(Hint: For maximum enjoyment be sure to read Parts 1-3 first.)

It should have been a good weekend. Cudworth was still away and Yakov and I were on the surgical trauma team covering the emergency room. It should have been exciting with lots of work and lots of chances to learn. Not so much.

By Saturday afternoon we had still had no calls and it was starting to get tense. Yakov was sitting and staring out the window at the empty ambulance bays. A mangled pen hung from his lips, another victim of the hospital’s no smoking policy. He grunted and threw the pen in the garbage. “Is quiet.”

“Too quiet?” I offered.

“Yes, that is thing. Too quiet.”

“Well, there’s nothing to do about it. It’s not like we can go out and cause accidents.”

Yakov snapped to attention and twisted to peer at me through narrowed eyes. He held the pose for a moment before grimacing and slumping back in his chair. “Nyet, we cannot do. Would be taking too much time.”

“Huh?”

Yakov waved a hand in the air and lurched to his feet. He leaned against the window, trying hard to see around the corner. No flashing lights. He screwed his eyes shut and tilted his head. No sirens. He grunted again and frowned.

If there was one thing I had learned, it was that a bored Yakov was a dangerous Yakov. I had to do something. “We could do ward rounds.”

The dull film covering Yakov’s eyes slowly lifted. A glimmer of hope. He smiled. “Yes. We go ward. Someone need spinal tap.” His smile broadened. “Maybe chest tube.”

That wasn’t what I had meant but it was too late. He was already halfway to the stairwell before I could get to my feet. I had no choice but to follow.

The surgical ward nurses liked Yakov but they didn’t really trust him. Oh, they trusted his surgical skills. They trusted him to take care of the patients and considered him an excellent surgeon. In fact, more than a few had confided that if they ever needed something done they wanted Yakov to be the one holding the scalpel. It was just that he when he was on the ward he tended to make work for them. No matter what he did he always made a mess. And his skill set did not extend to cleaning it up.

“Greetings nurses, here I am being.” Yakow stood in front of the nursing desk and waiting for his proclamation to bear fruit. The ward clerk and one of the nurses stared at him in silence. They looked at each other and shrugged before turning back to Yacov. He grinned and spread his hands. “Something you have for me to do?”

“Uh, well—that is—we didn’t actually call you.”

“Is okay. I am here now.”

“Uh, all right. I’ll get the charge nurse.”

The nurse hurried into the staff room and I could overhear her as she pleaded with the charge nurse to solve the dilemma. Yakov had wandered over to a supply cart and began pawing through the instruments. He was gazing lovingly at a rigid sigmoidoscope when the head nurse approached.

“Everything is actually pretty quiet, doctor,” she said.

“Is some problem somewhere.” Yakov cradled the sigmoidoscope in one arm and pulled out a suture set with other. “I am sure.”

The head nurse’s face went pale as Yakov began exploring the orthopaedic trays. She had to do something. Grabbing Yakov’s arm she began to pull him away from the cart. “There is something. Mr. Burns.”

“Mr. Burns?” Yakov allowed the first nurse and the ward clerk to divest him of the various instruments while the charge nurse led him down the hallway. Mr. Burns was an elderly man who had been in for a laparoscopic cholecystectomy. Because of his medical conditions he had been kept on the ward for an extra day but was expected to be discharged on the morrow. He was a bright, spry ninety year old who had kept the nurses entertained despite being a bit too independent for their tastes. He had even insisted on managing most of his medications himself. Everything had gone fine until that morning.

“I’m concerned about him,” the head nurse was saying, “All of a sudden he can barely hear us. I worried that he may have had a stroke.”

Mr. Burns was sitting up on his bed when we arrived. He looked fine. Yakov went to work, quickly doing a thorough assessment. His strength and sensation were normal. Lungs clear and heart beating strong and regular. Everything was normal with the sole exception that he could barely hear a word we were saying. Yakov grabbed an otoscope and peered into the old man’s ears. He paused, looked again, and spoke into Mr. Burn’s ear, “You have thing in ear.”

“Huh?”

Yakov looked again and shouted louder, “You have suppository in ear.”

“Huh?”

“SUPPOSITORY. IN. EAR.”

A light went on. Mr. Burns started to smile and then a look of complete horror filled his face. His voice was a low whisper. “Now I know where my hearing aid is.”