The Cloud (5 page)
I
t’s no wonder most people think of the emergency room as the ER. The initials fit and, perhaps more powerfully, the TV show spread the popular misconception. Most physicians actually think of it as the ED—emergency department. I think of it as something altogether different: Reason Number 4 I quit medicine.
I’m sitting in the ER/ED in a yellow plastic chair waiting to get the cut in my scalp checked. I’m flashing back to my second year of med school, on rotation right here, when I learned a painful lesson that helped redirect my professional aspirations. The teddy bear is a trap.
A seventeen-year-old redhead with pale skin, attended by her mom and clutching a stuffed brown bear with deep green inset eyes, comes in wailing from hip pain. The girl says it’s been brutal since she careened off a mogul at Squaw Valley and hurtled into a tree. A surgical repair four months earlier left pins and a small metal plate securing her femur to her pelvis. She’s run out of her opiates. She says the surgeon is located in Marin and not available to see her for a few days to refill her prescription.
The emergency-room doctor overseeing my rotation calls me aside and tells me we’re witnessing classic behavior of an addict. As evidence, she points to 1) the teddy bear; and 2) the mother’s arms.
The doc tells me that when someone over the age of about twelve carries a teddy bear, it’s an unusually accurate sign of an attention-getting effort, or an emotional problem, or a prop. She also instructs me that if I study the mom, I’ll find the thin skin, scarecrow teeth and, she speculates, the tracked arms of a heavy drug user. The doc says the girl is either sharing opiates with the mom or fronting for her.
The doc turns down the drug request and gives the girl a strong dose of over-the-counter pain-killers.
I excuse myself and I stealthily follow mother and daughter to the parking lot. They have a terrible shouting match. As I stand in the shadows, mom tells daughter she wasn’t acting sympathetic enough, then slaps her offspring.
I feel an arm on my shoulder. It’s the attending doctor. She gently admonishes me for invading patient privacy, inviting a lawsuit, not trusting an attending physician, and wasting time.
She explains the emergency-room ethos: We stop the bleeding. She asks me what I’d have recommended we do with the mother-and-daughter drug seekers. I don’t have a good answer.
I hate the ED. It’s the coldest place on Earth, the reductio ad absurdum of a medical profession, populated by generally well-meaning but worn-out doctors who in the name of expediency make tough calls, one after the next. It’s the extreme version of why I left medicine, which I took to be too black-and-white, and so instead embraced the grainy and blurry world of journalism, where black is one side of the story and white is the other. I don’t make the tough decisions anymore; instead, I comfort myself, fairly or not, that I give other people the information to decide.
Now, I’m waiting in the exact same ED for my head to be checked, two seats down from an obese woman holding her stomach, rocking back and forth, and mumbling. My money is on fast-food poisoning. Across the room, a large man in his early twenties watches the ABC
Evening News
on a TV mounted high on the wall in the corner. His rapid left-eye twitch suggests
blepharospasm
, a condition likely caused by stress, not pathology, which, oddly, may make it of little interest to the docs here even though the underlying causes are ultimately more dangerous than, say, stepping on a rusty nail.
Sizing up my fellow patrons distracts me from my dislike of this place and of hospitals, which has only grown since that chilly July night when Isaac was born at Pacific Medical Center. Crinkly and beautiful, he appeared three weeks early by C-section. It was a miraculous night, divine. But it was also the beginning of the abrupt end with Polly and my utopian visions for a perfect family.
“Nathaniel Idle,” a woman calls from the reception desk.
She directs me to a cubicle where a nurse takes my vitals and temperature, and checks my eyes with an ophthalmoscope. He’s looking for signs of papilledema, a swelling of the optic disc, which can result from brain swelling.
“Let’s get you into a room. A doctor will see you shortly.”
The standard ED room—with its reclining bed covered in relatively sterile blue paper, jars of gauze and Q-tips, cabinets filled with various bandages and swabs, and a monitor mounted in the corner that can be used to measure breathing or heart rate, among other things—offers me no entertainment value. So I keep the door open to watch conditions pass by.
My cell phone signal is weak, to say the least. And a sign reads: “No phone use in patient areas.” But I dial Polly. Underscoring the bad connection, the ringing sound is intermittent but she answers on the third ring.
“Hello, mother of my child,” I say, with manufactured cheer.
“Hello.” Her voice sounds strange, garbled.
“Polly?”
“Hello.” She can’t really hear me.
“It’s me. How’s the nugget?”
The connection dies. I know from experience she’s got bad reception on her end too. I dial again, without success. Maybe she’ll send back a text, which tends to take less bandwidth than a phone call, and less interpersonal energy.
