The Real Doctor Will See You Shortly

by Matt McCarthy

  I sat on the edge of the bed—doing so really did force me to listen. “So,” I said, taking her soft left hand in mine, “you were about to say you’re ready to get back on the meds.”

  She pulled her hand back slightly, but I didn’t let go. “Nope.”

  “Please.”

  “No, thank you.”

  I hadn’t yet asked her what she was so afraid of. Death? That couldn’t be it. Without the medications, she would die. Sure, I now found myself dealing with diarrhea so aggressive it occasionally left bloodstains on the toilet paper, but there was no other option. I tried to put myself in her shoes, but where did that leave me? In her position I’d take the pills. “Help me understand what’s going on.”

  “I’m impervious to your advances, Em.”

  I returned to my own fear. No amount of begging or reasoning could get me to strap on a parachute and take that leap. The only way I’d do it is if you pinned me down against my will and shoved me out of the plane. But here I was, in free fall. Could we forcibly administer HIV medications? “I’d like to explain where I’m coming from. What we know about your condition and what we still need to figure out.

  “Wasting your breath, Em.”

  But the skydiving analogy didn’t seem apt. In truth, I was far from a model patient—I routinely ignored the medical advice to wear sunscreen despite my family’s history of melanoma—but why?

  “Sometimes,” I said, considering what to say next. “Sometimes we do things…”

  And then I went for it. “I take HIV meds,” I said quickly. “I’ll take them with you.” It felt good to say it. I said it again, this time slower and louder. “I’ll take them with you.”

  “Oh, please.”

  “I will. I swear. I take them at home.”

  “Try again.”

  “I’m serious.”

  She squeezed my hand. “I’m blind, not naïve. Not—”

  “I give you my word.” Was this manipulative? Did it matter?

  “You have HIV?” She felt for the remote control near her pillow.

  “I might have HIV.” I inched closer. I could feel my voice about to quiver, so I whispered. “I stuck myself the other day with a needle. The patient had AIDS. And…”

  “And your fingers are crossed.”

  “Yeah.”

  She shook her head. “Ain’t that the shit.”

  I cleared my throat. “Do me a favor. Just take one pill, one time.”

  I took both of her hands in mine like we were reciting May-December wedding vows. I had a vague sense that I was making progress. She was engaging more with me than I’d seen with other doctors, most of whom she immediately waved away. It wasn’t much, but it was something.

  I wondered what exactly she saw, staring at me. “Fine,” she said. “One pill. One time.”

  “All right!” If Jim O’Connell could see me now! If there had been a wineglass I would’ve stepped on it. I suspected Dre was in denial about her illness, and I wanted her to break through that. I wanted her to become angry, I wanted her to pass through the stages of grief and accept that she had a very real, very treatable condition. I didn’t care if she used marijuana; I didn’t really care if she sold marijuana. I just wanted her to acknowledge what she was up against and realize she could win. Until that moment, I would remain frustrated. But here, I saw an opening.

  “And if that goes okay,” I said exuberantly, “we can do two. Two pills.” She had at most a few months before it was too late. “And then, three.”

  “I said one pill. One time. Keep talking and I might change my mind.”

  I let go of her hands and stood up. “Wonderful. See you tomorrow morning.”

  Dre and I still needed to confront the spinal tap and to get her there, to get her to agree to the procedure, I would undoubtedly have to go deeper still, searching for other ways to connect with her.

  Walking out of her room, for the first time, I felt like a real doctor. In the words of Baio, it was fucking cool.

  25

  “Great news,” I said to Ashley the next morning. We had exactly thirty-seven minutes to discuss twelve patients. “I talked Dre into taking the HIV meds.”

  “I don’t want to know what kind of freaky shit you had to do to get her to agree to that.”

  She broke into laughter and held up her palm. I touched mine to hers. “I almost got to second base.” I was still feeling exuberant.

  “You are sick.” She smiled and grabbed her coffee. “So what cocktail are we giving her?”

  “I suppose the all-in-one pill makes the most sense.”

  She smirked. “Atripla? Sorry. Wrong answer. Her strain is resistant. She’ll need something else.”

