“Come in, come in,” he said, waving me toward the distressed leather chair in the corner of the room.
“What’s new?” I asked.
He muted the television and shook his head. “Nothing new. Nothing new with me, nothing new with the Knicks. You?”
“Same ol’ stuff,” I said, taking a seat. I stared out at the Hudson River, as I had so many times, wondering if it was going to freeze over. The river was nearly still, its dark water bleak and ominous, and I momentarily felt the urge to compare it to Benny’s predicament. “Almost halfway through the year,” I said. Benny wrinkled his brow, perhaps contemplating a mental calendar, before I added, “almost halfway through intern year.”
“Right! Congratulations. You’ll be running this place soon.”
We both smiled. “I hope not.”
Our eyes gradually drifted to the Knicks game, and I tried not to ask the question I always asked, but I couldn’t resist. “Anything going on with the wait list?”
“No news is bad news,” he said softly, like air being let out of a balloon.
We stared at the television impassively as I thought of something to say. I worried that my constant reminders of the wait list weren’t helpful. Just because I thought about it didn’t mean he needed to. Did forcing this kind man from Miami—a guy who’d spent most of his childhood on a beach—to talk about his limited, difficult life help him in any way? Probably not. I needed to change the subject.
“But I have faith,” he said. “I know God has a plan.”
He had said this many times before. Over time it had become clear to me just how deep Benny’s faith ran. It was, strangely, the biggest chasm between us. At first, it embarrassed me; then it angered me. How could he believe that this was all part of a master plan, that a supreme being was choosing to confine him to a hospital, waiting for a heart that might not ever come? Then I came to see that, our caregiving notwithstanding, his faith was the primary thing keeping him alive. His perpetual good nature, his resilience in the face of countless near-fatal setbacks—all was built on the foundation of his belief that God would take care of him. I had to admire the intensity of his belief, even if I couldn’t share it.
“It’s not fair” was all I could muster.
My tired eyes drifted down from Benny’s face to his light blue hospital gown, and as I zeroed in on his chest, the Bee Gees song “Stayin’ Alive” began playing in my head. What if Benny’s frail heart gave out? Would I be able to lunge into action? Would I be able to bring him back to life? Could I perform chest compressions so vigorously that his ribs might crack?
“What?” he asked. “What’s not fair?”
But my mind had already moved on. Our conversations were often like this—clumsy, uneven, awkward. Prolonged silence often followed an unanswered question. I routinely lost my train of thought in mid-sentence, remembering that there was something else I needed to do for a different patient on a different floor. There was a condition called ICU delirium—living in an intensive care unit can cause profound cognitive impairment—and I occasionally wondered if he had it. My sleep deprivation certainly didn’t help things. We were two delirious guys, just trying to hold a conversation.
“Medicine,” I said, feeling my voice tighten, “is the only place I can think of where everyone is miserable. Doctors are miserable, patients are miserable, support staff is—”
“I’m not miserable,” he said. He turned his head away from the television and locked eyes with me. “Really, I’m not.”
I knew he was telling the truth. But it still confounded me. When a patient yelled at me or an error was made, it was easier to think of something else—to think of Benny—and transfer the anger or disappointment in my own moment to the faceless system that had wronged him. But there was no one person to blame for his situation. Certainly not his doctors, who vigorously advocated for him at the weekly transplant meetings, not the nurses, not the organ donors, not even the administrators at the UNOS organ-sharing network, who had carefully crafted an algorithm to remove subjectivity from the allocation process. There was no one to blame, no one to silently curse. But that didn’t change the way I felt. He said he wasn’t miserable, but I felt that way for him.
“The whole thing is bullshit,” I said under my breath. I again wondered if I’d crossed the line between patient and friend. Technically he was no longer my patient; he was just another guy stuck in the hospital over the holidays. He was more than that, though, and we both knew it.
“Well, today I am miserable,” I said, looking at the clock. “I’m on hour seventeen of thirty. These shifts are insane.”
