The Real Doctor Will See You Shortly (5 page)

I was back in the unit the next day before sunrise. Benny waved from his bike each time I passed his window, hustling from one room to the next, familiarizing myself with the new patients. A woman was now residing in Gladstone's recently vacated bed. He had been transferred to another floor shortly before his wife, Sasha, arrived searching for answers. I gave her my best summary of the situation but ultimately referred her to my supervisor for a complete explanation. On her way out of the unit, she flagged me down to express her gratitude.

“He's going to get through this,” I said, hoping that my optimistic spin on the situation was appropriate and, more important, accurate. It was a good sign that he was no longer in the unit, but I really couldn't speak to his long-term prognosis. Sasha, with hair so white it appeared to be dyed, was twisting her lip back and forth as we spoke.

“I pray you're right,” she said.

I grabbed her right hand and gave it a soft squeeze. “We have to stay positive.”

“Did you get to talk with him at all?”

“I did not.”

“He's one of those creatures of habit. Starts every day the same.” She repositioned her purse on her shoulder and smiled at the thought of her husband's routine. “Makes coffee, hops in the shower. Goes to his office. I don't understand why the other day was different.”

“We're going to do everything in our power to answer that.” Her lip quivered as I spoke. “Tell me more about him,” I said.

A few minutes later, Baio, standing in front of a chest X-ray, summoned me. “We're going to do at least five minutes of teaching every day. Today's lesson is the chest X-ray.”

I grinned. “That's very kind of you.”

“I'm not doing it out of kindness. I'm doing it so you're not a terrible doctor.” He slapped me on the back and grinned. “Okay, how do you read a chest X-ray?”

“Systematically,” I said, thinking about his approach to any- and everything.

“Correct. Without a system, things get missed. So what's your system?”

“I don't really…I know I should, but I don't have one. I just kinda look at it. Like here,” I said, pointing at a white blot in the left lung, “pneumonia.”

“No!” He shook his head. “You've got to be better than that. But at least you're honest. Take another stab at it.”

If Baio was Charles in charge, I was Charles's dopey pal on the show, Buddy Lembeck. Perhaps it wasn't pneumonia, but it certainly looked like it. “Okay, the left lung appears to show pneumonia and the right lung…”

“Stop.”

“What?”

“If you see a beautiful woman on the street,” he said earnestly, “do you first look at her chest?”

I wondered if this was a trick question.

“The answer is no, Dr. McCarthy. Start in the periphery. Does she have an ankle tattoo? Or a wedding ring? Then work your way in.”

I nodded. “Okay.”

“If you went straight for the lungs, you'd miss this at the edge.”

He pointed at a hairline fracture of the left clavicle. He was right: I certainly would've missed it.

“Let's get started,” Dr. Badass bellowed from the other end of the hallway. “Chop, chop. Cut the bullshit.”

Rounds began promptly at 7:30
A.M
. and proceeded at a dizzying pace. Blips of conversation were exchanged between the more senior members of the group in a medical shorthand that I was not yet able to fully process. My role was to present the overnight events on a handful of patients and to give a short presentation based on a question I had asked on rounds a day earlier, when I wondered aloud how long we had been doing heart transplants at Columbia. As it turned out, if you posed a question on rounds for which there was not an immediate and obvious answer, you would be asked to give a short presentation on the subject the following day.

In between presentations, I occasionally whispered questions to Baio, searching for further explanation of an acronym or clinical trial, but each time he held an index finger to his lips and shook his head. My notebook continued to fill up throughout the morning. We finished rounds shortly before noon. As I jotted down
cardioversion,
I felt a hand on my shoulder. It was the Badass.

“You're doing a nice job,” he said softly, his large brown eyes staring down at me. It was the first time we'd spoken outside of rounds, and thus far I'd found him as approachable as a supermodel. Innumerable wrinkles lined his forehead and cheeks, and his hair looked like wet hay. “But, Dr. McCarthy, you should really know how to read a damn chest X-ray.”