  There was no other all-in-one HIV pill. “Shit.”

  “She’ll need a combination of three or four pills,” Ashley said. “Good news is we have some options.”

  “Said she’d only take one today. Maybe the one with the least side effects.”

  “Also not an option. You have to hit the virus simultaneously from a number of angles with several different pills. Giving her one pill could make her strain even more resistant.”

  “She said she’d only take one pill today.”

  “Well, it won’t be one for HIV. That’s a nonstarter.”

  I clenched my fists in frustration. My big breakthrough was already going south and I’d barely had time to celebrate it. Worse, I worried that this would set back my growing relationship with Dre. She might see the news as a betrayal, or think I was playing with her emotions and not just an idiot who didn’t even check to see what kinds of pills she needed to take before trying to convince her to take them.

  Just before rounds I made the long march to her room. I felt like a parent who’d canceled a trip to Disney World and was about to break the news to my kids.

  “Bait and switch!” Dre howled when she heard the news. “Now it’s four? No, thank you.” She turned her back to me and pulled a sheet over her upper body.

  “Why do you think I’m being such a pain in the ass?” I asked. I tried to maintain my composure, but exasperation was starting to peek through. She didn’t move. We were back at square one. “Talk to me.”

  “You have no idea, Em.”

  She was right, I didn’t. I moved across the room and reentered her field of vision. My eyes were once again drawn to the innumerable lumps on her tiny face. I pulled a chair close to her bed and took a seat and began to plead my case. Did I have a case? Or should I just apologize for failing to understand the complexity of her disease? I explained how the medication worked, and why taking multiple pills was the only way to tackle her strain of the virus. But Dre was in no mood to listen. After twenty minutes of Beckettian back-and-forth, I threw in the towel and agreed to take one of my HIV pills—raltegravir—in return for her ingestion of a magnesium supplement. It was a paltry victory; we really only worried about magnesium supplementation in patients with cardiac problems. Dre had a number of issues, but heart disease wasn’t one of them.

  “Thank you,” I said as my pager went off. “Progress.” The spinal tap discussion would have to wait.

  YOUR PRESENCE IS REQUESTED IN THE CCU ASAP

  “Let’s go for two pills tomorrow,” I said, closing the door before she had a chance to answer.

  The page made me nervous—everything in the hospital was done ASAP—which made someone writing it out in a text page seem suspicious. The CCU was my old stomping grounds, where I had first met Baio, first met Ariel and Meghan and Lalitha, and where I had first encountered Carl Gladstone. I mostly considered the Gladstone chapter behind me; I had learned from a colleague that he had been transferred to a rehab facility and was expected to make a full recovery. I hustled down four flights of stairs into the CCU, reflexively whispering “ABC, ABC” until I was intercepted by Mark, a cointern.

  “Matisyahu!” he said, standing in the center of the unit with his hands on his hips. He had closely cropped, fire engine red hair and wore wire-rimmed g
lasses.

  “Still trying to make that happen?” I asked.

  “Got my page?” he asked. Mark, my puckish colleague, was informally known as the social chair of our intern class, always arranging happy hours and beer pong tournaments.

  “Yeah,” I said, holding up the pager. “What’s up?”

  He ran a finger across his upper lip. “Mustache race! You in?”

  I was still thinking about Dre. The bait and switch, as she’d put it, had definitely been a step back for us. Seeing Jim O’Connell work his magic had not quite left me prepared for the complicated, delicate trust building that it must have taken him to reach his most difficult patients. I remembered Sheryl, and the six years it took Jim just to get her to agree to one therapy session. I could see now how slow the process would be with Dre. It might take me weeks or even months to get to her, time she barely had. I should have been back with her right then instead of down in the CCU talking about a goofy contest. Would Dre or any of the other patients care if the interns suddenly sprouted mustaches? The question prompted thoughts of Axel and his nuggets of doctorly wisdom—don’t wear a bow tie, don’t buy a motorcycle—and I imagined him ripping into me for the mustache.

  Then the image of Dre’s off-white eyeballs came to mind; they were like two igloos, flipped on their sides. Her words stung me, and I suddenly wanted a distraction. Luckily, there was one right in front of me. I put my hands on my hips, mimicking Mark. “I believe I am. I’m in.”