Still, I felt no urge to get up. Even though I was inching my way out from under the microscope, I had not yet totally recovered from Dre’s wordless departure. Calibrating my emotional investment in patients still filled me with anxiety. It was easier to live behind the wall, to stay detached, which was fine but for the lingering feeling that each time I withheld some piece of myself from my patients, I was doing them a disservice. I balanced the guilt with a rational explanation: I didn’t need to relate to my patients’ pain because it was all I could do to handle my own. But underneath the excuses my need to connect with patients still existed; it was a fundamental quality of the doctor I wanted to be. I suspected I was spending more time with Benny to compensate for the barricade I’d constructed for others.
“Don’t know how you guys do it,” he said. “I really don’t.”
“I’m gonna look like ass in the morning.”
Benny’s attention returned to the television, and I reflexively checked my pager. I felt awkward eliciting his sympathy. He didn’t need to hear how long I’d be in the hospital or how tired I’d be in the morning. With all that was going on around him, I doubted he ever got a decent night of sleep. But complaining had, for so many interns, become second nature. It may even have been part of the twelve-step process toward breaking. Enthusiastic intern becomes bitter intern becomes broken intern. “Some of it’s great,” I added, “but some of it is rough.”
Benny turned off the television, and I took this as a sign that I was allowed to vent. There was so much I wanted to say, so much of the quiet hellishness of an intern’s life that I wanted to describe. Why did Benny need to be the one to hear about it? Because my colleagues already knew what it was like and people outside the hospital would never understand. But Benny Santos, professional patient, was a man apart.
“Talk to me,” he said.
I took off my white coat as a symbolic gesture that I was now talking as a friend, not a physician. “So many things go into being a doctor,” I said, “connecting with patients, medical knowledge, performing procedures—and on any given day you can consider yourself a failure at one of them. Or all of them.” He nodded. “You can beat yourself up to the point that you’re ready to quit. But on the other hand…at any moment you can look around and say, ‘I’m better than that guy. I’m a better doctor than her.’ ”
“Huh.”
“So much of it is mental.”
“I can imagine.”
“I’m sure you can.”
“It’s like sports,” he said, pointing to his head. “All mental.”
“It’s like you have to trick yourself into thinking you should stick with it. And to be honest, I resent the fact that some of my buddies—the same ones who could never get into medical school—are making ungodly sums of money while Heather and I are hundreds of thousands of dollars in debt.”
Benny looked away, and I realized I’d said too much. I glanced down at my scut list, embarrassed that I was complaining to someone who had so much more to complain about. It felt good to vent, but then it didn’t.
“How is Heather?” he asked. “She good?”
“She’s great.” I didn’t mention that residency had also affected my personal life. Intimacy was something that now almost had to be planned. And when we discovered that we had a night off together, it was euphoric. Otherwise it was like being in
a long-distance relationship with the person you live with. I stared at Benny, lost in his big, wet, brown eyes. I knew I was talking too much. “Tell me about the Knicks,” I said.
He didn’t tell me about the Knicks. Instead, he clasped his hands like he was about to pray. “You guys,” he said, “give me hope. Makes me feel like you’re invested in me. Invested in what happens.”
The comment caught me off guard. I tried to think of something significant to say. “Of course we are.”
Benny shifted positions in his chair. “I meant to ask, Matt, what happened with that test?”
My mind quickly scanned all of the daily tests, both literal and figurative, and drew a blank. “What test?”
“Few weeks ago I passed you in the lobby and you said you were having a test. Or getting the results of a test. A blood test.”
Oh, right. That test.
After I’d completed my ridiculously complex regimen of pills, a series of blood tests had been arranged to determine if I’d contracted hepatitis C or HIV. The intervening days—after the blood was collected and while the tests were being performed—had been some of the most nerve-racking of my life. I was unable to sleep, I was distracted on rounds, and if I thought too deeply about the possibility of living with HIV, I dry-heaved. I had bounded past Benny in the hospital’s lobby on my way to see Banderas to learn the results.
