Текст книги "Dude, Where's my Stethoscope?"
Автор книги: Donovan Gray
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Текущая страница: 7 (всего у книги 14 страниц)
I’d like to pull a John Wayne and say that the apparent oversight didn’t bother me, but it did. I kept thinking: “All those years I worked so hard at trying to keep him healthy and the florist gets thanked? Now there’s gratitude for you.” I grumbled about it all evening. I was still muttering to myself that night as I fell asleep.
When I got to my office the next morning there was a beautiful gift basket waiting for me on my desk. The card attached to it read: “Thank you for your wonderful care of Dad over the years. From the Anderson family.”
I felt like a jerk.
Every Breath You Take
Molly was a slightly anxious 40-year-old woman whom I had seen in my office a few times for minor health issues. One morning she presented to the ER intensely short of breath. Her oxygen saturation was only 70 percent and her chest was full of crackles. It took a high-flow oxygen delivery mask to bring her sats back up into the normal range. A chest x-ray was done to help rule out congestive heart failure and pneumonia. To my surprise, it showed extensive scar tissue consistent with a diagnosis of severe pulmonary fibrosis. I admitted her for further investigation.
Pulmonary fibrosis is usually an insidious process. Over the next few days I searched for a reason for her abrupt decompensation. No cause was found. Despite quitting her five-cigarette-a-day smoking habit, she wasn’t able to maintain her sats above 90 percent without supplemental oxygen. Arrangements were made for her to have home oxygen as well as an urgent consultation with the nearest available lung specialist. When everything was in place, I discharged her from hospital.
Over the next several months Molly made a number of trips to the respirologist. A lung biopsy revealed progressive pulmonary fibrosis of unknown origin, so she was started on high-dose corticosteroids.
Although she was a pleasant person, Molly had always been a loner who pretty much kept to herself. She was single and had no living relatives. As her shortness of breath worsened, so too did her anxiety. With nowhere else to turn, my office gradually became her main source of support.
The steroids failed to halt the progression of her disease, so immunosuppressants were initiated. When it became obvious that they, too, weren’t helping, she was referred further south to a transplant unit in Toronto. The team there reviewed her case carefully and concluded she was a good candidate for their program. There was only one catch – she would have to move to Toronto. This was not an unreasonable request. Due to the logistics involved in harvesting and transplanting lungs, patients on the waiting list must be able to get to the surgical centre on short notice. Our town was 800 kilometres away from Toronto.
The idea of moving petrified Molly. She agonized over the decision for a long time, but in the end she opted to go. She had no choice, really – to remain at home in our isolated town would have meant certain death.
Packing up and moving to Toronto when you can hardly breathe is no easy feat. It’s even more difficult when you have limited savings and no family. True to the spirit of the North, our town came through for Molly. After a lot of searching, a suitable place for her to stay in Toronto was found. A community member whom she barely even knew volunteered to go live with her and provide general assistance. In addition to that, a local service club held a fundraiser to help offset her mounting expenses. Eventually everything was organized and a departure date was set.
A couple of weeks before she was scheduled to leave, Molly came in for an office appointment. Her shortness of breath had worsened and she was feeling overwhelmed. She asked if I could admit her to our hospital until she left for Toronto. I called the medical ward and let them know she’d be coming in.
A fresh battery of tests failed to turn up any new problems. Even so, I didn’t think she was well enough to handle a commercial flight. I spoke to the transplant team and they agreed to a direct hospital-to-hospital transfer by jet in one week.
For the next six days I made a point of dropping in and chatting with her for as long as time permitted. If there was no longer anything medical I could do for her, at least I could listen.
At 5:30 on the evening before the transfer a nurse on the medical floor called me at my office to say Molly wanted to speak to me. Apparently she needed to tell me something important. It had been a long day and I was tired. I had already spent 15 minutes with her during my lunch break and I just didn’t feel like doing it again. I asked the nurse to tell her I’d see her first thing in the morning before the jet arrived.
Molly died in her sleep at 6:00 a.m. on the morning of her scheduled transfer.
Sometimes at night I lie in bed and wonder what it was she wanted to tell me.
Thank You
It’s hard to figure out where the expression “thank you” fits into the practice of modern medicine. Are people obliged to thank me when I help them? Of course not. Would it be nice? Why, yes, it would. Most people do say thanks when I help lighten their load, but a surprising number do not. When I stay up all night struggling to keep a family’s loved one alive, I obviously don’t expect any sort of material reward, but I don’t think it’s unreasonable to expect a thank-you.
