The Real Doctor Will See You Shortly (7 page)

Several days had passed and I still hadn't mentioned Gladstone to anyone. And it was eating me up inside. Would there be repercussions? What would happen to him? Or to me? There were so few people I could talk to about this, so few people who would understand. Fortunately I lived with one of them.

“I fucked up,” I said as Heather poured cereal into a bowl. “I really fucked up.”

It was before dawn and we were both bleary-eyed. She wrinkled her brow and reached for a spoon as I continued talking, explaining the case of Carl Gladstone in painstaking detail. Reliving the moment was in no way cathartic; it only made me upset. As I had sufficiently laid out the case against my competence, I glanced at the clock. It was time to leave for work.

“The important thing,” Heather said, “is that you told someone.”

“Yeah, but that doesn't change what happened. The guy could've died. The guy
should've
died.”

“But he didn't.” She dropped her spoon and put her soft hand on mine. “You did what you were supposed to do. You didn't keep it to yourself.”

I shook my head. It didn't matter. “This is killing me.”

“Imagine how many people examined him and didn't even look at the pupils.”

“But I did.”

We ate our Cheerios in silence; my head pounded like I was hung-over, but I hadn't had a drink in days. Possibly weeks.

“You can't beat yourself up over this.”

I knew she was right. I knew these things could happen. But I couldn't recall her making a mistake. I didn't remember her dealing with a grave error.

“Yeah,” I said.

She looked into my eyes and smiled. “You're a good doctor, Matt. Remember that.”

We slid our bowls into the sink, grabbed our white coats, and headed to work.

An hour later I was back in the unit, scampering from one room to the next, acquainting myself with the five new overnight admissions. The turnover was dizzying; it would take me hours to get up to speed. Denise Lundquist—the woman for whom the death of a sibling had triggered a heart attack—was now off the ventilator and would likely be transferred out of the unit before the weekend. One constant, however, was Benny. There he was, hour after hour, riding the stationary cycle or watching TV on his bed, as though he were someone whose small apartment just happened to be in the middle of a cardiac care unit. For a man with a diseased, failing heart, he had a remarkably good attitude, which made checking in on him a nice break from the rest of the unit's tense atmosphere. This morning he was watching an episode of
House
when I passed his room, which seemed a little bit to me like watching a disaster movie on an airplane.

“You good?” I asked, giving him the thumbs-up sign as I stuck my head in the door.

“I suppose.”

“Excellent.” I started to close the door and looked down at my scut
list. There were thirteen more things to check off before rounds. I repeated his response to myself:
I suppose.
That didn't sound like Benny. I looked up and saw that he was wearing the same Giants T-shirt and hadn't shaved in several days. His beard was much whiter than I'd expected, and drops of sweat were gathering above his thin lip.

“You got a minute?” he asked.

“I have a minute. Less than a minute.”

He muted the television. “Matt, I see a new group of interns in here every month. And when the moment strikes me, I like to offer feedback.”

“Oh.” In my limited experience, impromptu feedback was rarely welcome or constructive.

“Matt, just sitting here, waiting, I encounter all types. Good, bad…” His voice trailed off. “Mostly good.”

“That's nice to hear.”

“The good, the bad, but not the ugly.” He chuckled to himself and fixed his eyes on mine. “Matt, you come across like you're always in a hurry.”

“That's because I am.” My spine unconsciously stiffened.

“Seems like talking to me or to just about anyone is another box to check for you.” He lowered his head. “I'm just saying this because I know you're young.”

“And impressionable,” I whispered. I relaxed a little bit. This kind of criticism was hard for me to take. Not knowing stuff as a young, inexperienced doctor was one thing, but no one wants to hear that his patients think he doesn't care about them. Still, Benny's comment didn't feel like a dressing-down; his voice had an off-the-record feel that put me at ease. I sat down in the chair next to his bed and exhaled. “No, you're right,” I said. “The truth is I feel completely overwhelmed.”

“It kinda shows.”

“Ha. Great. So much for never letting 'em see you sweat.”

“But it doesn't have to.”

I shook my head. “I suppose I should just get here even earlier.”

“It's not about that. Not about that at all. Take a look at what you're doing. You're sitting down and we're having an actual conversation. Normally you just—”

“Plan an escape route the moment I enter the room.”

“Yeah. And half the time you're looking at your papers or over your shoulder and not listening.”

“But I am listening.”