  I looked around the unit—it was strange to be back—and felt relief knowing that I wasn’t responsible for any of the patients. This was a social visit. “I really can’t wait,” I said, feigning a bit of enthusiasm in the name of professional camaraderie. It occurred to me that the next time I’d be working in the unit, it would be as a second-year resident, teaching an unseasoned intern how to be a doctor.

  “Nice! Gloria is going to judge. Be great for morale.”

  Gloria was the residency program’s senior administrator—an ageless, zaftig Latina who never missed a chance to socialize.

  “I should warn you,” I said, “mine comes in red.”

  “Amazing!”

  Mark seemed perfectly at home in the unit, somehow insulated from the weight of his work. Like Baio and Moranis, he genuinely seemed to enjoy practicing medicine. I wondered what his secret was. I had noticed how many interns, myself included, appeared at times to be faking it. Putting on a smile when we were delirious with exhaustion or enthusiastically offering to transport a patient or draw blood when in reality, we just wanted to go home and eat dinner. The gilded personas were omnipresent, but Mark was different—he didn’t seem like the kind of guy who would dwell on mistakes or on success. He would probably try his best with Dre and then move on.

  “Hey, that’s your guy over there, right?” Levity evaporated as Mark pointed to the bed formerly inhabited by Professor Gladstone. A crowd of doctors and nurses hovered in front of the room. “Didn’t I see you talking to him the other day?”

  I stood on the balls of my feet and saw Benny, who looked like he was on a roller coaster—his teeth were clenched as he tightly gripped the bed’s guardrails. “Oh, shit,” I said softly, “shit shit.” He was gasping for air when an anesthesiologist stepped in and obscured my view.

  “He flashed,” Mark said. “Not sure what tipped him over. Probably have to intubate.” Flashing meant his lungs were suddenly overwhelmed with fluid, like a flash flood. It happens when the heart fails to pump sufficiently; blood backs up into the lungs and creates a sensation of drowning. A common culprit, particularly for a guy like Benny who was waiting for a new heart, was dietary indiscretion. I thought of the Snickers bar. “Jesus.”

  I wanted to run over to him, but the room was full. Someone was about to attach Benny to a ventilator. I clutched my chest, anticipating the phantom pain of a large tube sliding down my own throat. But I felt nothing. I just stood there, stunned at what I was seeing. Benny was drowning in front of my eyes, drowning in his own bodily fluids. How could I be so powerless to help him? Or to help Dre, for that matter? A resident tilted Benny’s head back, and the large plastic tube was snaked down his throat. A moment later, a machine was breathing for him. A narcotic was quickly plunged into his IV to ensure he was sufficiently sedated.

  “Hope he makes it,” Mark said.

  He sounded like any doctor with a healthy emotional investment in his patients’ outcomes. I wasn’t that doctor. I didn’t know what I’d do if Benny didn’t make it. “Fuck.”

  Mark glanced at his pager as we stretched to get a better view of Benny. Mark lightly punched my left arm. “Looking forward to the epic ’stache. Now back to work.”

  And with that he strolled into Gladstone’s old room and calmly ordered a series of medications designed to remove the fluid from Benny’s lungs as I looked on, frozen in space. The smiling man who could ride a stationary bike for an hour couldn’t safely eat a Snickers bar without causing a flash flood in his lungs. On tiptoes, I stared blankly at the ventilator until my pager went off: YO, WHERE ARE YOU?—ASH

  I silenced the pager, pulled out my scut list, and headed back to the HIV floor. In the hallway, I ran into Baio, who was staring down a vending machine. I sidled up next to him and looked at the row of Snickers bars. We hadn’t had a substantive conversation since our time in the CCU together. I wondered if he knew about my mishap on the HIV floor.

  “I heard,” he said, carefully inserting a crumpled dollar bill. “Fuckin’ sucks, man.”

  Of course he knew. “Word travels fast.”

  He stared intently at the machine as it spat out his dollar again and again. I wanted to take the bill and insert it myself—to say something clever and walk away. The teacher becomes the student or something.

