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 Congestive Heart Failure

Systolic Murmur

Diastolic Murmur

Atrial fibrillation

Pericarditis

Preoperative Cardiac Clearance

Chapter 3. Gastroenterology

Epigastric Pain

Right Upper Quadrant Pain

Abnormal Liver Tests

Cirrhosis

Diarrhea

Chapter 4. Nephrology

Chronic Renal Failure

Nephrotic Syndrome

Hematuria

Hyponatremia

Hypernatremia

Hypokalemia

Hyperkalemia

Urinary Tract Infection

Chapter 5. Hematology/Oncology

Anemia

Thrombocytopenia

Polycythemia
 Coagulopathy

Deep Vein Thrombosis

Lymphoma

Leukemia

Breast Mass Evaluation

Breast Cancer

Lung Cancer

Colon Cancer

Prostate Cancer

Chapter 6. Infectious Disease

Fever of Unknown Origin

Acute Bacterial Endocarditis

HIV With Fever

Cellulitis

Chapter 7. Endocrinology

Diabetes

Diabetic Ketoacidosis and Hyperosmolar Nonketotic Coma

Hypothyroidism

Hyperthyroidism

Hyperparathyroidism

Adrenal Insufficiency

Cushing Syndrome

Osteoporosis

Dyslipidemia

Chapter 8. Rheumatology
 Low-back Pain

Polyarthritis

Gout

Rheumatoid Arthritis

Seronegative Spondyloarthropathies

Inflammatory Myopathies

Systemic Lupus Erythematosus

Vasculitis

Systemic Sclerosis

Chapter 9. Toxicology

Alcohol Intoxication and Withdrawal

Cocaine Intoxication and Withdrawal

Section 2. Pediatrics

Chapter 10. Newborn Nursery

Newborn Exam

Birth Trauma

Benign Skin Lesions

Chapter 11. Pediatric Clinic

Well-Child Care: Infant

Well-Child Care: Toddler

Well-Child Care: Child

Well-Child Care: Adolescent

Hyperactive and School-Related Complaints—ADHD

Chronic Cough and Wheeze—Asthma

Chronic Runny, Stuffy Nose—Allergic Rhinitis

 Heart Murmur

Hard Stool or No Stool—Constipation

Short Stature

Nosebleeds

Acne

Chapter 12. Pediatric Emergency Room

Anaphylaxis

Seizure

Syncope

Shortness of Breath, Wheeze, Cough—Asthma

Infant Who Stops Breathing (Brief Resolved Unexplained Event—BRUE)