“Right,” I said. “I forgot we bumped into each other.”
I briefly closed my eyes and considered what I had told Benny and what I wanted to tell him. I knew so much about him, so much about his medical history and his personal history, so much about the contours of his skin and his allergies and the unique way his heart murmured, but he knew relatively little about me. I had mentioned the needle stick in passing but hadn’t told him about the HIV risk or the pills. It felt unfair to burden him with my issue when he was dealing with so much more. But maybe I should have. Isn’t that what genuine friendship is actually about?
On the morning Benny was referring to, I’d woken up at 4:15 and popped out of bed knowing that my test results would be available later that day. I’d yanked a dress shirt and tie out of my closet, imagining myself as a sickly young man, a doctor with a chronic illness in need of a new wardrobe, with smaller clothes that would fit my withered frame and long-sleeved T-shirts to hide the skin abscesses that were destined to appear on my arms. I’d skipped breakfast and braced for the worst.
I’d kept my head bowed on the subway to work, silently praying that things would turn out okay. In between prayers, I’d glanced around the train for Ali—the fraudulent spiritual adviser, my fraudulent spiritual adviser—but I wasn’t sure why. Perhaps I took comfort in familiarity; I liked the pretend powers I projected onto him. He was a sign of normalcy. At that point, I would’ve taken any sign that I’d be okay. If Ali was on the train, being weird, all would be right in the world.
During rounds, I had quietly counted the minutes until Employee Health opened and sprinted toward Banderas’s office the moment I could excuse myself. I had nearly knocked Benny over when I turned a corner and bumped into him in the lobby.
Sitting in Benny’s room on that cold night in December, I wanted to tell him about all of this, I wanted to tell him how I’d imagined Banderas rolling into work, checking his email, pulling up my test results, perhaps putting a hand to his face, wondering if he could break the bad news to me over the phone or if I needed to be told in person. I wanted to tell Benny that I could have checked the results on the computer myself but I was afraid to. I wanted to recount every moment in painstaking detail just as I’d lived it.
But when I looked into Benny’s eyes, I chose not to say any of this. A man who’d been on the receiving end of so much bad news in his life didn’t need a dramatic reenactment of my good news.
“Things worked out,” I said.
“Oh.” A smile emerged over his face. “Oh, that’s wonderful. I’m so relieved for you. Whatever it was.” He stood up to hug me, but the IV kept him tethered to the metal pole, so he waved me toward him. As I leaned in and extended my arms, as if on cue, my pager went off and I was summoned to the intensive care unit for an orientation session.
32
The first night on call of my rotation in the intensive care unit occurred in mid-January, as a gentle snowfall blanketed Washington Heights. I was lying on a black leather couch in the doctors’ lounge, reviewing a stack of EKGs, when the door flung open.
“Nap time’s over,” a voice said as I pushed a banana peel off my chest and flung myself upright. “Looks like we’ve got some more business.”
The voice belonged to my blond, floppy-haired supervisor, Don, a second-year resident who had taken over for Baio and Ashley as my medical swag coach. Among the many disorienting aspects of intern year was the constant shuffling of supervisors. Just when I became comfortable with one resident’s style, I was pawned off on a new resident with a new system. The carousel of bosses meant I was exposed to all kinds of teaching philosophies, and as the year wore on, I realized just how special Baio had been. Others were excellent in their own ways—some were nimble with needles, others were master negotiators—but no one quite brought the incredible immediacy of medicine to life the way Baio had.
I had heard of Don before I had ever spoken with him. He was a bit of a cornball—a milquetoast midwesterner who loved to show cell phone pictures of his eight-month-old son—but more recently he was known around the hospital as the guy who had picked up a congenital blood vessel abnormality in a young woman after noticing a subtle difference in blood pressure readings in her arms. Word of his careful eye had spread quickly, and Don was now regarded as a master diagnostician. I suspected that he, like Baio, was someone special, and I couldn’t wait to work with him. Don reinforced my belief that professional reputations could be created or destroyed with a single patient.