I catch a scent that I realize smells distinctly like the flowery aroma rising from steaming wonton soup. I look around the antiseptic room for Chinese food, seeing none, poke my head in the corridor and find only bustle. It’s then I realize that what I might actually be smelling is a memory, a manufacture of my injured brain.
Polly sits across from me in a cubbyhole restaurant in Pacific Heights, tapping chopsticks, uncharacteristically nervous. Or maybe she’s just trying to start working off the food. She’s eaten voraciously. After the dumplings and wonton soup, she ordered mu-shu vegetables, kung pao chicken and fried noodles, but reluctantly bypassed emerald shrimp because shellfish and pregnant women don’t mix.
She rests her left elbow on two folders she’s been showing me. On the cover of one, a silver-haired man flashing dentures stands beside a sports car, a boat in the background. It’s a prospectus for an investment fund Polly would like me to consider putting my nest egg into, all $19 of it. The other folder includes preschool applications. It’s about three years too early to think about this for our unborn nugget, but her advanced planning might well average out my procrastination. In terms of life strategies, this beauty and I combine for a happy medium.
A waiter drops fortune cookies onto our table. He’s got a limp in his left leg, my guess a meniscus tear from playing sports. I ask him. My diagnosis is wildly wrong. It’s not knee but ankle. He hurt it tripping over a plate of fried duck a busboy dropped. As the waiter walks off, I ask Polly: How was I supposed to know that? Am I really supposed to be able to diagnose poultry-related leg injuries? I’m smiling. She’s not. She’s cracked open her fortune cookie. She holds it up. There’s no fortune inside. Her lips quiver like she might cry.
Hormones, I assume. I gesture to the waiter to get another fortune. I look back at Polly. A single tear slides down her left cheek. Why do single tears seem so much more sad than torrents?
“Everything okay?”
“I need another fortune.” She clears her throat. She forces a smile. Then she says, “We need to talk.”
Back in the ED, I open my eyes, feeling woozy. I blink. Not for a second could I have imagined that my relationship with Polly was hanging in the balance that night—between the first fortune and the one the waiter would bring just a few minutes later. I blink again, squeezing my eyes hard. Much as I’ve replayed the conversation, I can’t quite replay what we said or how things went so wrong in that unexpectedly pivotal moment.
I hear a knock.
S
tanding at the door is a doctor in his late twenties or early thirties, dark skin, glasses, closely shaven. He’s thin to the point of an eating disorder. This is not an illness he suffers, but it’s certainly a condition I remember well. It’s the product of working seventy-hour weeks, including regular all-nighters, time usually spent walking or jogging from exam room to exam room, eating when time and a perpetually tight stomach permit. This is MRA, medical resident anorexia.
“I’m Dr. Sudanagunta. I’m the resident. I’ll give you an initial check and then an attending doctor will see you. You hit your head?”
I give him the rundown of the moment and point of impact.
“I’ve been tired and groggy. I’d ordinarily ignore it but it was a sharp-enough impact that I’m wondering if I’ve got a punctuate hemorrhage.” I smile to preface a joke. “I have that light-headed feeling that comes with a quadruple latte at Starbucks or a diffuse axonal injury.”
I make light of my know-it-all-ness but by way of letting him know I’ve got some training. Why not just say so? Because it’s just not done. It’s the medical trade’s own version of the “don’t ask, don’t tell” policy. In keeping with the strange custom, the resident’s face registers only a small tic when he hears my use of the technical language.
Wearing rubber gloves, he prods the wound at the base of my skull, prompting me to wince.
“It’s closing nicely. We’ll obviously want to keep it clean. I don’t think it needs a bandage.”
He disposes of the gloves in a black hazardous-materials bin. He sits at the end of the bed and crosses his arms.
“Can I ask you a few questions? Basic stuff just to check cognition and memory.”
He pauses, just instantaneously, and I can imagine him going down a checklist for the Mini Mental Status Exam—the basic concussion test. I feel for him, trying to remember and apply a range of triage techniques—from concussion in Room 2 to second-degree burn in Room 3—on the eight hours of sleep he’s had for the week. But this exam, I know, is so often executed that it becomes rote.
He asks me to recite today’s date and where I am, and asks if I know why I’m here. Then we move on to the more complicated questions.
“Let’s start with memory. I’m going to list three objects. I want you to memorize them. In five minutes, when I’m done with the rest of the exam, I’ll ask you to repeat them to me. Make sense?”
I nod.
“Here are your three: apple, tree and chair. Can you repeat those back to me?”