Chest Pain

Abdominal Pain—Rule Out Appendicitis

Infant With Projectile Vomiting—Pyloric Stenosis

Vomiting and Diarrhea—Enteritis

Bloody Diarrhea—Colitis

Infant With Episodic Pain and Vomiting—Intussusception

Chemical Ingestions

Foreign Body

Edema—Nephrotic Syndrome

Easy Bruising or Mucosal Bleeding—ITP

Fever Without Associated Symptoms

Fever With Irritability and Vomiting—Meningitis

Fever With Productive Cough—Pneumonia

Fever With Barking Cough—Croup

Fever With Wheezing Cough—Bronchiolitis

 Fever With Runny Nose, Dry Cough—Viral URI

Fever With Sore Throat—Pharyngitis

Fever With Dysuria—Urinary Tract Infection

Fever With Rash—Viral Exanthem

Fever With Rash, Conjunctivitis, and LAD—Kawasaki Disease

Rash With Pruritis

Henoch-Schönlein Purpura

Bites and Stings

Limping in Child Without History of Trauma

Head Trauma

Limb Trauma

Suspected Physical Abuse

Suspected Sexual Abuse

Chapter 13. Pediatric Ward

Inpatient Care

Dehydration and Intravenous Fluid Management

Pain Control

Postoperative Care of the Appendicitis Patient

Postoperative Care of the Pyloric Stenosis Patient

Inpatient Care of the Orthopedic Patient

Section 3. Obstetrics and Gynecology

Chapter 14. Obstetrics Clinic

Initial Visit

Second Trimester Visit

Third Trimester Visit

 Postpartum Visit

Anemia

Antiphospholipid Syndrome

Chronic Hypertension

Gestational Diabetes Mellitus

Hyperthyroidism

Intrauterine Growth Restriction

Isoimmunization

Mild Preeclampsia

Nausea and Vomiting of Pregnancy

Severe Preeclampsia

Twin Gestation

Urinary Tract Infection

Chapter 15. Labor and Delivery

Term Labor

Third Trimester Bleeding

Chorioamnionitis

Labor Dystocia

Preterm Labor

Pyelonephritis

Rupture of Membranes

Chapter 16. Maternity Ward

Postpartum Day 1

Postpartum Day 2

Dyspnea

Postpartum Fever
 Postpartum Hemorrhage

Chapter 17. Gynecology Clinic

Well-Woman Exam

Abnormal Uterine Bleeding

Breast Mass

Chronic Pelvic Pain

Dysmenorrhea

Family Planning—Barrier Method

Family Planning—Depot MPA

Family Planning—Emergency Contraception

Family Planning—Intrauterine Device

Family Planning—Oral Contraceptives

Family Planning—Sterilization

Galactorrhea

Hirsutism

Infertility

Menopause

Perimenopause

Premenstrual Syndrome

Recurrent Pregnancy Loss

Secondary Amenorrhea

Urinary Incontinence

Vulvovaginitis

Chapter 18. Emergency Room and Consultations

First Trimester Bleeding—Abortion

First Trimester Bleeding—Ectopic Pregnancy

 Acute Pelvic Pain

Gestational Trophoblastic Disease

Pelvic Inflammatory Disease

Pelvic Mass

Section 4. Surgery and Emergency Medicine

Chapter 19. Cardiology

Aortic Dissection

Bradycardia/Complete Heart Block

Cardiac Arrest

Endocarditis

Hypertensive Crisis

Myocardial Infarction

Palpitations

Syncope

Unstable Angina

Venous Thrombosis

Chapter 20. Pulmonary

Pneumothorax

Pulmonary Edema

Pulmonary Embolism

Chapter 21. Gastrointestinal

Abdominal Aortic Aneurysm

Appendicitis

Bowel Obstruction

Biliary Disease
 Diverticulitis

Foreign-Body Ingestion

Gastroesophageal Reflux Disease

Gastrointestinal Bleeding

Hepatitis

Ischemic Bowel

Pancreatitis

Peptic Ulcer Disease

Chapter 22. Genitourinary

Acute Renal Failure

Epididymitis

Hernia

Hydrocele/Varicocele

Kidney Stones/Nephrolithiasis

Pyelonephritis/UTI

Rhabdomyolysis

Testicular Torsion

Chapter 23. Neurology

Altered Mental Status

Headache

Meningitis

Seizures

Stroke

Vertigo

Weakness
Chapter 24. Trauma

Animal Bite

Ankle Sprain

Burns

Fracture

Head Injury

Laceration

Section 5. Psychiatry

Chapter 25. Guidelines for Conducting a Psychiatric Interview

Chapter 26. Personality Disorders

Chapter 27. Psychotic Disorders

Chapter 28. Anxiety Disorders

Chapter 29. Mood Disorders

Chapter 30. Dissociative Disorders

Chapter 31. Impulse Control Disorders

Chapter 32. Neurocognitive Disorders

Chapter 33. Somatic Symptoms

Chapter 34. Sleep Disorders

Chapter 35. Eating Disorders

Chapter 36. Sexual Dysfunction

Chapter 37. Substance Use Disorders

Chapter 38. Posttraumatic Stress Disorder

Appendix A

Index
Acknowledgments
I would like to thank all of the SOAP authors for their hard work and commitment to making
this series a success. I would also like to express special appreciation to Matt Hauber, Julie
Kostelnik, and Andrea Vosburgh at Wolters Kluwer for their patience and persistence in
keeping this project on track.
Contributors

