The Real Doctor Will See You Shortly

by Matt McCarthy

  “Tough crowd,” Ashley said, patting me on the back.

  “Yeah.”

  “Give it another shot after lunch. She likes you.”

  “She hides it well.”

  “I saw the way she let you paw her face.” I’d noticed a change in Ashley’s demeanor toward me. The drill sergeant act had been cast aside; in its place was someone who was treating me with kid gloves. I couldn’t tell if that was a good thing.

  We walked back to the conference room and finished rounds. As Lalitha, who had been up for more than twenty-four hours, presented the next case—flawlessly maintaining the role of exuberant, compassionate, put-together intern—I stared at the small clock on the wall, counting the minutes until I was due for my next dose of comic book villains. I thought of the burnt-orange football and of the astronaut pill. The medications tasted rather bland, except for ritonavir, the sweet one, which was encased in a sugary capsule and tasted like a Flintstones vitamin. I wondered if Dre took any of these pills, or if she’d forgotten what medications she was on and felt embarrassed. I was tempted to leave rounds and show them to her, but I wasn’t sure what she’d be able to see. Was it wise to show a legally blind woman a handful of pills and ask if they looked familiar?

  As Lalitha began drawing on a marker board, I felt for the pills in the pocket of my white coat, rolling each one back and forth in my fingers, wondering exactly how long they would be a part of my life. It was a mistake to think about my own condition when we still had patients to discuss, but I couldn’t help it. Dr. Chanel said I had to take the assortment of medications for a minimum of four weeks but possibly longer. Possibly forever.

  —

  “Your luck continues,” Ashley said after rounds. “Today is intern report.”

  I shook my head. “What’s that?”

  “I hold your pager for an hour while you have lunch with the other interns and vent.”

  The thought appealed to me, mostly. I had so much I wanted to say and discuss. Were others slogging through internship the way I was? Or were they gliding effortlessly, as I imagined Carleton would. I still hadn’t met all of the interns—spending three years in a pod of four would undoubtedly have its benefits, but the isolation also seemed a significant drawback. Of the group I had started the year with, I’d probably spoken to only half. I had shared a beer with only a handful and rarely seen anyone let their guard down. We were all trying to fit in as real doctors while maintaining our pristine, gilded personas. It was exhausting.

  “If nothing else,” Ashley said, “it’s an hour break.”

  I slipped out of the conference room and headed down a long corridor, feeling my stomach rumble along the way. It was almost time to pop the pills. Replaying my appeals to Dre, I considered new tactics. Good cop? Share my own experience? Beg.

  I entered the standing-room-only intern report, where a youngish physician—a chief resident named Dave—stood before a marker board addressing close to forty seated interns. In his left hand was a butterfly needle and in his right was a tourniquet. I scanned the room for familiar faces as I meandered toward the paper plates, soda, and pizza.

  “Seven needle sticks already this year,” Dave said loudly, adjusting his glasses. “Far too many.” A few eyes from the crowd looked in my direction as I took my first bite. “This should really be second nature by now.” I felt a swirl of anger when his eyes met mine. This was supposed to be a venting session, not a harangue. “We’re going to review the basics of drawing blood today,” he went on. “The key to this, as in any procedure, is to focus. You can’t be in a hurry and you can’t be sloppy. Take pride in your work.”

  I felt like he was talking directly to me, suggesting that my mishap had something to do with a lack of respect for the profession. But as I processed the words and looked out at the room, I also felt a sense of relief. I wasn’t the only one. My colleagues were sticking themselves, too. In theory, we weren’t even supposed to draw blood—the hospital hired professional phlebotomists to do that. But if one of them failed to find a vein or was unable to convince a patient that the blood test was necessary, we were called in for mop-up duty. There had been no orientation seminar on how to draw blood, no guidebook or instruction manual. As with so many other things, we had been forced to figure it out on our own.

  I scanned the room, looking at each intern’s face, searching for a glimpse of discomfort or anguish—a sign that someone else was dealing with the fallout of a needle stick. But what I mostly saw was exhaustion. As the greasy pizza was devoured, I caught several interns surreptitiously tapping their hips, checking for pagers that, for this solitary hour, were not there.

