He clenched his teeth. “It was communicated to me. And there are phone translators in every room.” He scribbled down a phone number on an index card and handed it to me. “Use it.”
I looked at the numbers and tried to wrap my head around what was happening. I took a deep breath. “Okay.”
He closed his eyes and sighed. “That’s it. That’s all I have to say. I’ll give you one more chance to get this right.”
Then what? I was too scared to ask.
28
Two days later I found myself sitting cross-legged in a group circle in Palisades, New York, at the intern retreat, where for twenty-four hours we were given a much-needed respite from hospital life. It was a crisp afternoon at the IBM Executive Conference Center, a corporate refuge with tennis courts, saunas, and walking trails. Geese walked by as eight of us—one attending physician and seven interns—sat next to a small pond. The retreat was an opportunity to clear our heads—mental hygiene was the phrase of the day—but I couldn’t stop reliving the past forty-eight hours. The delirious interaction in Dr. Phillips’s office felt like a bad dream. I didn’t think I was wrong, but I hated to think a patient might be suffering because of me. And getting dressed down by Phillips about my competence in the wake of the needlestick and Dre’s departure made me ashamed and nervous.
“It’s a heck of a year,” the attending said. “This is a chance to just talk, off the record, about how things are going. No judgment.”
She was tall and thin with sandy-blond hair and a mole on her left cheek and had been in our position a half dozen years earlier. She turned to her right and nodded. “You first.”
The physician to her right, a thin, mustachioed Indian man hoping to become a cardiologist, held up his palms and said “Great,” then turned to his right.
“Excellent” came next.
“Fantastic. Every day I show up to work and witness a miracle.”
I rolled my eyes. No chinks in the armor of enthusiasm.
“Really wonderful.”
These were not the words coming to my mind. I could hear Baio’s voice whispering, Everyone breaks.
“Incredible.”
Twenty-four hours earlier, I’d gone down to the CCU to visit Benny, who now appeared gaunt and frail. Buds of gray hair sprang up from his normally bald scalp, and he spoke in one- and two-word sentences. The past few weeks had been hell for him, and the intubation process had reminded him just how close he was to death. It had been a mistake to conflate his physical health with my mental health. Life inside the hospital was like life outside the hospital—unpredictable and unfair. The intern to my left touched my shoulder—my turn.
“Well, it’s been a challenge,” I said, thinking of Gladstone and Dre and Dr. Phillips and my most recent bout of radioactive diarrhea. “I’ve learned a lot, but I wouldn’t say it’s been great.” I saw a mix of nods and blank faces; I felt for one of the pills in my pocket and rubbed it against my thigh. I was due for an HIV test in just under two weeks. It loomed on the horizon like Judgment Day.
The attending leaned in. “Would you like to talk more about that?”
I thought about all the shit that I’d been through. Intern year had worn me down—I could feel myself getting burned out—and I didn’t know how to stop it. I looked around the circle at the vaguely familiar faces and realized I had spent very little time with the interns outside of my pod. Meghan, Lalitha, Ariel, and I had grown a bit closer as the year had worn on—taking trips to Wendy’s whenever we could steal away a few moments from the hospital. We talked about families and past lives—Lalitha and I discovered that we had been in the same organic chemistry class as undergraduates—but mostly we just vented. We talked about the occasional ups but mostly the downs: the tonguelashings and errors and sleepless nights. It was difficult for each of us, but in different ways. We promised to keep the frustrations within our close-knit group of four, remembering that no one wants to hear from a whiny doctor.
“This is a safe space,” the attending said, prompting me to elaborate.
“Maybe later,” I muttered. I didn’t feel like sharing with this group of relative strangers. The old intern code of protection kicked in: mistakes are signs of weakness, and these people didn’t really know me. Vulnerability wasn’t the first impression I wanted to make.