Jennifer Agard, MD, FACOG

Marin Fertility Center
Greenbrae, California
Section 3: Obstetrics and Gynecology
Terako Amison, MD
Assistant Professor, Department of Psychiatry
Psychiatry Clerkship Director, Vanderbilt School of Medicine
Nashville, Tennessee
Section 5: Psychiatry
Spencer Degerstedt
Interventional Radiology Resident
Oregon Health & Science University
Portland, Oregon
Section 4: Surgery and Emergency Medicine
Zaiba Jetpuri, DO
Assistant Professor
Department of Family and Community Medicine
University of Texas, Southwestern Medical Center
Dallas, Texas
Section 2: Pediatrics
Daniel C. Maldonado, MD
Attending Physician of Family Medicine
Assistant Director of Inpatient Medicine
White Memorial Medical Center (WMMC)
WMMC Family Practice Residency Program
Los Angeles, California
Assistant Clinical Professor
Department of Family Medicine
University of Southern California, Keck School of Medicine
Los Angeles, California
Section 1: Internal Medicine
Nida Zahra, MD
Assistant Professor and Medical Director
Department of Family and Community Medicine
University of Texas, Southwestern Medical Center
Dallas, Texas
Section 2: Pediatrics
To The Reader

Like most medical students, I started my ward experience head down and running, eager to
finally make contact with real patients. What I found was a confusing world, completely
different from anything I had known during the first 2 years of medical school. New
language, foreign abbreviations, and residents too busy to set my bearings straight: Where
would I begin?
Pocket textbooks, offering medical knowledge in a convenient and portable package, seemed
to be the logical solution. Unfortunately, I found myself spending valuable time sifting
through large amounts of text, often not finding the answer to my question, and in the
process missing out on teaching points during rounds!
I designed the SOAP series to provide medical students and house staff with pocket manuals
that truly serve their intended purpose: quick accessibility to the most practical clinical
information in a user-friendly format. At the inception of this project, I envisioned all of the
benefits the SOAP format would bring to the reader:

Learning through this model reinforces a thought process that is already familiar to
students and residents, facilitating easier long-term retention.
SOAP promotes good communication between physicians and facilitates the
teaching/learning process.
SOAP puts the emphasis back on the patient’s clinical problem and not the diagnosis.
In the age of managed care, SOAP meets the challenge of providing efficiency while
maintaining quality.
As sound medical-legal practice gains attention in physician training, SOAP
emphasizes adherence to a documentation style that leaves little room for potential
misinterpretation.

Rather than attempting to summarize the contents of a 1,000-page textbook into a miniature
form, the SOAP series focuses exclusively on guidance through patient encounters. In a
typical use, “finding out where to start” or “refreshing your memory” with SOAP books
should be possible in less than a minute. Subjects are always confined to 2 pages, and the
most important points have been highlighted. Topics have been limited to those problems
you will most commonly encounter repeatedly during your training, and contents are
grouped according to the hospital or clinic setting. Facts and figures that are not particularly
helpful to surviving life on the wards, such as demographics, pathophysiology, and busy
tables and graphs, have purposely been omitted (such details are much better studied in a
quiet environment using large and comprehensive texts).
Congratulations on your achievements thus far, and I wish you a highly successful medical
career!
Peter S. Uzelac, MD, FACOG, HCLD (ABB)
Abbreviations