“Perception is reality, Matt.”

Why was he sweating so much?

“What about you?” I asked. Was he sicker than I'd realized?

“Good days and bad days,” he said. “Today's not so great.”

I couldn't imagine being in his position, just waiting day after day. I'd be outraged. Unless his condition wasn't as stable as I'd supposed.

“You do look a bit warm,” I offered. “Let's make sure you don't have a fever.”

As I placed the back of my hand against his moist forehead, there was a knock at the door.

“Happy hour's over,” Baio said. “Let's talk.”

“Thanks for looking out for me,” I said to Benny as I backed out of the room. “I'll get a nurse in here.”

“Wasn't primary care clinic painful?” Baio asked as we walked to a pair of unoccupied computers. He was right, it was painful—but for a different reason; what I found overwhelming, he found boring. I studied Baio's face, wondering if he was ever going to bring up Gladstone. “Anyway, it's gonna be a busy day. Ridiculously busy.”

I didn't want to think about it. I took a deep breath and reached for a bagel. With each day that went by without my being called to account for Gladstone, it was that much easier to just move on. I had been tearing myself up but had started to reach a kind of numbness about it. I just couldn't keep worrying or else I'd never get on track with the rest of my work, and probably completely destroy my stomach in the process. And as time went by, and no word came back from my superiors, it was easier to think that I might've blown up the whole
incident in my mind. There was too much to lose in my bringing it up. In any case, Gladstone was undoubtedly in better hands now, wherever he was.

“You know,” I said to Baio as my cointern Lalitha, a tall, attractive woman with a hint of a British accent and originally from Bangladesh, zipped past me, “I really marvel at these gals.”

Lalitha was transporting Denise Lundquist to CAT scan while my other two pod mates, Ariel and Meghan, performed a paracentesis on one of the new admissions.

“Look at them,” I went on. “Bright, energetic, enthusiastic, bouncing around the unit doing a hundred things at once.” It hadn't been formally acknowledged that they were outperforming me, but I sensed they were, and constantly searched for signs.

Baio smiled. “Just remember everyone breaks.” The smile disappeared. “Everyone.”

“How so?”

“You can only shovel shit with a smile on your face for so long.”

“Until what? Did you break?”

He swiveled around in his chair. “No comment. But speaking of shoveling shit, I need you to guaiac someone for me.”

“Sure thing.” Baio wanted me to insert my gloved finger into the rectum of a patient to assess for internal bleeding. I wondered if he needed to sound so pleased about it.

“Time to rectalize,” he said. He patted me on the back. “You ever done one before?”

“Well—”

“I'll take that as yet another no. Honestly, did they teach you anything at Harvard? Anything?”

“I've done one before. But it wasn't on a patient.”

Baio rubbed his hands together and grinned. “Oh, Dr. McCarthy, please do tell.”

“Well, there's not too much to say. In med school a guy whose father had died of prostate cancer worked to help medical students learn
rectal exams by being a kind of all-purpose guinea pig. Pretty much our whole class had a finger up his ass at some point. Nice guy.”

“Whatever they paid him, it wasn't enough,” said Baio. “But frankly, of the handful of practical things that they taught you at Harvard, I'm shocked that this was one of them.” He waved his hand. “Anyway, I want to anticoagulate one of the new admissions. And before we can start a blood thinner, we have to make sure she's not bleeding internally. That's where you come in.”

Just then a voice blared over the intercom:
ARREST STAT, FIVE GARDEN SOUTH! ARREST STAT, FIVE GARDEN SOUTH!

In a flash Baio was gone. I leaned back in my chair and imagined him saying “ABC, ABC” as he sprinted down the corridor. He returned twenty minutes later, daintily holding his hands below his chest like he'd just received a manicure.

“Follow me,” he said faintly.

He looked washed out, like something terrible had happened. Fortunately I saw no sign of feces on his scrubs. He led me to the back of the unit and into the residents' workroom—a cluttered space with half-eaten bologna sandwiches and potato chip wrappers strewn about two black leather couches. “Feel these,” he said, keeping his eyes trained on his hands. “Go on, feel 'em.”

I looked for a smile, a sign that he was joking, but there was nothing. I reached for his hands and rubbed his fingertips.

“This is weird, dude,” I said, checking to see that no one was watching us. “What happened out there? And why am I rubbing your hands?”

“These, my friend, are healing hands.”

He held them up and walked toward the floor-to-ceiling window overlooking the Hudson.