It struck me how different this was from medical school, where I was friendly with just about everyone. We had classes in the morning, studied in the afternoon, and congregated in dorm rooms or apartments at night to socialize or study more. But in Manhattan, everyone lived separate, anonymous, exhausted lives.
“Certainly,” the attending replied and moved on to the woman next to me.
“Really rewarding,” she said.
“Okay, great,” our leader said. “So…I want this to be an opportunity to just talk. I have a few questions I’ll throw out to the group.”
A goose approached the circle, and someone threw a pebble at it.
“Has anyone seen something in the hospital that traumatized them?”
Silence followed by muffled laughter. “Where would I begin?” said another Indian physician, this one with a scruffy beard.
“Yes,” said a brunette. “Almost every day.”
Something had changed. You could see in the uncomfortable shifting around the circle that the question had shaken something loose. I wondered if each of my cointerns had an adequate release valve, a way to blow off steam after an awful day.
Those of us who felt ground down had an uneasy relationship with the hospital’s slogan: Amazing Things Are Happening Here! No doubt amazing things were happening every day, from breakthrough advances in treatment to saving lives that seemed lost; and part of the thrill was sharing in those successes. But some of us had no trouble in seeing the irony of the word amazing—the moments when getting spit on or physically threatened could leave you speechless. Many times, when sharing a particularly dispiriting story, an intern would turn the slogan on its head: “A patient barfed on me yesterday. Twice. Yep, amazing things are happening here.” It had become a kind of mantra for interns, a coping mechanism for trying both to appreciate the great moments of doctoring and to contextualize the tough ones. I couldn’t help but think the hospital PR office would have been aghast. But the more I thought about it, the more I considered it a brilliant tagline, a dead-on summation of our roller-coaster profession.
The leader smiled. “Would anyone like to elaborate?”
Eyes averted. More silence. “Okay, let’s switch gears. Has anyone made what they would consider a medical error?”
No one spoke. It suddenly seemed like a great time to take in our surroundings. Were we having even remotely similar experiences? Were we all destined to break? Suddenly I heard myself speaking.
“I did,” I said. I paused. I wasn’t quite sure why I had opened my mouth. A moment earlier, I’d had no intention of speaking. But here I was, on the verge of opening up. And the funny thing was I felt better already, just having said “I did.” It was the same feeling of relief I had experienced at Wendy’s telling Ariel about the needle stick and when I’d opened up to Dre. I was not a doctor who could live with these things unspoken or unshared. Maybe it was as simple as that.
“Same,” added the aspiring cardiologist.
“Me, too,” said another.
The attending nodded at me to go on. It seemed like I had an embarrassment of riches when it came to mistakes—which one to choose? The needle stick was a medical error, certainly, but I didn’t want to talk about that. Should I mention Dr. Phillips and his comment that he’d give me one more chance to get this right? I went with Gladstone. It felt the most resolved.
“In the CCU,” I said quietly, “first week of work, I had a guy with anisocoria.” Eyebrows rose, acknowledging the unusual condition. “I thought it was medication-related. But it wasn’t.” I considered how much to divulge. “It was…it was actually something entirely different.”
“I’ve done somet
hing like that,” the brunette said quickly. All eyes focused on her. “I thought someone’s cough was due to asthma,” she said, blinking her bright blue eyes, “but I got a chest X-ray and it was actually a pleural effusion.”
The attending smiled as the goose again approached our circle. “Matt, back to you. Did your patient have a bad outcome?”
I looked at the goose and softly said, “It’s…complicated.”
The attending rocked gently. “And, Matt,” she asked, leaning toward me, “did you apologize?”
I attempted to swallow. I had not been expecting this follow-up question. “I did not.” Heads hung; the brunette winced. “I wasn’t sure how to do it,” I said flatly. “Given the circumstances…I’m not sure it would’ve been appropriate. Someone else caught my error.” In theory, there were a million reasons why I didn’t apologize. But in reality there were none. I often thought I should’ve tracked down Gladstone’s wife and explained that if not for Diego, I would’ve made a colossal oversight, and the ramifications of that oversight gave me nightmares for months. But what purpose would that have served? I regretted the entire episode, but airing my self-doubt with a family member seemed unwise.