17OHP4 17-alpha hydroxy-progesterone

A1c hemoglobin A1c
A-a gradient alveolar-to-arterial gradient
AAA abdominal aortic aneurysm
AAP American Academy of Pediatrics
ABC airway, breathing, circulation
Abd abdomen
ABG arterial blood gas
AC abdominal circumference
ACE angiotensin-converting enzyme
ACLS advanced cardiac life support
ACS acute coronary syndrome
ADA American Diabetic Association
ADH antidiuretic hormone
ADHD attention deficit hyperactivity disorder
AFB acid-fast bacilli
AFI amniotic fluid index
AFP alpha-fetoprotein
AFSFO anterior fontanelle soft, flat, and open
AG anion gap
AIDS acquired immunodeficiency syndrome
AIHA autoimmune hemolytic anemia
ALL acute lymphocytic leukemia
ALS amyotrophic lateral sclerosis
ALT alanine aminotransferase
Alt alternative regimen
ALTE acute life-threatening event
AML acute myeloid leukemia
AMS altered mental status
ANA antinuclear antibody
Anti-ENA-4 panel of rheumatologic labs
AP anteroposterior
AP testing antepartum testing
APCR activated protein C resistance
APL acute promyelocytic leukemia
Appy appendicitis
APS antiphospholipid syndrome
AR aortic regurgitation
ARB angiotension II receptor blocker
ARF acute renal failure
ARDS acute respiratory distress syndrome
AS aortic stenosis; auris sinister (left ear); ankylosing spondylitis
ASD atrial septal defect
ASMA anti–smooth muscle antibody
ASO antistreptolysin O titer
ASQ ages and stages questionnaires
AST aspartate aminotransferase
ATFL anterior talofibular ligament
ATN acute tubular necrosis
ATNR asymmetrical tonic neck reflex
AUB abnormal uterine bleeding
AV atrioventricular
AVM arteriovenous malformations
β-hCG beta human chorionic gonadotropin
B bilateral
BAD bipolar affective disorder
BAL blood alcohol level
BDD body dysmorphic disorder
Bicarb bicarbonate
bid bis in die (twice daily)
bili bilirubin
BM bowel movement, stool
BMD bone mineral density
BMI body mass index
BMT bone marrow transplant
BP blood pressure
BPD borderline personality disorder
BPM; bpm beats per minute
BPP biophysical profile
BRCA breast cancer gene
BRUE brief resolved unexplained event
BS bowel sounds
BSA body surface area
BUN blood urea nitrogen
BV bacterial vaginosis

Ca calcium
CA cancer
CA125 cancer antigen 125 test
CABG coronary artery bypass graft
CAD coronary artery disease
CAH congenital adrenal hyperplasia
C-ANCA cytoplasmic antineutrophil cytoplasmic antibodies
CAP community-acquired pneumonia
CBC complete blood count
CBC w/ diff complete blood count with differential
CBT cognitive behavioral therapy
cc cubic centimeter
C/C/E cyanosis/clubbing/edema
Chem 7 sodium, potassium, chloride, bicarb, BUN, creatinine, glucose
CHF congestive heart failure
Chol cholesterol
CHOP cyclophosphamide, hydroxydoxorubicin, vincristine (Oncovin),
prednisone
CHTN chronic hypertension
ciTBI clinically important traumatic brain injury
CK creatinine kinase
CLL chronic lymphocytic leukemia
CML chronic myeloid leukemia
CMP comprehensive metabolic panel
CMT cervical motion tenderness
CMV cytomegalovirus
CN cranial nerves
CNS central nervous system
COPD chronic obstructive pulmonary disease
CP chest pain; cerebral palsy
CPDD calcium pyrophosphate deposition disease
CPP cerebral perfusion pressure; chronic pelvic pain
CPR cardiopulmonary resuscitation
Cr creatinine
CRF chronic renal failure
CRP c-reactive protein
C-section; C/S cesarean section
CSF cerebrospinal fluid
CST contraction stress test
CT computed tomography, Chlamydia trachomatis
CTA clear to auscultation
Another random document with
no related content on Scribd:
hän tytön sisään, sanoi jotenkin tuimasti hyvää yötä laivurille ja sulki
oven jälkeensä.