“Take a look at this.” He motioned me to join him. “Over here.” He pointed to small white marker board with a list of names, including his, running vertically down the left border. Across the top were four letters: ASDP.

“A,”
he said, slapping his finger against the board, “is for arrest. Number of arrests each one of us has responded to this month.”

“You keep track?”

“Indeed.
S
is for survived. The number of people who survived those arrests.”

“A scoreboard,” I whispered to myself.

“
D
is for death.”

“And
P
?” I asked, looking at the final, empty column. “Partial resuscitation? Paralysis?”

Baio laughed. “
P
is a category I made up just the other day. It's for pooping. The number of arrests called while the first responder was in mid-poop. Sadly, the number remains at zero.”

I blinked. “Wait, what?”

“You'll notice, Dr. McCarthy,” Baio continued, “that there are eleven slashes in both my
A
and
S
columns.”

“I do. Eleven arrests, eleven survived.”

“And that the column labeled ‘deaths'—that column is conspicuously empty.”

The other physicians on the list had a save rate just over 75 percent, a remarkable figure compared with national averages. But Baio was in uncharted territory.

“You've saved everyone.”

I stood before him, awestruck.

“Not bad,” I said, hoping to draw him out more.

“There's going to be a moment this year, many moments actually, when you'll ask yourself why you went into medicine,” Baio said. “The year is going to knock the wind out of you.”

“I believe it.”

“I want you to remember this moment,” he said, fighting back a smile. “Because it feels damn good to see a big goose egg up there under deaths.”

“I will. I certainly will.” Yet again I found it hard to believe that he had been in my position just one year earlier; what sort of process
could transform me into him? I quickly estimated that I was learning between twenty and fifty new facts and one new procedure every day. Stretched out over an entire year, that was a lot of knowledge. But it still didn't seem like enough time. The learning curve would flatten and I'd certainly forget a few things. And I couldn't imagine that all of my instructors would be as gifted as the talented Dr. Baio.

“The lows in this job will be low,” he said. “Very low. Unspeakably low. But the highs…”

“Yeah?”

“They're nice. The highs are quite nice.”

He clapped his hands together like cymbals. “All right, enough celebrating. Back to work. Where were we?”

I followed him out of the room and back to the computers. “Before you left you said you wanted me to guaiac someone.”

“Ah, yes. There are actually two treats in your future. Forgot to mention the M and M.”

“M and M?”

“Morbidity and Mortality. It's a conference. Every so often we get the entire department together and go over a case where someone screwed up.”

My mind instantly went to Gladstone. Surely his situation was tailor-made for unpacking at a conference that made case studies out of botch jobs. Could the case have made its way up the chain already? I knew about a small mistake or two made by one of my fellow interns, but nothing on the level of Gladstone, certainly nothing else worth exploring at length. In my mind, someone was holding a file folder marked “M and M” with a lone sheet of paper chronicling my idiocy. I was certain they were going to talk about me.

I might be able to drown my constant thoughts of Gladstone and my shame from Sothscott's phone call in the craziness of the CCU, but now I was forced to face the idea of a virtually public shaming in front of the entire department. What would the Badass think? Could any possible punishment or censure come out of it? My bowels shifted. I wondered if Baio could hear it.

“Jesus,” I murmured.

“It's allegedly anonymous, but we can usually figure out who's responsible. Makes for high drama. Tempers flare, egos are crushed.” Baio made a fist. “It's tragedy with a healthy mix of unintentional comedy. I'm always on the edge of my seat.”

“Sounds awful.” How could he be so fucking cavalier?

“Don't worry,” he said. “I'll remind you about it later in the week. But back to the task at hand.”

“Yes. Point me in the right direction of the rectal exam. I'm ready.”

“Here's some guaiac juice,” he said, handing me the developer that was to be applied to the stool. If blood were present, the brown fecal material would turn a brilliant blue.

“Thank you.”

“No, thank you.”

A nurse tapped Baio on the shoulder and whispered something in his ear. I applied a few drops of the developer to my finger to ensure there would be no mishaps with the actual stool sample. I sensed a moment to pick his brain.

“You said the lows this year would be really low.” I rubbed the developer between my thumb and forefinger.

“Yep.”

“But everyone says it gets better. Right? That it gets a bit better every year.”

He scratched his chin. “They do say that, don't they? Well, I want you to know that they're wrong.”