Now, I know what you’re thinking: “But Slim, it’s not like you’re treating these people purely out of the goodness of your heart! You’re well-paid by the Ministry of Health to provide these services!”
Yes, I know that. However, I say thanks when the operator puts my call through. I say thank-you whenever the guy at the service station fills my car’s tank with gas. I say thanks every morning when the woman at Tim Hortons hands me my bagel and coffee. Should it not therefore be reasonable for me to expect a simple thank-you for treating someone’s hemorrhoid, headache or heart attack?
One Sunday afternoon I was paged to the ER stat. I raced into the major treatment room to find a screaming 20-month-old boy with multiple second-degree burns all over his body. An older sibling had accidently knocked a kettle off the stove and doused him with boiling water. Large blisters were welling up everywhere and he was in acute distress. He needed immediate fluid resuscitation and pain relief. Unfortunately, he was an unusually chubby little fellow and there were no accessible veins in sight.
A few weeks earlier I had attended a pediatric trauma course and learned about a relatively new way to access the circulatory system of a child. It was called an intraosseous infusion. The technique involves drilling a large bore needle through the shinbone and into the marrow beneath it. Fluids and medications can then be administered directly into the bone marrow. From there they enter the bloodstream. As soon as I got back from the course I ordered some intraosseous kits for our ER. I figured they might come in handy someday.
Several attempts at starting a regular IV were unsuccessful, so I asked one of the ER nurses to open an intraosseous kit. The device consisted of a sharp, hollow, inch-long needle attached to a round, plastic handle. I explained the procedure to the boy’s mother. She gave her consent and went outside to wait until we were finished. The nurse immobilized the child for me. While I injected local anaesthetic into his upper shin, I reviewed the procedure in my mind. In the course I had taken we had practised inserting intraosseous needles into inert chicken bones, but this was the real deal – a shrieking, writhing toddler. I pushed the needle firmly into his tibia. When it was solidly embedded I began to twist it in deeper by rotating my wrist from side to side. I could feel the metal grinding its way through the bone. It was a strikingly unpleasant sensation.
Eventually the needle punched through to the marrow. After confirming proper placement we attached it to an IV bag and began infusing morphine and fluids.
As his condition stabilized we inserted catheters and applied dressings to his wounds. I contacted a burn specialist at a pediatric hospital in southern Ontario and had him flown down for definitive care.
Over the next several days we followed his progress via a number of sources, both direct and indirect. By all accounts he was doing well and was expected to have a satisfactory recovery. We were especially proud to hear the pediatric burn unit had been impressed with the quality of care he had received at our facility. We patted ourselves on the back for a job well done.
The only thing that bothered me slightly about the case was that the mother hadn’t thanked me for looking after her child in the ER.
“ But Slim, she had other things on her mind! Her son had just been badly burned!”
Yeah, I know. I was there, remember? Although I realize it sounds petty of me to even mention it, I still think a brief thank-you would have been nice. Oh, well. Life goes on.
Exactly one week later I was out in my front yard raking. My daughters were having fun running around and jumping into the piles of leaves. Suddenly an unfamiliar truck pulled up to the curb in front of our house. A man jumped out and strode purposefully across our lawn directly towards me. My kids stopped playing and eyed the stranger cautiously.
“Are you Dr. Gray?”
“Yes.”
“I’m Mr. Farquhar. You looked after my son Peyton last weekend when he got burned.”
I thought, "Oh, that's who he is! He's dropped by to say thank-you in person! Wow, isn't that considerate?"
He reached into his jacket pocket and pulled out a wad of forms.
“I need these completed ASAP so we can get our travel expenses paid. Can you do them right now?”
I was dumbfounded.
I was enraged.
I was hurt.
“If you drop those off at my office tomorrow morning, I’ll see to it they get filled out,” I said quietly.
“Sounds good.”
He turned around, marched back to his truck and drove off.
Snap!