After lunch, a ninety-second affair in which we gobbled down gamey tuna fish sandwiches, Baio gave me the task of placing a large-bore IV, what's known as a central line, into the femoral vein of a young woman. Baio would supervise the procedure and suggested I watch a simulation of it on
The New England Journal of Medicine
website.

Shortly after the video began, someone tapped me on the shoulder.

“Phone call for you, Doc,” said the ward clerk.

I paused the video simulation and took the phone, wondering who knew to reach me in the unit. “Dr. McCarthy?” said the man.

“Speaking.”

“This is Dr. Sothscott.” He had a soft baritone and spoke quickly. Residents and attending physicians often called the CCU in search of an explanation or clarification pertaining to a patient recently transferred out of our unit, but they never asked to speak to me.

“Hi,” I said tentatively.

“I'll cut to the chase,” he said, “you took care of a Carl Gladstone.”

“Yes. Are you—”

“I am.”

“How is he? I noticed he left the unit.”

“Well, I'll get to that,” he said before blowing a deep breath into the phone. “I'm sitting here reading your note on him and I want to commend you on your thorough physical examination.”

A pleasant surprise.

“You performed an exhaustive ocular exam and correctly spotted anisocoria.”

The different sizes of his pupils. “Thank you.”

“Let me continue. Your note goes on to attribute this pupillary asymmetry to the sedatives he received.”

“Yes.”

“Now, Dr. McCarthy,” he said, his voice rising slightly, “what medication did you attribute it to…specifically?”

I scanned my memory. Images of the handwritten notes in his chart fluttered across my brain. “Hmm. Well, he received several sedatives.”

“He did indeed.”

“I'll have to admit I don't remember all of the medications he received.”

“No problem,” he replied. “I have a list right in front of me. I'll read them to you.”

A medical variation of the Socratic method, I suspected, as he went through the list. It was a little annoying. I already had one Baio.

“I…I think several of them can cause pupillary constriction,” I offered.

“Right again.” There was a pause, and I looked at Baio, who was revolving his fingers to indicate that I should wrap up the conversation. It was time for me to insert the large IV.

“But how many, Dr. McCarthy, cause unilateral pupillary constriction of the kind you observed?”

I thought for a moment, suddenly wondering if I was speaking with another resident or an attending. “Off the top of my head…” I said.

“Oh, Doctor, this need not be off the top of your head.” His speech was becoming urgent. “Please, use references. Use a textbook. Use the Internet. Phone a friend. But please tell me, in all of medical literature, has anyone ever identified an intravenous medication that shrinks one pupil but not the other?”

Another pause. Now I wasn't sure.

“The answer is no!” he screamed.

My head shot back from the phone.

“Carl Gladstone was on a blood thinner for a clot in his leg. When he fell and hit his head in his classroom,” Sothscott continued, barely able to contain himself, “he started bleeding in his brain.”

I closed my eyes.

“And I know you know he fell because you documented the abrasion on his scalp.”

“Oh…no,” I said softly and turned away from Baio.

“Oh, yes. And when you saw him, Dr. McCarthy, the blood was flooding his brain and starting to impinge on his cranial nerves.”

I couldn't breathe.

“Yet your note does not reflect that. Your note is completely misleading. And it does a shocking disservice to—”

“I…”

“How much time was wasted?” he demanded.

“I am so sorry.” I wanted to hide. I wanted to disappear. I wanted to run, but there was nowhere to go. I was terrified to think of what I had done to Carl Gladstone. It had been more than a day since the Badass had said to scan his head. Was he bleeding the whole time until he reached Sothscott? That kind of time could have killed him. My knees buckled and I crouched toward the tiled floor, gasping for air as my eyes welled up.