I looked around the circle at each intern. It was different from intern report, where I’d been convinced I was observing gilded personas. Here I saw a mix of emotions—some faces smiling, pretending that life was incredible! or perhaps just relieved to have some time away from the hospital. But others appeared anguished, deep in thought about an incident that may have taken place in the hospital. We were all quietly reflecting on something. Soon the silence became uncomfortable; I ached for someone else to say something. Anything.
“I made a mistake once,” the attending said. “Week before my wedding I had to put a chest tube in someone. The lung was filling up with fluid and the patient couldn’t breathe. I made the incision and the tube slid right in. Easy peasy.” She frowned and looked away from the group. “I sutured the person up, shot a chest X-ray, and realized I’d put the tube in the wrong lung.” She bit her bottom lip and ran her hands through her hair. “I think about that chest tube every time I do a procedure. I was thinking about it a week later when I walked down the aisle.”
29
Two days later and back in the hospital, I received a page from Dave, the chief resident who’d given the phlebotomy tutorial at intern report. I wasn’t sure what it was about—the message only asked, YOU FREE?—and I quickly tried to recall if I’d said or done anything that would warrant a face-to-face discussion with an administrator.
My mind immediately leapt back to the Palisades retreat, which had ended up being a cathartic bonding experience with the other interns. The realization that I wasn’t alone gave me the courage to really unburden myself; I’d ultimately described in detail what I’d gone through with Gladstone, with Peter and Denise, and with Dre, though I’d skipped the part about the needle stick. Over the course of the retreat, only a few people had refused to speak candidly. Many of my colleagues had opened up about what the daily traumas of medicine had done to their fragile psyches. The surprising part was how, despite all the vicissitudes of the recent months, I was not the most exhausted or damaged intern. During a group hike several of my fellow interns confided that they intended to leave the program before the end of the year. I felt better having heard their stories, but now I wondered if I’d said too much; if, despite the retreat having been a safe space, something had made its way back to Dave.
I tucked my pager back into its holster and headed toward the chief residents’ office. There were four of them, and each chief resident had just completed the Columbia internal medicine residency program and was now spending the year arranging conferences, teaching medical students, and keeping tabs on the mental health of the residents. They were liaisons between residents and the hospital’s administration, often serving as the bearers of bad news when a new regulation or oversight committee was foisted upon us. It was a great honor to be selected as a chief resident, and the position was frequently a pit stop for physicians applying for the ultracompetitive cardiology fellowships. (Diego had once been a chief resident.) I tried to imagine what the meeting was about as I hopped down three flights of stairs.
“What’s up, guy?” Dave said as I entered the tiny, windowless room. On his desk were four pictures of an attractive woman doing yoga. “Take a seat.”
“Hi, Dave.” We had spoken a handful of times, mostly before and after educational conferences. He liked to put a hand on my shoulder when we talked, and he evoked the image of an assistant coach—someone who was there to advise and guide me, but lacking the gravitas of a senior physician. There was an off-the-record feel to our interactions; he knew what interns were going through because he’d been one just three years ago.
I sat down and crossed my legs. “How are you?” he asked eagerly.
I smiled. “You know…hanging in there.”
He nodded vigorously and readjusted himself in his chair. “How do you feel?”
“I’m good.”
I found myself staring at the yoga lady. Dave took off his glasses and we sat in silence. “I’m going to get right to the point,” he said, clasping his hands together. “We’re worried about you.”
We locked eyes momentarily. “What?” I said.
“Five interns are leaving the program. That’s unheard of.”
It was true. I hadn’t been aware of the deep discontent among my peers until the Palisades retreat. “Well,” I said, with as much enthusiasm as I could muster, “I’m not going anywhere.” I wondered why the departing doctors were all men. No answer sprang to mind.