Last Friday I was on call. During the day the emergency department was hopping. I zipped home at 7:00 p.m. for a quick bite to eat and a 30-minute power nap. At 8:00 I returned to see the evening crop of outpatients. I worked until 11:00 and then charted in Medical Records until midnight. When the paperwork was completed I dropped by the ER to make sure the coast was clear. A pink Post-It note was stuck to my knapsack. Those are never good. This one's raison d'être was to advise me that a patient named Mr. Yorke on unit 4 was short of breath and having a rapid pulse. Geez, how come no one paged me about this? I went over to the ward to investigate. As it turned out, Mr. Yorke was one hot mess and I ended up having to work on him for a couple of hours.
At 6:00 a.m. I was summoned back to the ER to stitch up yet another drunken Jethro. This particular genius had taken a swan dive onto a flotilla of empty beer bottles that had spontaneously assembled on his kitchen floor. By the time I finished with him there was hardly any point in trying to go back to sleep, so I raided the fridge on unit 4 and ate a couple of mystery-meat sandwiches at the desk. At 8:00 I started my ward rounds. I figured if I got rounds out of the way early I’d be able to enjoy the rest of the day with my family. Of the eight acute and chronic care patients I visited, Mr. Yorke was still the sickest. Our stockroom was fresh out of bags of IV Miracle, so I had to spend another hour or so getting him squared away. By 10:00 I was finished. Freedom! A sunny Saturday and no more work to do!
When I got home I asked my daughters if they wanted to ride their bikes to the park with me. It was looking like the perfect day to fly our new kites. Their answer was a resounding “Yes!” I went upstairs to get ready. Halfway through my shower the phone rang.
“Hello?”
“Hi Dr. Gray. We need a clarification on your order for Mr. Yorke’s potassium pills.”
After sorting that out I finished getting ready, rounded up the kids and herded them out the front door.
It’s not easy riding 15 blocks with a trio of girls ages five, six and seven. I was right in the middle of negotiating a busy intersection when my cell phone started ringing. I shouldered off my backpack and rummaged through its contents until I found it.
“Hello?”
“Dr. Gray, Mr. Yorke is refusing to take his potassium pills.”
Suddenly something snapped. A severely unhinged stranger who sounded a whole lot like me started caterwauling: “I don’t care! I’m not on call anymore! I did my call day yesterday! Get whoever’s on call today to deal with this crap!”
My kids goggled at me, their mouths hanging open. Passers-by edged away nervously. Small-town family medicine. What’s not to like?
Tough Call
One Friday night an elderly patient of mine presented to our emergency department with atypical chest pain. Her EKG had been chronically abnormal ever since a heart attack a few years prior, so it was difficult for the on-call physician to determine whether or not she was experiencing an acute coronary event. He increased her anti-anginal medications and watched her closely. After a period of observation in the ER she was admitted to the medical ward for further monitoring.
When I saw her during my daily inpatient rounds on Saturday morning she was surrounded by a phalanx of concerned family members. Despite the med adjustments, she was still experiencing intermittent low-grade chest discomfort. Her EKGs hadn’t changed and her cardiac enzymes were normal. I wanted advice as to how best to proceed with her, so I put in a call to our closest cardiac referral centre.
As luck would have it, my favourite cardiologist was on call. We have a very amicable working relationship, in part because I usually screen my referrals well. Most of the patients I send him ultimately prove to have significant coronary artery pathology. After I went over the details of the case with him he gave me two options: I could continue to manage the patient in our community and send her to his office in a couple of weeks for further workup, or if I was really worried about her I could transfer her to his coronary care unit via air ambulance immediately. It was a generous offer, particularly since her vital signs were rock-solid.
Deep down I knew I could probably soldier on with her a while longer, but my energy levels were low that morning and the thought of trying to unravel yet another medical mystery on what was supposed to be my day off was decidedly unappealing. I was still in the process of figuring out what to do when several of her relatives rushed to the desk to report she was having more chest pain. That did it. I told the cardiologist I’d make arrangements to have her flown down for admission to the CCU.
A week later she dropped in to see me at my office. “They didn’t think it was my heart,” she said. “In fact, they discharged me the next day. The cardiologist wants me to have a stress test in a few weeks.” I felt a sharp pang of guilt. Not only had I dumped on a colleague, I’d wasted already sparse health care resources by ordering an unnecessary air ambulance transfer. That week her discharge summary from the CCU arrived in the mail. The dictated note was polite, but reading between the lines I could tell the cardiologist was disappointed I had fast-tracked such a non-urgent case.