I wrinkled my brow. “Seriously?”

“All year people will reassure you that next year will be better. And the year after that. Trust me, it doesn't get better.”

“Come on.”

“Nope.”

“I look forward to the day when I will actually feel like I know what I'm doing around here.”

“That day ain't comin'. With more knowledge comes more responsibility.”

“I suppose.”

“You start taking your work home with you,” he said, staring blankly at the computer screen. I wanted access to his inner world. Was he struggling in a way I didn't realize? Was he thinking of Carl Gladstone? Or was he just messing with me? I studied his face, but it offered no clues. Unlike so many doctors, Baio appeared unencumbered by anxiety or self-doubt. But what was beneath that highly competent exterior?

“Fine,” I said, “I'm fine with that.”

“Not fine. Okay, focus, Dr. McCarthy. I need you to rectalize room fourteen. Go with God, my friend.”

The elevator door was closing several days later as Baio and I approached. He extended a hand and sprang it open, revealing a dozen white coats on their way to M and M—the Morbidity and Mortality conference. I thought about what I might say if Gladstone came up. I'd be contrite, certainly, but not defensive. I would acknowledge my mistake and accept the punishment and embarrassment that came with it. What else could I do?

“You can tell what type of doctor someone is by what they stick in a closing elevator door,” Baio said as we squeezed inside.

“Oh yeah?”

“An internist sticks his hand. Surgeon sticks his head.”

“And a social worker,” said a woman in the back, “sticks her purse.”

A six-three, rotund, bearded man in jeans and unlaced white tennis shoes flashed a grin and placed his hands on Baio's shoulders.

“Look who it is,” he said, grinding his hands into the base of Baio's neck. “My first, my last—”

Baio wiggled out from underneath his grasp like a younger brother escaping a headlock. “What's up, Jake?” Baio threw a thumb in my
direction. “This is my intern, Matt. Big Jake here was my first resident. Taught me everything I know—”

“When this guy showed up last year,” Jake interrupted, placing a paw on my tricep, “he didn't know his ass from his elbow!”

It was impossible to imagine. “It's true,” Baio said. “I was a mess.”

“No,” I said breezily. “No way.”

“Oh yeah,” Jake said, laughing to himself, “this guy was a total disaster!”

The rest of the elevator remained silent as I tried to imagine what his incompetence would look like. Baio racing around with fear in his eyes instead of assurance. Baio fumbling helplessly with primary care patients. Baio sitting on the other end of that miserable phone call from Sothscott. No mental image would stick.

The elevator reached the ground floor, and as we stepped out I realized Jake looked more like an offensive lineman than a physician. Perhaps he had been a football player; Columbia was full of ex-athletes. He slapped himself on the knee. “And now,” he said to Baio, “you're telling an intern, another doctor, what to do? Amazing.”

“Circle of life,” Baio said flatly.

Jake turned to me. “Did he tell you about M and M?”

“A bit, yes.” I didn't know what to make of this enormous oracle. “He said people get worked up. Something about egos getting crushed.”

“And tears,” Jake said, “don't forget about the tears.”

“I'll keep my eyes peeled.”

“Piece of advice,” Jake said as he leaned in and nodded toward Baio. “Don't believe a word that guy says.”

We took our seats in the auditorium, and I braced myself. Rapid-fire, shorthand conversations took place all around me, but a hush fell over the sea of doctors when a physician stepped onstage and tapped on the lectern's microphone.

“Welcome,” she said, “to M and M.”

I looked around the room, searching for signs of distress. I prayed
they would not be discussing Carl Gladstone. It's been said that the first half of life is boredom and the second half is fear. If that's the case, I'd just reached middle age.

“Today, we're going to discuss a case with an unfortunate outcome. As always, I remind everyone that today's conference is confidential and—”

My pager went off:
LUNDQUIST FAMILY WOULD LIKE TO DISCUSS DISCHARGE PLANNING. RETURN TO UNIT ASAP.

I took a deep breath, and another. I had to go but I couldn't get up. My ears were perked as the speaker ran through generalities pertaining to the M and M conference, tuned to any mention of the words “Gladstone” or “anisocoria.” But the intro just dragged on. Baio looked over at me as I scanned the room, searching for other sets of eyeballs that might have drifted in my direction. The pager buzzed again. I had to go. I showed the message to Baio, shrugged, and excused myself, wondering if I was about to be lambasted in absentia.