Dave put his glasses back on. “I heard about the error. The thing with the pupils.”
I flinched and looked away. It had taken place more than four months ago; why was he bringing it up now? Word must’ve trickled out from the retreat. “I thought that was confidential.”
“I also know about the needle stick.”
I felt a knot in my stomach; I wanted to know who else had spoken with him. I wondered if Dr. Phillips had told him about our conversation. Dave leaned back, pulled a handkerchief from his breast pocket, and blew his damp nostrils. I briefly closed my eyes and again felt the urge to disappear. “Look, people talk. What can I say?”
“You could say that stuff at the retreat isn’t actually confidential.”
His eyes scanned back and forth across my face. “Matt, this isn’t meant to be an inquisition. I’m just checking in to see how you’re doing.”
That wasn’t what it felt like. I was sick of the hot seat. “I’m…fine.”
“You’ve been through a lot.”
Ashley had once told me she didn’t want to hear that I was struggling. The whole complex hierarchy made it impossible to figure out when it was safe to vent and when not. But I was running out of patience. “Okay, Dave, I’m not fine.” I leaned back in my chair. “I’m not fine at all. Is that what you want to hear? I made mistakes, people are leaving the program, and…” The corner of his lip curled upward as he nodded. “And I might have AIDS.”
“You don’t have AIDS, Matt. But talking about this stuff is a good thing.”
It was making me feel worse. I had to take the HIV pills for ten more days, and then it was time for the blood test. Then I would know if I’d contracted the virus. Why did Dave want to talk about this stuff now? As I thought about what to say next, my pager went off. Perfect. I was getting the hell out of there. “I need to respond to this,” I said, without reading the message.
“Oh sure, sure,” Dave said, pushing the phone in my direction.
“No, it’s something on the floor,” I said. “I have to go see a patient.”
I extended my hand, and he smiled. “Good talk, Matt,” he said. “Let’s keep the lines of communication open.”
I had no intention of doing so. I felt my nostrils flare; I wanted to hit something. “Sure thing.”
I caught another glimpse of the downward-facing d
og and walked to the stairwell.
30
A day later, while sitting in on an informal talk by Dr. Chanel on the emergence of multidrug-resistant tuberculosis, I received a page from my faculty adviser, Dr. Petrak. A former chief resident, Petrak was now the junior faculty member responsible for providing me with clinical wisdom and career guidance. He was, in theory, the guy who would help me decide if I wanted to become a rheumatologist or a cardiologist. I excused myself from rounds and walked down the hall to his office.
I knew that every few months, I was supposed to review my faculty evaluations with Petrak and figured he was paging me to do so. I expected the initial evaluations to be weak—the Badass had scolded me for not knowing how to properly read a chest X-ray—but I knew I had made substantial progress. Both Ashley and Dr. Chanel had complimented me on my bedside manner with angry patients, and on the general medicine service I’d convincingly demonstrated that I could perform a poop check.
As I entered the office, I took in the diplomas and certificates of achievement that hung just millimeters apart from one another on a crowded beige wall. Dr. Petrak—a forty-something Lithuanian with bushy black eyebrows—stood up and smiled. Small framed pictures of his family were scattered across his desk.
“Dr. McCarthy,” he said, extending a hand. “Please…take a seat.”
“Thank you.”
The last time I had been in this office, a year earlier, Petrak was interviewing me for a spot in the residency program. Since then we had exchanged small waves and quick handshakes as we briskly passed each other in the hospital’s lobby, but that had been the extent of our contact. “How are you?” he asked.
“Good,” I said, removing my stethoscope from my neck and placing it in my coat pocket. “Very good.”
“Good,” he said as he sipped from a coffee mug. “Great.”
We stared at each other for a moment before he cracked his knuckles. “The purpose of this meeting,” he said, “is just to check in.”
The Real Doctor Will See You Shortly Page 18