  A hand grabbed my arm. It was Ariel. Her tangle of frizzy red hair was now in two pigtails like Pippi Longstocking. “Let’s go,” she whispered, ushering me out of the room. “Wendy’s.”

  We walked down the hall in silence, finishing our pizza. It was the first real food I’d eaten since the falafel cart. Ariel smiled and gently patted me on the back, like I was a child and she was encouraging me to eat.

  Due to our call schedules, I’d spoken to Ariel more on rounds than in private. She knew almost nothing about me and I knew exceedingly little about her, but I suddenly felt like we were old friends; we had shared a lot of experiences as pod mates, enough for her to feel protective of me when intern report promised to be more anxiety-making than calming. I appreciated that she was getting me out of the hospital. “The way I figure it,” Ariel said when we stepped into the empty elevator, “you could teach that class.”

  “Thank you for saving me.”

  As the elevator plunged toward the lobby, I felt an anger bubbling up inside of me. Sure, there had been six other needle sticks this year, but how many of them had involved HIV-positive blood? How many interns had been handed a sack full of HIV pills to hide in their lockers? How many were worrying if they’d be able to have a child without passing on the virus?

  The wave broke as we exited the hospital. “Fuck!” I blurted as we walked down the street together. “I feel like fucking shit! Fuck!”

  Rather than ducking my words, Ariel leaned in and intentionally bumped shoulders with me. “Fuck and shit?” she asked. “I hear that’s bad.”

  “Fucking shit.” I laughed. “Also bad.”

  We walked south along Broadway, mostly in silence, and reached Wendy’s a few minutes later. “Two double cheeseburgers and two Frosties,” I said, assuming my companion was not a vegetarian. I imagined Ariel in her previous life as a consultant, having a steak lunch with clients in midtown, discussing profit margins.

  “Still have your appetite, I see.”

  “Sort of.”

  “I can’t imagine,” she said, “what yesterday must have been like.”

  “I don’t really want to talk about it.”

  “Neither do I,” she said as we brought our food to a small booth. We toasted Frosties and reflexively felt for our absent pagers.

  “You ever watch Saved by the Bell?” I asked, still thinking about Dre’s marijuana and my decision to report it.

  “Once or twice.”

  “There’s this scene,” I said, preparing to quote what was arguably the show’s most famous line, “where one of the girls, Jessie Spano, gets hooked on caffeine pills and has a meltdown. She starts crying and screaming I’m so excited, I’m so excited, I’m so scared.”

  Ariel dipped her pinkie finger into her Frosty and smiled. “Matt, are you having a Jessie Spano moment?”

  Ariel was a soft touch; she could shoot the shit with anyone. As the weeks went by, I was discovering that there were two types of interns: those who had gone straight from college to medical school to internship, and those, like Ariel, who had not. The latter group seemed to have a distinct, more comfortable way of interacting with patients. I thought about the way she had delivered the new HIV diagnosis to the young woman. It was a difficult spot to be in, but she’d handled it well. Better than I would have, certainly. Her approach was less frantic, less
forced. Perhaps it was simply age and maturity, or maybe it was something else.

  As we ate our food, I thought about telling Ariel about the needle stick—as if going through each painstaking detail would help me move on. But the words didn’t sound right in my head—it felt like I was seeking pity, or looking to sensationalize a mistake. Ariel wasn’t my therapist and she wasn’t my doctor.

  “You know,” I said, looking out of a large window, “this stuff we do all day…it’s a weird job.” She nodded. “It’s like it could be a movie. Or a TV show. Or a book.”

  She grinned.

  “And sometimes,” I went on, “a lot of the time, actually, I just feel like things aren’t clicking.”

  “I know what you mean.”

  She had graduated at the top of her class. I wasn’t sure if she was just humoring me. “Really?”

  “Yeah.”

  “Sometimes I worry I’m a hazard—to myself, to the patients.” I suppose I did want to talk about it. The needle stick had further undermined my self-confidence, and it was eating away at me. I needed to tell someone so I wasn’t dealing with it alone. “I don’t feel that way all the time, but sometimes I do.”