  “You’ll get through it,” he said. “You will.”

  “Yeah,” I said. “You wouldn’t believe all the pills.” I was due to take another in half an hour.

  “Hey, at least the guy didn’t have hep C.”

  “Funny you mention that.”

  “No!” he said, running his hands through his hair.

  “I went back and looked. HIV and hep C. Daily double.”

  I wondered what he saw when he looked at me. Did he ever wonder what I was doing in the hospital? How I was progressing as a physician? Did he ever think about our time together in the CCU?

  “You’ll be okay,” he said.

  “Hope so.”

  “No doubt.”

  The machine accepted his dollar. “Is that a thing,” I asked, “just tell everyone they’re going to be okay?”

  “Nah.”

  “Really?”

  He smiled and patted me on the back. “Yeah, it’s a thing.”

  26

  The sky was slate gray the next morning as I stepped out of my Upper West Side apartment building and headed to the subway, reformulating my case to Dre. It had been all I could think about overnight, as I read and reread the various notes I’d made to myself throughout the previous day. When I had gotten home from work, Heather could tell I was in need of a distraction and had taken me out to a BYOB Indian restaurant to get my mind off things. But I found myself unable to talk with her about anything other than the hospital—my patients, my pills—and I doubled over after I tried to take my first sip of beer.

  I wasn’t much of a conversationalist with her these days; I picked at my tikka masala as I stared off into space, trying in vain to divorce work life from my private life. But I was consumed by thoughts of Dre and Benny and of my own medical condition. Heather offered reassurance on a daily (and sometimes hourly) basis, but it was of little use. We both knew statistics were on my side, but what if I was the outlier? Shortly after boxing up the leftovers, I crawled into bed and drifted off to sleep, returning to Dre and the lumps on her face. She ultimately needed to be on nine different medications, which I hoped to achieve, one by one, as soon as possible.

  It had been a fitful night of sleep—I’d scarfed down the l
eftover Indian food at 3:00 A.M. and spent the next hour checking my email—but as I strolled toward the uptown subway station, just as the morning sun was rising above the East River, I realized that Ashley was right. Under her gruff exterior, Dre did kinda like me. It wasn’t quite like the relationships Jim O’Connell had with his patients, but it was something. It might give me enough of a toehold to get past the bait and switch. As I hopped on the 1 train toward Washington Heights, the idea of a career spent using unconventional methods to work with only the most difficult cases took hold of me.

  Oh, McCarthy’s the guy who touches faces. Like an even weirder Patch Adams, he’s not for everyone, but there’s a method to his—

  A lavatorial whiff of the 168th Street subway stop—sulfur and saliva today—cued me that it was time to stop daydreaming. As I stepped into the Tuberculator, my thoughts returned to the silver screen and my favorite movie, Groundhog Day, where Bill Murray relives the same day again and again. Life at Columbia, which often took on a cinematic quality, was the antithesis of that film. I liked to think that was a good thing. My experiences outside of work, by contrast, were relatively unremarkable. When Heather and I could eat, we ate; when we could sleep, we slept. And if the mood struck us, we devoured episodes of Lost. But the needle stick had upended all of that. Now I routinely found myself at home, nodding through dinner or staring at a wall, trying to regain the physical and emotional energy to handle the rigors of my job, while contemplating an uncertain future and uncomfortable possibilities.

  The news wasn’t all bad. Benny had been stabilized and was expected to come off the ventilator in the next twenty-four hours, after the fluid was removed from his lungs, and Ashley had commended me in front of Dr. Chanel for convincing Dre to take the magnesium supplement. They were small victories, but they felt like something I could build on.

  “Two pills,” I said to myself over and over as I approached the hospital. “I know you can do it, Dre.”

  I exited the elevator and made a beeline for Dre’s room. I knocked on the door and called her name, but there was no response. “It’s Em,” I said loudly as I opened the door. The room was empty. “Dre?” I wrinkled my brow and wondered where she could be. Patients often left the floor for imaging studies, but I hadn’t scheduled anything for her. As I stared at her empty bed, an elderly white woman was wheeled into the room by a nurse.