The conversation with Sothscott left me hollow, paralyzed. I closed my eyes, tracing and retracing the creases in my palms as I tried to make sense of it. I had just told Carl Gladstone's wife that he was going to be okay, that he'd get through this, all as I had almost single-handedly assured that this would not be the case. I dug my fingernails deep into my hands, creating a physical discomfort that served as a blissful, vivifying moment of distraction from the perverse mixture of worry, fear, and anxiety. I opened my eyes and again examined the creases. They almost formed letters—an
A
in my left palm and an
M
in my right. I searched for significance but drew a blank. Then I felt a tap on the shoulder.

“What is this?” Baio asked. “What's happening?” Trying to compose myself, I looked up. Did Baio already know about the error? Did Dr. Badass? “Are some amazing things happening here?”

“Well.” Part of me wanted to blurt out the entire conversation with Sothscott. But a bigger part didn't. Baio wasn't responsible for leaving notes on patients; that was the intern's job. There was no documentation of his faulty reasoning, only my own. I felt like I was going to throw up.

“Are you okay?” he asked.

“Not really.”

“You look terrible.”

“I'm not feeling well.” I didn't know where to begin. “I'll be back in a minute,” I murmured.

I went to the only place of refuge I could think of—the call room, with its lilac walls, buzzing fluorescent lights, and flimsy bunk beds. It would almost certainly be deserted at this time of day. I punched in the three-digit code and headed for the bathroom. Catching a brief image of my face in the mirror—I looked like wet shit—I bit my bottom lip and dry-heaved over the toilet bowl.

My arms went limp as my face turned into a damp mess. But I had to get back to the CCU. In the room next to Benny's, there was a young woman in need of the large-bore IV. I threw cold water on my face and tried to focus on her story so I could momentarily forget about my own. Her name was Denise Lundquist, and she had just been transferred to us from a hospital in New Jersey. Baio had obtained her medical records and explained to me that a few days earlier, she had come home from work to find her husband, Peter, in the kitchen, holding his head in his hands. Peter informed Denise that her brother had been killed in a traffic accident. Upon hearing this, Denise collapsed; minutes later an ambulance arrived and took her to a local hospital, where it was revealed that she, like Gladstone, had suffered a massive heart attack.

It was a terrible story, but the details were a welcome distraction. After a seemingly successful catheterization, Denise's heart had continued to deteriorate as her lungs filled with fluid. Doctors ultimately placed her on a respirator, at which point they also made the decision to transfer her to our CCU, which was better equipped to deal with such critically ill, unstable patients.

I grabbed a paper towel and dabbed my face. I had to get back to work. Denise needed the large IV to receive a cocktail of potentially lifesaving medications, and every second I spent in the call room delayed her treatment. When I reentered the CCU a minute later, Baio had already started the procedure. By the time I had put on my gloves and disposable gown, the IV had been inserted.

“Go home, dude,” Baio said as he walked out of the room. “Come back when you're ready to work.”

I shook my head, remembering some of the first words he ever said to me:
We have to work as a team. Everything is teamwork.

“Seriously,” he said, glancing around the unit. “Go. There's not much left to do today. Go.”

After a weak protest, I was on the southbound 1 train to my apartment, wondering how my absence might affect the others. What would they think? Exiting at Seventy-Ninth Street, I blew past my large Eastern Bloc doorman with a small wave before he could get a word out. Heather was still at work, seeing patients in her primary care clinic. I had the apartment to myself. I dropped my shoulder bag and spilled its contents—stethoscope, white coat, and a small bible called
Pocket Medicine
—on my living room floor, collapsed on the couch, and slept soundly through the night.

I woke the next morning to the caterwauls of small children outside my window, and immediately my anxiety came flooding back. How was I going to face the day? I had no emotional frame of reference for something like this. Something so grave, so awful. A swirl of questions bombarded my conscience. What had happened to Carl Gladstone after he left the unit? What would I say to Baio? Should I just keep the phone call to myself and move on? And was that even possible? If someone found out, were we in danger of being sued? I imagined for a moment having to tell people that I'd been a doctor for two days but then I accidentally killed someone. The thought made me almost throw up again.