Three weeks later she had her stress test and passed it with flying colours. I promised myself I’d never bail out like a nervous rookie again. Nobody likes a sieve.
A month later I came in to do rounds on a Sunday morning and discovered a patient of mine had been admitted during the night with a diagnosis of pulmonary edema. Judging from the chart notes Mr. Trapper’s course in the ER had been fairly rocky, but things had settled down nicely since his transfer to the ward.
Mr. Trapper was an elderly bachelor with diabetes. He was a cheerful man who liked to crack jokes. When I went to see him he said he was feeling about 75 percent better. On examination, he still had signs of some fluid on his lungs. His EKG showed non-specific changes, and his cardiac enzymes were normal.
As I wrote out his new diet and medication orders I toyed with the idea of calling to request a transfer to the CCU. Although my patient had improved considerably, flash pulmonary edema can sometimes be associated with critical narrowing of a major coronary artery. In addition to that, diabetics are at higher risk for silent ischemia. Don’t be such a wimp, I told myself. Look what happened the last time you jumped the gun and flew someone out prematurely. Do you want them to think you’ve turned into Chicken Little? I decided to continue managing him at our facility for the time being.
By his fourth day in hospital Mr. Trapper was back to normal. A referral letter requesting outpatient investigations was faxed to the cardiologist. I wrote a prescription for his new medications and arranged for him to see me in my office the following week.
Before he went home I reminded him to call me or return to the hospital if he experienced any further difficulties. He thanked me, packed his belongings into a battered canvas suitcase, and departed.
Mr. Trapper had a massive heart attack and died alone in his cabin a few days later.
So Sue Me
A few years ago I was getting ready to start a shift in the ER when a Code Blue was broadcast on the overhead PA system. I sprinted over to the medical floor. When I got there, a wide-eyed ward clerk pointed mutely at one of the patient rooms. Inside I found three nurses frantically trying to revive an unconscious nine-year-old boy.
Before I had time to ask what had happened, he stopped breathing. I snatched a pediatric ET tube off the crash cart and intubated him. With ventilation his oxygen sats quickly returned to normal. His pulse and blood pressure held steady, so no chest compressions were required. Within minutes most of my colleagues were at the bedside. Together we formulated a differential diagnosis for the respiratory arrest, initiated a course of therapy and contacted a tertiary care centre. A few hours later he was en route to a pediatric ICU via air ambulance.
To our dismay he went into shock and died a few days later. The news decimated us. A pall hung over our hospital for weeks.
I don’t often attend patient funerals, but I felt an overwhelming need to go to his. Not surprisingly, the church was packed. The air was so thick with grief it was hard to breathe. I usually have a firm grip on my emotions, but when the deceased child’s classmates joined hands and formed a circle around his coffin, I cried.
A few months later I was doing some charting at a workstation in the ER when a briefcase-toting stranger sidled up to me.
“Are you Dr. Gray?” he inquired.
“Yes, I am. How can I help you?”
He fished a manila envelope out of his bag and handed it to me. “This is for you.”
“What is it?”
“Notification.”
“Of what?”
“You’re being sued for malpractice.” He flashed me a jagged smile, turned spryly on his heel and left the department. Talk about schadenfreude.
I opened the envelope. Sure enough, it was a lawyer’s letter stating the parents of the deceased child were suing two colleagues and me. Having never been sued before, I was stunned. I contacted my legal representative immediately. After carefully analyzing the case, my attorney came to the conclusion I had been included in the lawsuit solely because my name had been recorded in the boy’s chart. The fact that the only reason it was there was because I had voluntarily responded to the Code Blue and helped with the resuscitation didn’t seem to matter. Apparently, malpractice lawyers like to cast a wide net in order to improve the odds of ensnaring someone. I was advised there was a fair chance I’d eventually be “cut” from the case. There was only one catch – it would take at least a year.
The first six months were sheer misery. My appetite vanished and I lost weight. I couldn’t concentrate properly and I developed gruelling insomnia. I reviewed the case in my mind so many times it must have worn a permanent groove into my brain. I could understand the existence of the lawsuit, but why me? What would my family and friends think? What effect would it have on my career? I cycled endlessly between fear and indignation. Sometimes apathy would set in, leaving me feeling hollow and indifferent. I became moody and irritable. Even my kids noticed the change in my behaviour.