  “We could drop you in one of those hazmat bins.”

  “You think I’d fit?” I asked, raising an eyebrow.

  “Matt,” she said, putting down her burger, “it was an accident. You heard: seven sticks already.”

  “And,” I said, “I have to wonder, temperamentally, if this job is—”

  “Hold that thought,” Ariel said as she stood up. “Let’s get another round.”

  We got back in line and reviewed the menu—there was something decadent and mischievous about ignoring medical advice and gorging ourselves on double cheeseburgers and Frosties. I imagined thousands of tiny French fries clogging my arteries.

  “I feel like…” I considered the proper way to phrase my vague unease. “This sounds silly but…I feel like I’m a wall that needs to get painted. And every day a bit of paint gets splattered on me.” Ariel grinned. “It’s like every time I see a new patient or a new case, a bit of paint gets splattered.”

  “What color paint are we talking about?” she said, popping a French fry into her mouth, “just so I’m with you.”

  I looked at the ketchup packets between us. “Red.”

  Now we both grinned.

  “A lot of days,” I went on, “I see the same shit—heart failure, pneumonia, blood clots—and the same parts of the wall get painted. But there are these huge blank spots on the canvas. Reading about cases does nothing for me. I fall asleep before I can finish a page. I have to see it in person or it never happened. But what about rare diseases? What’ll happen when I’m the attending and I’m confronted with a dying patient and a constellation of symptoms I’ve never seen before?”

  “I feel the same way,” Ariel said flatly. “Can’t learn medicine from your sofa.”

  Ariel might have been humoring me—I imagined she had glided through her rotations much in the way that Carleton would—but I doubted it. It felt like she was similarly in search of a way to learn everything about everything.

  “And now, of course, I’ve got other shit on my plate.” I shook my head and glanced down at my finger. “I still can’t believe it.”

  “We’re all dealing with something.”

  I waited for her to expand on the thought. I wanted to know what she was dealing with. Had she made mistakes? Been talked down to? Or yelled at? Was she befriending patients like Benny? I hadn’t seen any of that, possibly because I was so wrapped up in my own world, just trying to get through each exhausting day.

  I waited and waited but Ariel didn’t elaborate, and I wasn’t sure how much I could push. I wondered if her reticence had more to do with giving me the chance to vent or with keeping her cards close. It would’ve been the reflexive thing to do. Even intern report, ostensibly a place for new physicians to let their guard down, had turned into a remedial tutorial on the basics of phlebotomy.

  Ariel turned her head to look outside. She again felt for her absent pager.

  “Anyway,” I said, breaking the silence, “I can assure you this damn needle stick is singed into my brain forever. And I will never, ever forget the side effects of HIV meds.”

  “I bet.” She raised her Frosty. “You’re going to be okay.”

  “You think?” Lie to me, I wanted to say, lie to me if you have to.

  “One day this’ll be just another splotch of blood on the wall.”

  “Paint,” I said, smiling as I dabbed my right index finger with ketchup. “Let’s stick with paint.”

  Ariel glanced at her watch and we stood up; playtime was over. We had pagers to retrieve and patients to see. And I had a date with a bagful of HIV pills.

  24

  “My gift to you,” Ashley said, handing me my pager ten minutes later. “Thing never stopped buzzing.”

  “Gracias.”

  “How was intern report?” she asked.

  “Fine,” I said. “Listen, I’m gonna give it another shot with Dre.” On the walk back from Wendy’s I had tried to think more about how to break through to her. I hadn’t come up with much, but I felt momentarily invigorated by my lunchtime heart-to-heart with Ariel. “I think what she needs is some tough love.” I imagined what Ariel might say to Dre. “Or the opposite. I really have no idea.”

  “I wanted to talk to you a bit more about her. Something that didn’t come up on rounds.”

  “Of course.”

  Ashley pulled out a sheet of laboratory data. “Do you think she needs dialysis?”

  I scratched my head. “Someone mentioned kidney disease, but I’m not sure she needs dialysis.”

