1 Appointment

October 8, 2007, Athena is on the phone trying to set up an appointment. She woke up this morning feeling tired, body sore all over, and blood on her pillow.

"That is correct. My date of birth is May 22, 1986. The last name is Roland. Yep, that is me. What is the earliest available date for Dr. Perkins? On October 18? What is the earliest time slot? I will take it. Thank you."

Athena hangs up the phone and sends a text to Carson.

Text too Carson: "Hey. I have an appointment set for October 18 at 10:00 am. If you are not in class, you are welcome to join me, have a nice day Car."

Carson responds to Athena's text message after his study group lets out.

Text to Athena: "Thank you for giving me the date and time. I will make room in my calendar to be with you at your appointment. Take care At."

October 18, Athena is in the waiting room at Perkins, Everett, and Stan Family Health Clinic. Carson will run a little late, which does not bother Athena.

"May I have Ms. Roland come to the back please?"

"Sure, I am on my way." (Athena is feeling a bit nervous and takes a few deep breaths to calm her nerves. She turns towards the front desk worker and starts talking).

"Oh, an individual by the name of Carson should be coming any minute. When he arrives, will you send him to the back please?"

"I will do my best Miss."

"Thank you."

Carson arrives five minutes after Athena goes into the exam room.

"You must be Carson. Head to room 101B."

"Thank you."

Knock, knock.

"Come on in Carson."

"Sorry I am late. (Carson kisses Athena on the cheek). Have I missed anything?"

"Nope, I am still waiting for Dr. Perkins to get here. She has another patient and running behind."

Knock, knock.

"Come in."

"Sorry for running late Athena, let me pull up your chart and we can get started. Who are you, young man?"

"Carson. Athena's fiancé."

Athena has been seeing Dr. Perkins for four years. They have a solid relationship in terms of health management. Learning about Athena's recent engagement piques Dr. Perkins' interest.

"How did you two meet? And when were you officially engaged?"

"Dr. Perkins, Carson, and I met in eighth-grade...and he grew a pair and popped the question last week. Is not that right Carson?"

"You're too much at times Athena. That is why I decided to marry you."

"What brings you in today Athena?"

"I have been experiencing extreme fatigue, random nose bleeds and bruising. And I was taken to the emergency room last week due to a fainting incident."

"She did not concuss her head or anything during the fainting spell."

"Are you experiencing blurred vision?"

"No ma'am."

"Any changes in your diet, weight, or physical activity?"

"I have been running two to three times a week, and crossing training. One of my classmates and I are running the Seattle Marathon."

"Congratulations."

"Thank you."

"When did you start noticing your symptoms? And you mentioned something about bruising earlier."

"The fatigue started in June during summer classes, and before I started marathon training. It was nothing unusual...lack of sleep and studying. Then I noticed the fatigue grew progressively worse over the last few months. It became more intense as if my body wanted to rest for no reason at all. I have started getting more sleep, but it does not help."

"What about the bruising?"

"Yes, last week I dropped a can of flour on the floor and it hit my foot. The can itself was not too full and hardly grazed my skin. And this morning I woke up with this."

Athena raises her shirt and reveals a bruise on her left hip. The bruise starts under my rib cage and ends below the left pubic bone.

"I must have run into something...but I have not experienced bruising of this sort before. My body also hurts when I wake up in the mornings."

Dr. Perkins is typing notes into her computer and looking over Athena's blood work from Swedish Medical Center. She is comparing the labs from Swedish Medical to labs Athena has had drawn over the years.

"Looking over your lab work, there is an elevation in your white blood cell count and a slight decline in your red blood cell count. You have lost weight since last we met: but, I am attributing the weight loss to changes in physical activity."

'When you say I have an elevated white blood cell count and a decline in red blood cell count..."

"You have enough red blood cells for a diagnosis of mild anemia. And your elevated white blood cell counts suggest your body is fighting something. I don't know what your body is fighting, but I would like to run some tests. Have you eaten anything in the last 24 hours?"

"What type of tests would you like to run and why? No, I fasted."