In time, the obsessive rumination settled. I started being able to go longer intervals without thinking about the lawsuit. My appetite and sleep improved, and my interest in hobbies slowly began to return. A new steady state was evolving.
Approximately 18 months after my initial notification I received a letter from my attorney stating I had been dropped from the case. No one on the opposing side bothered to apologize for needlessly putting me through hell for a year and a half. I guess my feelings weren’t very high on anyone’s priority list.
A month later one of the parents of the deceased child telephoned me at my office.
“Dr. Gray?”
“Yes?”
“Can I transfer my family to your medical practice?”
“ What?”
“We’d like to switch doctors. Can we start seeing you?”
“I don’t think that would be such a good idea.”
“Why not?”
“Because you just tried to sue me! You ruined a year of my life!”
“Oh. Okay.”
Oddly enough, they called back two weeks later with the exact same request. My answer didn’t change.
Earlier this week I was working in the emergency department when we got word a child who had just undergone surgery was having a malignant hyperthermia crisis. As I ran to the OR to assist our anaesthetist, an unexpected thought popped into my head: For God’s sake, don’t go in there! If there’s a bad outcome, you’ll get sued! I still went, of course.
How can things have been allowed to deteriorate to the point where a qualified physician with training, skills and experience is tempted to not get involved when help is needed?
3:00 a.m.
Most people rarely witness 3:00 a.m., but I see it all the time. I’m a rural physician, so my schedule is frequently out of synch with the rest of society. Due to the small size of our town, it’s not unusual for my car to be the only vehicle on the road when I leave the hospital in the dead of night. Driving home alone across a frozen landscape at 3:00 a.m. can be depressing. The complete absence of traffic fuses with the darkness, the drifting snow and my fatigue to create a crushing sense of isolation. Sometimes I feel like I’m the last living person on the planet.
I park in our garage and lug my gear inside. As always, I am struck by how silent the house is at this hour. I hang up my coat and make my way to the kitchen. The supper I missed earlier is waiting for me in the fridge, but it’s far too late for me to have a full meal now. In the end I settle for a bowl of cereal. While I eat, I try to read the newspaper. Tonight the stories seem wispy and insubstantial, as if the events described all occurred in a distant universe. I toss the paper into the recycling bin and retreat to the living room. The curtains are open. An arabesque of silver ice crystals garnishes the edges of the picture window. I sit on the piano bench and watch the moonlit snow swirl across our yard.
Eventually I head upstairs. Partway down the hall I stop to check on our daughters. They look so innocent asleep in their beds with their limbs akimbo and their stuffed animals scattered everywhere. After retrieving the cast-off blankets, pillows and toys, I tuck the girls in and give them each a kiss on the forehead. The youngest stirs and awakens. “I love you, Daddy,” she murmurs. She hugs me, rolls over and returns to her dreamworld.
It’s good to be home.
Carpool Conundrum
Every Monday evening I sit in the subarctic bleachers of our local arena and watch two of my daughters figure skate. Their lesson runs from 6:00 until 7:00. About 10 minutes before the session ends I slip out of the building and drive halfway across town to pick up my third daughter at Beavers. Beavers also finishes at 7:00, which makes retrieving all three of them on time pretty much impossible.
If Beavers happens to wrap up early I try to swoop in, collar Kristen and race back to the arena before Ellen and Alanna get off the ice. Unfortunately, Beavers has a tendency to run late. Even when it does end on time, most nights Kristen doesn’t want to leave right away because she’s busy touching up her craft du jour. As a result, we usually wind up getting back to the arena several minutes after 7:00. Ellen and Alanna don’t like it when I’m late, but they try not to complain about it too much because they understand there’s no way I can be in two places at the same time. Jan can’t bail me out of this weekly predicament, either – she directs the town’s community choir every Monday, and as luck would have it, their practices begin at 7:00 p.m. sharp.
One Monday last October I was waiting impatiently for Kristen to finish off her Beavers’ Halloween project.
“Come on Kris, we have to go,” I said in that voice parents use when we’re trying to urge our children to get moving and they’re dawdling along as though they have all the time in the world.
“I just need a couple of minutes, Daddy,” she pleaded. I checked my watch: 6:59. The zamboni will be rolling out any second now. Sigh… .
When Kristen was finally finished, she held up her freshly minted Play-Doh sculpture for my scholarly opinion.