“New admission from the emergency room,” Don said, gliding across the linoleum. His face was pinched—as if his features were rallying around the scar from his surgically repaired cleft palate—and I wasn’t yet sure if he was one of those guys who would lord his sterling reputation over me. He picked up the black plastic phone and put it on speaker.
“Fellas,” the voice on the other end said. It was Baio.
“My man,” Don replied. “I’m here with Matt McCarthy. What you got for us?”
“Kindly give Dr. McCarthy my regards.”
I moved toward the phone, took a seat in an orange plastic chair, and said, “Hey!”
“Got a young guy down here in the ED,” Baio said quickly. “Nineteen-year-old morbidly obese kid with asthma coming in acutely short of breath. Labs look like shit. Chest X-ray looks like shit. I’m thinking it’s…”
“Influenza?” Don asked.
“Oh, Don,” Baio said, not nearly as impressed with Don’s powers of deduction.
“Sorry, sorry,” Don said, picking up a marker, “I’ll shut up now.”
“We’re thinking viral infection with superimposed bacterial pneumonia. Probably triggered an asthma exacerbation. We might have to tube him.”
“Yikes,” I said softly. I hadn’t heard of someone so young requiring a ventilator.
“Well, send him on up,” Don said. “He’ll take our last bed. ICU’s full.”
The conversation abruptly ended, and Don stood up and moved to a small white marker board. “Stupid mistake,” he said. “Never hone in on a diagnosis so quickly. Let’s make a list of the things this kid could have other than infection. Go.”
Life in the medical intensive care unit was wildly unpredictable. Some nights we admitted up to a half dozen new, exceedingly sick, exceedingly complex patients. Working in the ICU required an advanced grasp of physiology and the ability to remain calm yet assertive while dealing with complex, terrifyingly sick patients. It was the perfect fit for a guy like Baio, but not so much for me. Patients in the ICU are often too sick to describe the events that led up to their admission, and the aim is not to cure
a condition but rather to stabilize it. There isn’t much red meat there for doctors who find meaning through personal connection.
Fortunately, tonight was looking relatively quiet. Our unit was nearly full and Don had put out most of the fires earlier in the evening, so we had some time to talk. He and I spent the next half hour creating a preposterously long list of what might be wrong with our new patient, until a nurse knocked on the door, poked her head in, and said, “New admission, Darryl Jenkins, is being wheeled in now.”
Don dropped the marker. “Showtime.”
33
I watched closely as Don examined Darryl, who was clutching his chest while gasping for air. Darryl’s huge body took up the entire hospital bed. He must’ve weighed three hundred pounds, and yet his face was childlike—he looked like a boy trapped in a body far too large for him. And he looked like a wreck. I could hear him wheeze from across the room. Large beads of sweat dripped from his forehead down the side of his face as a nurse placed an oxygen mask on Darryl’s face, and a nebulizer treatment was administered to open up his asthmatic lungs. It was jarring to see someone so young who was so sick. Don stood off to the side, fixated on Darryl’s fingernails. I pulled my stethoscope out of my white coat and cleaned it off with an alcohol swab, wondering what Don was doing.
“Just going to take a quick listen,” I said to Darryl as I tapped his upper back. “Need to listen to your lungs.” He closed his eyes, failing to acknowledge my comment.
As I leaned in, Don said, “Stop.” He was holding Darryl’s left hand, shining a penlight onto the middle fingernail. “Look at this, Matt. What do you see?”
I withdrew the stethoscope and inched toward the outstretched arm. “What?” I asked.
“What do you see?” Don asked again. “Describe it to me.”
It looked like a normal fingernail, perhaps slightly shorter than average. “Looks a little short,” I said. “Maybe he was biting it?” I looked up at Darryl’s round face; his eyes were still closed, and he was generating quick, shallow breaths. “Understandable, considering the circumstances.” Two more nurses entered the room and administered more nebulizer treatments.
The Real Doctor Will See You Shortly Page 20