Pää aivan pyörällä illan moninaisista vaiheista, kiiruhti laivuri

takaisin kuunariinsa. Tultuaan lähemmäksi laituria, alkoi hän juosta.
Samoin näkyi tekevän vastapäiseltä suunnalta tuleva pieni olentokin.

"Sinä kuljeksija", huohotti laivuri ja tarttui samaan aikaan kuunarin

sivulle saapuvaa poikaa kaulukseen.

"No? Minähän teen vaan kuten tekin", sanoi Henry.

"Heittäkää yli syrjän", sanoi perämies, joka melun kuultuaan oli

uudestaan tullut kannelle.

Pimeän suojassa vilkasi Henry tähän herraan sanomattoman

halveksivasti, ja katseella, mikä selvään ilmaisi hänellä olevan
tärkeän asian takanaan, alkoi hän kertoa matkastaan, sovitellen
siten että juttu kävi hiljalleen yhä jännittävämmäksi. Molemmat
kuulijansa eivät kuitenkaan olleet tyytyväisiä tällaiseen
kertomistapaan, vaan selittivät kiihkeinä asianomaiselle, mikä hyöty
oli asiallisesta ja lyhyestä kertomistavasta.

"Minä en ymmärrä hölyn pölyä", sanoi laivuri, kun kertoja

kuuntelijoiden mieliksi oli pilannut koko historiansa. "Joku on
peloittanut häntä; parasta sentään, että lähdemme heti perässä."

"Ne purjehtivat kello yhdeltä", sanoi perämies. "Ja ajatelkaa mitä

teette, ellei hän tulekaan sovinnolla takaisin, — ja jos mies ei
olekaan tytön isä. Kirotun sekasotkuinen koko juttu."

"En todellakaan ymmärrä mitä tekisin", sanoi laivuri. "En ollenkaan

ymmärrä mikä olisi viisainta."
 "Niin, minua ei asia tietystikään koske", sanoi Henry
välinpitämättömästi, "mutta kyllä minä tietäisin tehtäväni."

Molemmat miehet kumartuivat uteliaana. "Minä tietysti olen

katukuleksija", sanoi Henry, nauttien tavattomasti voimansa
tuntemisesta. "Se minä ehkä olenkin. Minut tietysti joku irvistelevä
joukko kantaa kojuun. — Minä tietysti…"

"Mitä sinä tekisit?" kysyi laivuri rauhallisena.

"Noutaisin miss Gethingin takaisin laivaan", sanoi poika, "ja sillä

olisi koko asia autettu."

"Tuhat tulimmaista, poika on oikeassa", huudahti perämies.

"Kunhan vaan ehdittäisi." Mutta laivuri oli jo matkalla. "Sinä olet kiltti
poika, Henry", sanoi perämies. "Juokse nyt uudestaan ja pidä
tarkkaa tähystystä 'Febestä'. Heti kun huomaat sen aikovan
purjehtia, kiiruhda takaisin ilmoittamaan. Jos se purjehtii sivutse
ennenkuin laivuri on tullut, koitan minä jollakin tavalla ottaa selvän,
mitä tämä kaikki merkitsee." Laivuri oli tällä aikaa juossut, henki
kurkussa, Overcourtiin. Numero viisi oli pimeän peitossa, mutta kun
laivuri hetkisen moukaroitsi ovea, ilmestyi valoa ikkunaan.

"Kuka siellä? Mitä te tahdotte?" kuului kimakka, kiukkuinen ääni ja

äskeisen vaimoihmisen pää pisti ulos avatusta ikkunasta.

"Tahdon tavata sen nuoren naisen, jonka hetkinen sitten saatoin

tänne", sanoi laivuri. "Heti!"

"Mitä? Näin myöhään yöllä?" sanoi vaimo. "Olkaa toki järkevä,

nuori mies, niin rakastunut kuin lienettekin."

"Asiani on erittäin tärkeä", sanoi laivuri kärsimättömästi.