“Hey, that looks great, Kris! Ready to go?”
“Okey-dokey.”
I helped her gather her belongings. We were just about to make like Elvis and leave the building when I heard an unfamiliar voice call my name. I turned around. A complete stranger was surging across the room towards us. A tiny waif of a girl with pixie-like features trailed in her wake. She looked to be about five years old.
“Hi, I’m Martha!” the woman trumpeted. “We just moved into the house at the end of your street, and our daughter Frieda joined Beavers tonight. My husband drives transport and he’s out of town every other Monday. Our car is going to be in the garage for the next few weeks. Would you be able take Frieda to Beavers every second week until we get it back?”
I wasn’t sure what to say. Jan usually used my little two-seater sports car to drop Kristen off at Beavers at 6:00 while I took Ellen and Alanna to the arena in the minivan. If I agreed to pick up Frieda then I’d have to transport all four of the children in the van, which would mean I’d need to leave the house earlier and do a double drop-off. As if life wasn’t complicated enough already! On the other hand, if I said no I’d look like a selfish arschloch. Even if I explained the complexities of our Monday evening schedule to her she’d probably just think I was manufacturing lame excuses. Frieda looked up at me expectantly.
“Sure, that’s okay,” I said.
“Are you certain it won’t be a bother?”
“No bother at all. Will she need a ride next week?”
“Yes, thanks.”
“All right, we’ll see you next Monday, then.”
It’s a bit of a pain, but picking up an extra kid every second week for a month or so isn’t going to kill me, right?
A week passed and it was Monday evening again. I had assumed Martha would escort her daughter to our house, but when there was no sign of Frieda at 5:50 I dispatched Kristen to go get her. A few minutes later she returned with the wee bairn in tow. Frieda promptly handed me the plastic grocery bag she was carrying.
“My mommy says for you to give this to the ladies at Beavers.”
“What’s in it?” I asked.
“A list of things I’m allergic to.”
“Oh.”
“And my EpiPen.”
“Okay.” Whatever. I ushered the foursome into the van. When they were all settled in I began backing out of the driveway.
“Excuse me?” came a tiny voice from one of the seats behind me.
“Yes, Frieda?”
“I can’t do up my seatbelt.” I stopped, twisted around, and buckled her in. “Thank you,” she said. Very polite, our Frieda.
As we headed to the arena to drop off the skaters, Ellen initiated a conversation with our new ward.
“Hi, my name’s Ellen. I’m eight. How old are you?”
“Almost six.”
“I’m in grade three. What grade are you in?”
“I don’t know.”
“What?”
“I don’t know.”
“How come you don’t know what grade you’re in?” Ellen asked, puzzled.
“I don’t go to school. My Mommy teaches my brother and me at home.”
“Why?”
“She’s afraid if we go to school we’ll get beat up.”
“Oh.”
After the stop at the arena I took Kristen and Frieda to the Scout hall. Kristen and I exited via the van’s front doors and waited outside for Frieda. She didn’t get out. I reopened my door and stuck my head in to see what the problem was.
“Excuse me?”
“Yes, Frieda?”
“I can’t unbuckle my seatbelt.” I leaned over and extricated her. “I can’t open my door, either.” I did the honours. When we entered the hall I delivered Frieda’s lengthy allergy scroll and her EpiPen to troop leaders Bubbles and Rainbow. I thought they took it pretty well, considering the fact that they’re volunteers, not the staff of a pediatric ER. They did have one question for me, though: “Did Frieda’s mother sign the consent form we sent home last week?”
“What consent form?”
“The one giving the children permission to sing at the nursing home next Monday. See?” She pulled one out of Kristen’s coat pocket. Jan had signed it. “If she forgets to send it in, Frieda won’t be able to go.”
“I’ll let her know when I see her later.”
After Beavers and skating ended I chauffeured the girls home. When we got to Frieda's house I unbuckled her seatbelt, opened her door and walked her to the front porch. Several knocks later, her mother appeared.
“When you take Frieda next week, don’t forget to bring her permission slip for singing at the nursing home,” I reminded her.
“Would you mind taking her next week? My husband’s going to be out of town again.”
“Okay.”
After I drove Frieda home the next week she said, “Thank you,” and then quickly added: “My mom said to ask you if I’d be able to get a ride again next Monday.”