  “Why not?” She batted her hazel eyes. “Walk me through your thought process.”

  “It’s going to be a short walk.”

  “Try.”

  “Her creatinine is almost three,” I said, referring to the blood test that reflected kidney function. A normal value hovers around one. “Not great but not horrible.”

  “Fine.”

  I recalled the handful of patients I’d taken care of with kidney failure. “Dialysis is usually an emergency.”

  “Sometimes. But not always.”

  “Okay. I mean, she looks stable. Sick but stable. I can call and arrange dialysis, certainly.”

  “When you call, you have to make a case for it.” She put her thumb and index finger together and stared deep into my eyes. “The nephrologists are busy and it’s a pain in the ass to dialyze someone. You gotta have a leg to stand on. What’s your argument?”

  “I’d say her kidneys are only marginal and to be on the safe side we should do it.”

  “Wrong!” She made the sound of a gong. “Never say ‘to be on the safe side.’ We’re in a hospital—that’s a given.” She took a large swig of her latte. “Remember your med school lectures on dialysis?”

  “Vaguely.”

  “It can all be distilled down to this: A-E-I-O-U.” She motioned to my breast pocket, and I pulled out a pen to take notes. “A. Acidosis—is the patient’s blood acidic? If so, dialysis. E. Electrolytes. If an electrolyte is severely off—”

  She pointed at me.

  “Dialysis,” I said.

  “Good. I. Intoxication—did the patient ingest something toxic like moonshine or overdose on something like lithium?”

  Dialysis had always confused the shit out of me. Was it really this straightforward?

  “O. Overload. Is there fluid overload—too much liquid on the lungs?”

  Her approach on this recalled Baio’s, and I knew I wouldn’t forget it. The truth is that complex decisions are often made using simple mnemonics. Linguistic shorthand wasn’t encouraged at Harvard—information needed to be mastered before it could be abbreviated—but Ashley had just simplified a series of baffling medical school lectures on dialysis into a mouthful of vowels.

  My pager went off in mid-scribble. I glanced down at it.

 
THE GREAT MUSTACHE RACE—YOU IN?

  I tilted the pager out of Ashley’s line of view. “U. Uremia,” she said quickly, “and that’s it. A-E-I-O-U.”

  “Wow.”

  “Next year, the Ash Safety Net disappears,” she said, putting a warm hand on my shoulder, “and the Republicans take over. You’re on your own. That said, you’re doing a good job. Just try to relax a bit.”

  I no longer felt like deadweight, and she no longer seemed like an annoyed babysitter. Was it because of the needle stick? Or something else? She knew I stayed late and arrived early, that I cared deeply about my job and that I wanted to get better at being a doctor. Perhaps I had earned her respect and she felt invested in me as a member of her team. Or maybe she just felt bad for me. I wanted to know what had changed, but I couldn’t figure out how to ask.

  “All right,” I said, standing up, “thanks for that mnemonic. Time to joust with Dre.”

  “Good luck.”

  “Any final words of wisdom?”

  She stood up and clasped her hands together. “Get on your knees, Matt, and grovel.”

  “Seriously?”

  “I don’t know. What would you want to hear?”

  —

  As Ashley scuttled away, I stared at the Impressionist seascape hanging on the wall and racked my brain. How had I been talked into unsavory things in the past? Fear, deceit, alcohol, and money came to mind—tactics that weren’t appropriate here. I’d jumped at the offer of HIV medications, but that scenario wasn’t really applicable either. My biggest fear was skydiving. How could someone talk me into jumping out of an airplane? They couldn’t. I wouldn’t even consider doing it. What would Jim say to Dre? Or Baio?

  I had a new tactic in mind, one that was risky and would potentially leave me exposed, but I had a hunch it might work and I was running out of options. I simultaneously knocked and opened the door to Dre’s room a few minutes later. “That you, Em?” she asked.

  “How do you always know it’s me?”

  “Smell,” she said, leaning back in bed.

  “Seriously? What smell?” I glanced at my armpits.

  “I’m playin’! It was just a hunch.”