"I would like to draw more blood: get a complete blood count, A1C Test, Fasting Glucose, and a bone marrow test. I want to rule out the possibility of cancer, diabetes, and anemia. Based on what you are describing to me, your body bruises easily and you have general weakness. Your symptoms don't align with your overall health, and lifestyle choices."

Dr. Perkins performs a general physical on Athena, places an order for labs, and schedules a follow-up appointment with Athena for next week. Two hours have passed, and Dr. Perkins gives Carson and Athena some privacy.

"Talk with me At. You are making a concerned face again."

"There is a lot of information to digest. And I don't know how to process it all. We will have to wait and see what happens Carson."

October 26th, 2007: Dr. June receives Athena's message and calls her back. The phone call goes straight to Athena's voice message box.

"Hello Athena, this is Dr. June returning your call. I have a few open appointments for this week and next. Please call my office at your earliest convince."

Athena is caught in the middle of rotation at Seattle Children's Hospital and unable to take Dr. June's call. It is a really stressful day for Athena and she has not eaten anything. Her stomach is not able to handle solid food anyway.

"I swear to goodness. All heck must have broken loose today because it feels like I am losing my mind!"

"Athena, go to room 101-B and draw some blood from the patient. Meet me by the nurses' station when you are done."

"Copy that Nurse Frank."

Nurse Frank is Athena's preceptor.

"Ok, I get that I have not eaten and the stress is high, but it should not be this easy for me to get out of breath."

By the time Athena has drawn the blood work in Room 101-B, sent the blood to pathology, and returned to the nursing station, she has to sit down. It is clear her health is not in tip-top shape. Nurse Frank takes notice.

"Athena, you look pale and weak. Are you able to continue with today's rotation?"

"Yes, Nurse Frank. I will be alright."

Athena goes to stand up and falls back down into the chair.

"You are not well enough. Please clock out for the day and come back tomorrow. I will write up a note for your professor explaining what happened."

"But I am...."

"This is not a suggestion Athena, go home and rest."

Athena feels defeated, furious, and sad. She keeps a poker face on as she clocks out. Once she is outside the hospital, she takes out her phone and texts Carson.

The Text: "Hi Carson. I am out of rotation early today due to my health. Feeling upset and want to cry. Going for a walk and calling Dr. June back. Love you."

"Fine Nurse Frank, if you feel I am not well enough to keep going today...I hope Dr. June picks up."

Athena dials the number for Dr. June's office, after the third ring, someone picks up.

"Swedish Medical Center Oncology department office of Dr. June, Dr. Evans, and Dr. Sprout. How may we direct your call?"

"Yes, I would like to speak with Dr. June."

"What is the nature of your call?"

"Trying to get an appointment. I had called the office yesterday and Dr. June left a message for me this morning."

"Let me see here...I am going to place you on a brief hold. Is that alright?"

"Yes. I will hold."

"Thank you."

Athena is growing impatient and has started pacing back and forth. She checks her phone and sees a text from Carson.

"Athena. Let me know when you have made an appointment with Dr. June. Going to be studying late tonight."

Athena does not have time to respond to Carson since the individual on the other end picks the conversation back up.

"Hi, thank you so much for waiting. What did you say your name was?"

"Athena Roland."

"Thank you, Ms. Roland. It looks like Dr. June does not have any appointment slots until February 2008. Would you like me to schedule..."

"What do you mean Dr. June does not have any time slots until February? She left me a message saying she had availability for this week and next! This is an urgent matter that can't wait. And I was referred to her by someone else."

"Let me transfer you to her direct line. Please hold."

At this point, Athena has lost her patience and tries to calm down. After ten minutes of being on hold...

"Hello, is this Athena Roland?"

"Yes. Who am I talking to?"

"This is Dr. June. How are you doing today?"

"I have been better."

"I understand where you are coming from, I assume you got my message?"

"Correct. What is the earliest date and time you have for this week? My symptoms are getting worse and I want answers to whatever is happening with my body!"

"I can fit you in tomorrow at 11:00 am. Will that work?"

"Yes. 11:00 am tomorrow will work. What should I bring to my appointment?"

"Nothing special. Your insurance card, any questions you may have, and someone for support. I will see you tomorrow Ms. Roland."