 "Ettekö saata minulle sitä ilmoittaa?" kysyi eukko, joka välttämättä
tahtoi saada uteliaisuutensa tyydytetyksi.

"Olen saanut tietoja hänen isästään", sanoi laivuri, koettaen pysyä

rauhallisena.

Pää katosi ja ikkuna suljettiin. Hetken perästä, mikä laivurista

tuntui ijankaikkisuudelta, kuului askeleita eteisessä, ovi aukeni ja
Annis seisoi hänen edessään.

Lähdettiin takaisin satamaan ja laivuri kertoi matkalla tietonsa. Tie

oli pitkä ja Annis tunsi väsyvänsä, mutta kieltäytyi kuitenkin ylpeästi
nojautumasta seuraajansa käsivarteen — liiaksikin hyvin muistaen
edellisen matkansa samalla tiellä. Päästyään laiturille näkivät he
perämiehen tulevan juosten vastaan. Laivuri sai ankaran
sydämentykytyksen.

"Sinne ei enään kannata mennä", sanoi perämies. "'Febe' on jo

matkalla.
Huudammeko kun se menee ohitse?"

Laivuri unohti Anniksen laiturille, hyppäsi laivaan ja tirkisti jokea

ylös. Yö oli tähtikirkas ja hetkisen katseltuaan eroitti hän epäselvästi
pienen kuunarin, joka hiljalleen lähestyi.

"Vetäkää ylös pari merkkilyhtyä, Jack, ja ajakaa miehet kojusta",

huusi hän perämiehelle.

"Miksi niin?" kysyi tämä ihmeissään.

"Tehkää kuten käskin", huusi laivuri kiukkuisesta "Henry, auta

näiden luukun kansien nostamisessa."
 Perämies sytytti lyhdyt ja juoksi keulaan herättämään miehistöä.
"Febe" oli enään parikymmentä metriä peränpuolella.

"Ohoii! Kuunari, ohoi!" huusi Wilson ja juoksi syrjälle.

"Halloo", kuului käheä ääni.

"Onko teillä täysi lasti?" kysyi "Merilokin" kapteeni.

"Ei."

"Laskekaa sitten ankkuri ja tulkaa viereen", huusi Wilson. "Meidän

pitää vielä viikon päivät viipyä täällä ja ruumassa on pari tusinaa
sillitynnöreitä, joiden välttämättä pitää olla Lontoossa tällä viikolla."

"Febe" oli nyt aivan "Merilokin" rinnalla; laivuri pidätti henkeään

levottomuudesta.

"Ette siinä viivy jos puolen tuntia", huusi hän huolestuneena.

Ankkurin kolina oli musiikkia hänen korvilleen ja tuskin luottaen

silmiinsä, näki hän "Feben" miesten korjaavan juuri ylös saatuja
purjeita. Kymmenen minuutin kuluttua keinuivat kuunarit vieretysten.

"Merilokin" lastiruuman luukut olivat auki ja keinuva merkkilyhty

märssyssä levitti heikkoa valoaan miehistön unisille kasvoille.
Perämies seisoi kajuutan seinän nojalla ja supatti ohjeita Anniksen
korvaan.

"Rientäkää", sanoi "Feben" laivuri, "otan ne vaan kannelle kun

matka ei ole pitempi."

Toimekkaana riensi hän syrjälle ohjaamaan lastin siirtoa ja tarkasti

uteliaana toimitusta katselevaa tyttöä.
 "Kaunis laiva", sanoi Annis. "Saanko tulla katsomaan sinne?"

"Kernaasti, ellette vaan tule tielle", kuului vastaus.

Käyttäen hyväkseen tätä ehdollista lupausta, astui Annis "Febeen"

ja kuljeskeli ympäri sen kantta. Saavuttuaan kajuutan rappusille, hän
pysähtyi ja katseli ympärilleen. Kaikki olivat toimissaan, eikä kukaan
näyttänyt enempää kiinnittäneen huomiotansa häneen. Tyttö epäili
silmänräpäyksen ja astui sitten pimeään kajuuttaan.