I do so. He asks me to repeat them again and I do. He tells me he’ll ask me to repeat them once more in five minutes.
“Now. I want you to count backwards from one hundred by seven. One hundred, ninety-three, and so on. Or you can do three or eight if you want.” He finally smiles. “We’re not rigid.”
“Sevens. I’m a traditionalist. One hundred, ninety-three, eighty-seven, eighty, seventy-three, sixty-six, fifty-nine . . .” I pause. I notice that he averts his eyes for a second.
“I missed one?”
“Ninety-three minus seven is eighty-six. Can happen to anyone. Let’s try something else.” He reaches for his clipboard, which sits on the sink counter behind him. He rips a standard admittance form.
“Take this piece of paper. Fold it in half, then in half again the other way to create a square. Then unfold it, and hand it back to me.”
It’s a test called a three-step command, which I perform ably.
“Good. Earlier I asked you to remember three words. What were they?”
“Piece of cake.”
He looks at me with cocked head.
“Joke. Here ya go: apple, tree and high chair.”
He looks up. “One more time, please.”
“Apple, tree and high chair.”
“You said ‘high chair.’ ”
“I did.”
“Apple, tree and
chair
.”
“You’re sure?”
He nods. “Do you have kids?”
“A son. Nine months. He’s in the DustBuster phase.”
“He likes to clean up?”
“He likes things that make noise and have buttons.”
He nods. “Let’s get you a CT scan.”
T
he reason I know he’s worried is that I wait a mere fifteen minutes to get my head examined by the massive white imaging machine.
The results come half an hour later from the resident and the attending doctor, a short woman with intense blue eyes and sandy blonde hair pulled back tightly in a bun, revealing tiny pimples dotting her forehead. Maybe rosacea.
She slaps the scan on a light tray on the wall. I know immediately what I’m looking at when I see the small white dots on a region of my brain that stretches across the front of the inside of my skull.
“This tells us to worry but not panic,” she says. “The white dots show us blood spots, which is not good news. This is a serious concussion. But I don’t see any evidence of hemorrhage or really troubling tissue damage.”
“What can we do about it?” I ask, though I know the answer.
“As you may know, there’s not much. Rest, but serious rest, not a lot of physical activity. I don’t think we need to admit you. At this point, you’re not looking at long-term damage but your short-term functioning could well be impaired. How much do you know about the frontal lobe?”
“It’s what keeps me from acting like a two-year-old.”
She smiles. “Right. Impulse control, and lots of other things. It’s the last part of your brain to develop and it’s essentially what lets you modulate everything else, the control center.”
I nod. “I already tend to have an impulsive streak.”
“In all seriousness, you should watch to see if you’re feeling emotionally taxed, having trouble making decisions, more impulsive than usual. This is nuanced stuff to measure, but we’d want to follow up on that. How’s your pain now?”
“I’m fine with Advil and a really soft pillow.”
“Use it. Really.”
I leave the hospital in the dark.
As I climb into my car, I realize I’ve had another short-term memory lapse. I’ve not gotten back in touch with Faith. I dial her and get voice mail. I ask her to call. From the trunk, I yank out my laptop. With it in my lap, I drive to a residential corner where I find a network connection I can Bogart. I log in and I search for “Sandy Vello,” and “obituary,” and lots of other variations that might give me the same information about her that I got last night and this morning on this same computer. But the obituary is not there.
It’s absolutely official: the narcissistic reality-show contestant is not dead. Again.
For a West Coast-based journalist whose stories often have to do with technology, I’m remarkably not technology savvy. I’m the opposite of that. (For instance, I couldn’t understand the need for instant messaging. What, email not instant enough for you?) In short, I’m not particularly sure where to look on my computer for the phantom traces of the obituary—to prove it was there, and erased, and, further, that I’m not imagining things.
But the traces must be there. After all, I don’t really suspect I’d imagined the obituary because I’d have had no way of knowing that Sandy volunteered at the jail. And, beyond that, I’ve got a concussion, not a case of the crazies.
On my browser, I pull down the list of sites I’ve recently visited. There is no evidence of a Sandy Vello obit. I pull down the “History” menu and get a similarly unsatisfactory result. It stands to reason. I found Sandy Vello through a Google search, so my history shows my visits to the search engine and the terms I’ve searched.
It’s just after 9 p.m. and I should absolutely be resting my brain and body. But I need to take my computer for a thorough diagnosis.
It’s time to pick up a carnitas burrito, then visit Bullseye, the Witch’s husband, a computer geek who doubles as a bar-stool statue.
Destination: the Pastime Bar, my regular pub and a black hole of San Francisco real estate that managed not to gentrify.