I pulled an outfit out of my closet and took a deep breath as I recalled a small silver lining: my schedule today would take me out of the cardiac care unit in the afternoon, down to the other end of 168th Street to begin work in a primary care clinic. As part of my medical training, I also had to learn how to treat everyday complaints like back pain or the sniffles. Many residents found the transition to a slower pace more difficult; they included Baio, who warned that primary care would be the most painful part of my medical education. Other residents loved it, considering it a much-needed change from the frantic
pace of the hospital. Given what I'd just been through in the CCU, an afternoon spent in an office chatting with patients who were in no immediate danger of dying seemed like a godsend.

As the subway lurched northward into the dewy morning, I overheard two young men considering Barack Obama's chances in the upcoming election—both agreed he had promise but was ultimately too inexperienced—and my thoughts turned inward to my own inexperience. My medical school diploma hadn't yet been framed and already I found myself racked with guilt.

On the other hand, it seemed impossible that this was all my fault. I had told Baio my differential diagnosis on the anisocoria, but he didn't have to listen to me. He could make his own clinical decisions. His job was to show
me
the ropes. What the hell did I know? One might say this was really a case of faulty oversight. Still, I felt like shit trying to blame Baio, and either way it didn't change what happened to Carl Gladstone. Or maybe Baio hadn't listened to me; maybe he'd called my sedative suggestion “reasonable” but ultimately ignored it. What if I wrote a note that didn't reflect what actually happened to my patient? I was very confused.

My mind continued to wander, as it often did on the subway. Were these first few days in the hospital a sign of things to come or just a bump in the road? People enter medical school with the belief that they're on the path to becoming revered, trustworthy physicians, but what if I was destined to become the one colleagues whispered about? Maybe it would be safer to have me tucked away in a laboratory, tinkering with those imaginary numbers and—

“Excuse me, ladies and gentlemen!” a man in the center of the subway shouted. “It is your lucky day!”

I looked up to see a black man a few steps away dressed in a purple bathrobe and sandals.

“My name is Ali and I am an internationally renowned spiritual healer.”

I pulled out
Heart Disease for Dummies
.

“I have been blessed with the clairvoyant powers of my ancestral spirit and I am here to help you!”

Ali looked up and down the aisle, largely ignored, and raised his tawny arms. His facial hair had been fashioned into a Vandyke beard, and I guessed he was originally from West Africa. “My powers include, but are not limited to: bringing back loved ones, depression, substance abuse, debt, and impotence!”

The woman next to me put down her
New York Times
and looked up at him.

“I can also help with court cases, immigration status, breaking black magic, breaking curses, breaking jinxes, and all general demonic forces that may cause you trouble!”

He paced the length of the subway car, tying and untying the bathrobe. “Your pain is my responsibility,” he continued. “I can also help with success in business, success in sports, and SAT prep!”

He produced a stack of cream-colored business cards from the bathrobe pockets and handed one to me. It read:

A
LI
Y
OU
K
NOW
I C
AN
H
ELP
Y
OU
K
NOW
W
HERE
TO
F
IND
M
E

I put down the book and stared at the card. I wasn't a superstitious person, but at the moment I was willing to indulge almost any fantasy that my life could be improved instantly. Was this some sort of sign? After all, I did need help. I was unprepared for the extremes of emotion that medicine provided and found myself in search of something—a moral compass, a mood stabilizer—anything to get me through the ups and downs of hospital life. What if Ali was actually some font of wisdom who could provide sage if unexpected advice to guide me through my career?

As I rubbed the business card between my thumb and forefinger, wondering how Heather would react if I asked if Ali could move in with us, the neighboring passenger tapped my knee with her newspaper. “Last week,” she whispered, “this guy was selling candy for youth basketball.”