"Oletteko se te, kapteeni?" kuului ääni. "Minkätähden

pysähdyimme?"
Annis ei vastannut.

"Kuka se on?" kuului ääni uudestaan, tällä kertaa jyrkemmin.

"Hiljaa", sanoi Annis.

"Mikä hätänä?" kysyi herra Tillotson.

Annis säpsähti ja koetti kuunnella toista ääntä. Mutta ainoastaan

heikko hengitys oli kaikki mitä hän saattoi eroittaa.

"Isä!" huudahti hän yht'äkkiä. "Se olen minä, — Annis! Missä sinä
olet?"

Kuului huudahdus toiselta puolen kajuuttaa ja Annis näki jonkun

hypähtävän pystyyn ja lähestyvän häntä. Se tarttui hänen
vyötäisiinsä ja partaset kasvot koskettivat hänen hienoa hipiäänsä.
Vuoroin nauraen, vuoroin itkien, kiersi Annis käsivartensa isänsä
kaulaan ja puristi häntä suonenvedontapaisesti.

"Kas niin! — kas niin, lapseni", sanoi lopulta kapteeni Gething.

 "Oli kerrassaan ihme, että onnistuimme pysäyttää teidät", sanoi
Annis innoissaan. "'Merilokki' on aivan vieressä, enkä minä ymmärrä
miksi sinä uudestaan aiot mennä matkaasi."

"Sitä en itsekään ymmärrä", sanoi Gething väsyneesti.

"Voit toki käsittää, etten minä johda sinua mihinkään vaaraan. Ota
takki päällesi ja tule mukaan."

Sanomatta sanaakaan teki kapteeni Gething mitä käskettiin ja

seurasi tytärtään kannelle.

"En tulekaan mukaan, kapteeni", sanoi hän, tavatessaan "Feben"

laivurin nostamassa sillitynnöreitä.

"Vai niin", vastasi tämä lyhyesti, "mutta rahoja ette enää saa
takaisin."

Häpeissään ja pitäen tyttärensä käsivarresta, astui kapteeni

Gething "Merilokkiin" ja pudisti Wilsonin kättä. Saavuttuaan
kertomuksensa ja selvityksensä puoliväliin sai laivuri ihmeellisen
halun kohdata Tillotsonia, mutta Annis sai hänet sentään estettyä, ja
kun "Febe" oli saanut lastattua sillinsä, liukui se hiljalleen,
toivotettuaan ystävällisesti hyvää yötä, jokea ulos ulapalle.
"Merilokin" miehistö pääsi jatkamaan häirittyä untansa.

"Oletteko tyytyväinen nyt?" kysyi laivuri Annikselta, kun kapteeni

Gething väsyneenä oli mennyt kajuuttaan.

"Täydellisesti", vastasi Annis.

"Mutta minä en ole", sanoi Wilson merkitsevällä äänenpainolla.

 Miss Gething hymyili ja nojautui laivan syrjälle katselemaan
tummaa vettä ja nukkuvaa kaupunkia. Hän ei liikahtanut, kun Wilson
asettui hänen viereensä ja kun tämä tarttui hänen käteensä ei hän
estellyt.

"Minä en ole tyytyväinen — — vielä", sanoi Wilson ja vei tytön

käden huulilleen.

Samassa huomasi hän merkkilyhtyjen loistavan liian kirkkaasti.

Hän laski ne alas ja puhalsi sammuksiin. Vaan yht'äkkiä kuului
pidätettyä naurua, laivuri kääntyi ympäri — silmänräpäystä liian
myöhään. Annis Gething katosi kajuutan rappusista.
 *** END OF THE PROJECT GUTENBERG EBOOK LAIVURI ON
RAKASTUNUT ***

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