my hands to the bed and began to scoot myself off the table.

"Just a moment." I froze in response to the voice I had already memorized, and Dr Wesley suddenly stepped directly in front of me. He placed both of his hands on my shoulders. "Alright, go ahead."

I resumed my previous motion safely enveloped in the hands of my savior, and dropped myself to the floor. I waited a moment, but my vision and equilibrium seemed to be fine.

Dr Wesley's hands deftly moved from my shoulders to my chin. He cupped my face and gazed deeply into my eyes. His hands were soft and warm. "Any dizziness?" He asked.

His face was centimeters from mine. I blinked twice. "No," I breathed.

Nathan gently released my face. I thought I felt one of his fingers linger a bit longer as if tracing along my jaw.

"Be careful on your way back. Try not to get up or bend over too quickly. That seems to trigger your episodes. If you have another one, you can come back and see me. Page me if you need anything; my pager number is on the paper." Dr Wesley seemed to have snapped back into his former role.

I nodded, a little dazed, and left the room.

I felt awkward as I walked down the hall, as if I could feel his eyes following me as I walked down the hall. I didn't have it in me to turn around and look. I felt my arms swinging with my steps, but it felt wrong, awkward and off-balance. As I rounded the corner I tried to look for him with my peripheral vision, but did not catch any human movement or presence. Silly. Why would he be looking?

I was nothing to look at. I was a lowly medical student and he was a senior resident. He was gorgeous, young, and muscular. I was fairly young, perhaps even the same age as him, but I was older than the average first-year medical student. I'd had a long road getting into medical school, and a difficult one at that. The cards had been against me in many ways and for many reasons, and I had matriculated several years after finishing my undergraduate degree.

By the time I reached the library, I had come to the conclusion that I would avoid Dr Wesley at all costs. Not only did I make a fool of myself in front of a senior resident, but I had nearly fainted in the arms of one of the most attractive potential-people-I might-work-with-one-day. How embarrassing. I groaned to myself in disgust as I thought of this and walked over to my table. My books were still there. I threw the paper to the bottom of my bag, packed up my textbooks, and headed back to my apartment.